A few days after the Tedros press conference, in response to growing international pressure, the Biden administration promised 20 million doses from its stash of Pfizer-BioNTech, Moderna and Johnson & Johnson vaccines to COVAX. This represented a significant change in policy: it was the first time the United States donated doses that could have been used nationally. (The administration has also committed to donate 60 million doses of AstraZeneca to COVAX but has also done so.)
Glenn Cohen, a law professor who heads the Petrie-Flom Center at Harvard Law School for Health Policy, Biotechnology and Bioethics, says the commitment of 20 million doses is “a first step” for a countries that can’t get enough of their own people will use their vaccine supply soon enough.
But, he adds, he does not deny ethical turmoil of having American cities and states offer, or consider offering, vaccines to visitors as official policy. Cohen, who has written a book on medical tourism, says vaccines are meant to go first to “those who need it most” and not to “people who are able to travel, who have visas, who are able to “.
To put it another way, he says, it’s as if “someone lends you his car to take your mom to the hospital, and then you decide to take that car and instead return it to the person – or take other people to the hospital – run it like Uber ”.
Externalize ethical dilemmas
Robert Amler, dean of New York Medical College’s school of health sciences and practices, says encouraging travelers to fly to the United States from places with low vaccination rates – and potentially higher levels of infection – may be himself ill for public health.
“Any risk of‘ importing ’covid infections will depend on the volume of incoming travelers and the percentage of travelers who arrive who already have covetous infections,” says Amler, a former CDC chief medical officer. “We can’t even predict with certainty the city’s ability to manage its numbers if they become excessive.”
To combat this danger, some people who travel for vaccines take their own precautions to avoid becoming involuntary vectors for the virus — or causing other types of damage.
“Michael” (also a pseudonym) and his wife flew from Quito, Ecuador, to New Orleans for a five-day trip in mid-May, during which he received a J&J shot and had his first dose of Pfizer vaccine.
Michael’s family in Canada have yet to meet the couple’s twin boys, who were born in January 2020. Going to Louisiana for their shots, they estimate they have accelerated their vaccination status – and therefore their family reunion – from six to nine months.
However, the couple wanted to make sure they didn’t get vaccines that could go to someone else. “Our first thought was to go into a red state, because we knew that supply exceeded demand,” he explains.
They took extra precautions before and during their trip. Having both contracted covid much earlier in the pandemic, they had antibody tests before flying. They are then required for themselves to limit their exposure.
Taking the initiative may have mitigated the potential negative impact from their trip, but this highlights another issue of vaccine tourism as a policy – and a large part of the world’s covid-19 response in general. The difficult ethical decisions that could have – or, some say, should have been – have been policy issues have instead been pushed to individuals.
“The city is what sets the line,” says Pamela Hieronymi, a philosopher at the University of California, Los Angeles. So if you have a problem with vaccinated tourists in, say, New York, “it seems that your complaint is made to the city, not to the person using the line that is offered to them.”
Nicole Hassoun, professor of philosophy at Binghamton University and head of her Global Health Impact Project, also argues that while vaccinated tourists may struggle with their choice, the real ethical issue is not at the individual level. . “I think the question is really about what states do with their resources and which countries continue to use them [vaccines] for its own advantage, “she says.” Overall, it’s really wrong. “
There may also be second-order effects such as exacerbation of local inequality, says Yadurshini Raveendran, a graduate of Duke’s Institute of Global Health, who points out that the richest individuals in low-income countries – those who travel internationally and are therefore more likely to benefit from vaccine tourism – they already have better access to health care than the poorest people in those countries. Israel has the highest vaccination rates in the world, note, but Palestine administered a dose to only 5% of the population.