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The developing world can’t access vaccines: Is it ethical to mandate them for international travel?

Vaccination proof for travel seems like a fair public health safety measure. But when much of the world can’t get access to doses, is it cutting off all but a small sliver of humanity from global movement.

The developing world can’t access vaccines: Is it ethical to mandate them for international travel?
[Photos: John McArthur/Unsplash, Bizhan33/iStock/Getty Images Plus]

This year’s COP26 Climate Change Conference included a large volume of programming on climate justice, and the crisis’ effect on the poorer parts of the world. Yet, many would-be participants from those countries couldn’t even get to the conference. Campaigners complained of the event being the “whitest and most privileged ever” as residents of the global south were unable to travel to Scotland, largely due to their inability to show proof of vaccination—not because they don’t believe in vaccination, but because shots, quite simply, were not available to them.

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Even as many outright travel bans have been lifted—with the notable exception of new injunctions on southern Africa—de facto bans still exist. Vaccine requirements for travel may seem fair and achievable from a public health standpoint, in order to avoid total border shutdowns, but, that’s the perspective from the West, where vaccines are in excess. Immunization rates in the developing world are lagging; only 7% of Africa is vaccinated, locking much of the global south out of travel to much of Europe and the U.S. and raising questions about the ethics of the policy. Ultimately, the developing world needs better access to shots. But, in the meantime, some health and migration policy experts say governments should allow alternative credentials for the unable-to-be-vaccinated—or even offer them shots as part of the travel process.

The U.S., and many European countries, including France, Germany, Spain, and Sweden, now require vaccinations for non-essential travel. There are exceptions: for instance, the U.S. allows unvaccinated diplomats, minors, refugees, and visa holders from “foreign countries with limited COVID-19 vaccine availability,” which it defines as nations with a vaccination rate of less than 10%. But, that still excludes countries like Jamaica and Pakistan, and Rwanda and Botswana, whose vaccination rates are slightly above that threshold, but still incredibly low.

In contrast, in the developed world, booster shots are available, and thousands more are just going to waste; yet, it continues to prohibit the people who are at the West’s whim for supplies. “It’s nothing new. COVID, and COVID-related restrictions, are additional weapons to contain migration from south to north,” says Mehari Maru, a professor at the School of Transnational Governance at the European University Institute in Florence, referring to a long history of western immigration policy that has limited people from the developing world. Mehari’s worry now is that the vaccine requirements, essentially travel bans for the global south, could remain for years longer than the original border closures, as scientists predict it could be three to four years, or more, before the whole world has access to vaccines.

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This isn’t only a matter of tourism, rather of potential losses of economic opportunity and livelihoods. Travel has always been exclusionary and cost-prohibitive the poorest, but was essential for students, businesspeople, and seasonal migrant workers. What’s more, there are many people who have been vaccinated but whose form of immunization is not formally recognized, because they took the Sputnik vaccine, common in places like Argentina, Pakistan, and the Philippines, but not recognized in the U.S.; or the generic-made AstraZeneca vaccines from India, which many European countries don’t accept. (That could be an ongoing issue if American drug companies waive their intellectual properties and allow more generic vaccines to be made in the developing world, a policy that the World Trade Organization, various aid groups, and now the U.S. government are now favoring.)

In order to accommodate those unable to get vaccinated, governments should offer alternatives of testing and quarantine, says Vardit Ravitsky, a bioethics professor at the School of Public Health at University of Montreal. Many already do, but, the prohibitive costs add to the inequity. On a recent trip to the U.K., I spent £160 ($210) on two required tests; for a family, that can stretch into the thousands. Hotel quarantine packages generally cost $2,500 in Australia, and more than $3,000 in the U.K. This makes travel even more exclusionary than in the past. “The cost is prohibitive, even for citizens of the global north,” Ravitsky says. “A lot of people are not going to the U.S. to visit family that they haven’t seen throughout the pandemic, not because of the cost of the flight, but because of the accumulative cost of the tests.”

One idea that would allow travel, and also help increase vaccination numbers, is to immunize people as part of the travel process, says Meghan Benton, director of research for the international program at the Migration Policy Institute. Embassies and consulates could issue shots as part of the visa (or visa waiver) process in home countries, with enough time for immunity to set in before travel. Another option is vaccination on arrival at the airport, which is potentially easier, since the vaccine supplies in the destination countries are already abundant. If “the point is to try to proliferate the options and touchpoints to get vaccinated,” Benton says, the airport, with its high foot traffic, seems practical. While that could increase risk of transmission on the plane before arrival, there’s already the chance of unnoticed breakthrough infections among the vaccinated; and, this could also be supplemented with tests. To cut costs for travelers, they could be financed partially by embassies.

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Some airports, including London Heathrow and Amsterdam Schiphol, already allow people to get immunized for diseases like yellow fever, if they don’t have it or forget their proof. In August, San Francisco International Airport issued a press release encouraging “vaccine tourism,” reporting having administered 30,000 one-shot Johnson & Johnson COVID vaccine doses over three months. World event organizers, such as in the case of COP26, could provide jabs for incoming guests. Benton also suggests there could be booths at airports where experts translate foreign vaccination credentials into recognized western certification.

The experts agree that all these are only additional mechanisms, when the ultimate answer is global vaccine equity: sending more vaccines to the developing world, or allowing countries to make their own using pharmaceutical formulas. In the meantime, if the world’s vaccine gap does continue for years, as expected, Ravitsky fears a troubling scenario where “a part of the world is free and mobile, and a part of the world is imprisoned locally.”

To remedy this, Ravitsky suggests governments should create different travel categories to ensure essential travel, on which people’s livelihoods depend, can resume. “You don’t necessarily level the playing field for everybody to go to Disneyland,” she says. Rather, prioritizing economic travel over tourism could help keep everyone on equal standing with respect to opportunity and dignity: so that Africans, for example, can travel to work events just like their European colleagues. “The short-term versus long-term makes a big ethical difference here,” she says. “In the short term, we’re all paying some sort of price. But, long term, it may become a very dramatic difference between those who can and cannot.”

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