WWith more than 50 unique vaccination plans in the United States, access to the Covid-19 vaccine depends largely on where you live. In Wisconsin, mink producers are being considered for the next vaccine prioritization phase. In New Jersey, smokers may have priority access to the vaccine. In Colorado, journalists fall into the category of frontline workers.
This complex system has given rise to a new type of pandemic travel – dubbed “vaccine tourism” – in which people cross borders between states or even countries to gain faster access. Without a standardized protocol and due to the fragmented American health care system, tens, if not hundreds, of thousands of people took vaccines outside their home states.
“They are coming from Canada, Brazil, New York, Georgia, the people from Minneapolis came here. Some friends of mine in St. Petersburg [Florida] they told me they were on a vaccination line with people from Venezuela, ”said Dr. Jay Wolfson, professor of public health at the University of South Florida.
He credits international travel agency ads with at least part of the tourist vaccine flow. “I get calls all the time from people saying, ‘Jay, can you put me somewhere?’ – and I can not. And I will not. “
Florida has been one of the most popular vaccine tourism destinations for domestic and international travelers, due to the state’s initial policy of vaccinating anyone over the age of 65. The state recently implemented new identification rules in an attempt to target more vaccines to Florida residents, but not before about 50,000 out-of-state recipients received a dose. While some of these vaccine recipients are seasonal residents of the state, or snow birds, whose decision to spend the winter in Florida was unrelated to their vaccination prospects, many thousands came to the state just for an injection.
The 50,000 doses represent only about 3.4% of the total vaccinations administered in Florida, but even a small percentage going to out-of-state recipients in any state can affect the nation’s vaccination infrastructure.
“Administering a dose of vaccine involves consultation, involves needles, involves human resources. And all the resources that are vehicles for delivering doses of the vaccine are tied to a local community, state or city in terms of allocation, ”said Dr. Kyle Ferguson, postdoctoral fellow in the medical ethics division at New York University Grossman School of Medicine.
Cities and states generally receive lots of vaccine from the federal government based on the adult population in the area and plan their distribution strategy accordingly. When someone crosses municipal, state or national borders to obtain a vaccine, it hinders the successful distribution of the vaccine in both jurisdictions.
“Vaccine tourists are using their power to create an unfair opportunity for them. There are design flaws that people are exploring, taking advantage of some weaknesses in these systems, ”said Ferguson. “None of this should be about dignity or merit, but when someone travels for the vaccine, they are using resources, both doses and all the mechanisms of application, which have been allocated to a different community.”
Vaccine tourism can also be risky for patients and healthcare professionals. “If you give a dose of the vaccine to someone who may not be able to return and receive the second dose or if there is an adverse event, who is responsible?” Wolfson asks. “Traveling long distances for an injection runs the risk of the patient not meeting the dosage and not being able to follow up with health professionals to have, what we call in health, continuity of care.”
However, many are willing to take the risk, especially if they are particularly susceptible to health complications caused by the virus or do not need to travel far to be vaccinated across the border.
A New York resident saw several of her friends and family planning to cross state boundaries for vaccines. “My friend’s mother, a New York resident currently awaiting an end to the Florida pandemic, is driving to New Jersey to get a vaccine in February,” she said. “She has high blood pressure and has researched several states where she may be eligible for the vaccine and New Jersey fits the bill.”
Her brother, a teacher who hoped to return to the classroom safely, had abandoned plans to travel from New York to New Jersey to be vaccinated in accordance with the state’s priority vaccination policy for teachers with pre-existing illnesses. “There is no burden of proof in New Jersey to show that you are a former smoker, so it is an easy loophole to exploit,” she said. Another family friend, over 65 and immunocompromised, resident in New Jersey, signed up to get the vaccine in New York due to the lack of consultations available in her home state.
Wolfson said these types of decisions are understandable, although not necessarily recommended, especially considering the government’s widespread mismanagement of the pandemic and the human instinct for self-preservation.
“When we have limited supplies of a highly sought-after product that saves lives and people don’t even know how to get it, or the phone lines are full and the computer sign-ups are not working and they go online at 3 am in the morning at 85 years old waiting the first dose comes out, it just decreases the confidence that people have in this system ”, he said.
“The more you are inconsistent – with one state saying, ‘We will accept smokers’, and another state saying, ‘We are not going to take prisoners’, and politicians proudly jumping the line in many parts of the country – the less support you will have for follow the rules, ”said Dr. Arthur Caplan, professor of bioethics at the NYU School of Medicine. “There is some excusable leeway for those in high-risk groups trying to protect themselves.”
But vaccine tourists who manage to cross state borders to get vaccinated are, in large part, those with the means and ability to travel a distance – twice – to get the vaccine and the technological knowledge or connections to request an appointment. This has contributed to racial and socioeconomic disparities in vaccine distribution so far: from New York to New Jersey and Chicago, vaccine recipients have been predominantly white, residing in richer postal codes.
“The most important thing is: don’t waste vaccines. I much prefer to go to someone’s arm than to a garbage can, ”Caplan said of the reality that some doses of vaccine are not claimed at distribution sites across the country. “But we have not completed the vaccination of health professionals and the elderly. So, getting in line in front of people who are at greater risk of actually dying, often of younger people, can stay at home, quarantine, wear masks and protect themselves, this is reprehensible ”.
In addition to these individual decisions, however, there is a systemic problem, Caplan said. “What happened to the vaccine supply? How do we not know how much we have? There was a major failure of leadership. “