How far is too far? The murky, uncharted waters of vaccine tourism

How much would you be willing to pay, and how far would you be willing to travel, if you could get the COVID-19 vaccine right now?

This month, President Joe Biden said all adults in the United States should be able to get the vaccine by May. That's two months ahead of earlier estimates — but for many people, it's still not soon enough.

When COVID-19 vaccines first emerged at the end of 2020, they were an incredibly rare commodity available almost exclusively to the most vulnerable and at-risk populations. Qualifications for eligibility varied from one country, state and even county to the next, and changed often.

What resulted was a "predictable but ethically complicated" situation, said Ross Silverman, a professor of health policy and management at the Indiana University's Fairbanks School of Public Health and bioethics expert.

These are the circumstances that gave rise to people traveling just to get vaccinated against the novel coronavirus.

Snowbirds and second homes

At first, vaccine tourism was most prominent in destinations with notoriously lenient vaccination policies.

An Argentinian lawyer and television host from Mexico were among the foreigners taking advantage of Florida's loose definitions for eligibility. Anyone, regardless of residency, could get a shot as long as they were 65 or older.

Gov. Ron DeSantis ultimately responded by saying vaccines should be reserved for full- or part-time residents. But by March, state data indicates that more than 80,000 people from out of state have been vaccinated in the Sunshine State — including part-time residents, according to Yahoo.

"People who may have multiple residencies in multiple states, or perhaps in multiple countries, [can] use the advantages they have to claim a vaccine," said Silverman. He said this causes both ethical and logistical problems.

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"This may make it harder to plan for local supply needs — if [a bunch] of people from out of state show up, it will slow the opportunity to have all of [a] state's eligible residents vaccinated because the allotment of shots will be smaller than the effective population."

But it's not just snowbirds with second homes who are skipping the line.

Wealthy vacationers and vaccine flights

Vaccine tourism is a murky business where there's often more hype than actual travel.

In January, reports emerged of British elites jetting off to the United Arab Emirates for month-long "vaccine holidays" that included two doses of a COVID-19 vaccine for a cool $55,670 (40,000 pounds sterling).

And Zenith Holidays, an India-based travel company, has been advertising vaccine tours in the United States and the United Kingdom, the latter of which includes a 22-day package from $6,140 (450,000 rupees) — with "availability and cost of vaccination ... subject to guidance" from the National Health Service (NHS).

TPG inquired with Zenith about the vaccine tourism packages and was told they are still waiting for approval and guidance for vaccine tourism in overseas countries.

Most recently, Germany's flag carrier, Lufthansa, made headlines for reportedly devising a "vaccine flight [program]" that would include doses of Russia's Sputnik V COVID-19 vaccine at the preexisting vaccination center at Moscow Domodedovo Airport (DME) — currently open to airline employees, Russian citizens and foreigners with resident status in Russia — Bne IntelliNews reported.

A source told the business media company that two round-trip flights to Moscow from Frankfurt (FRA) for the vaccine would cost 1,000 euros ($1,200), though transit visas would need to be arranged.

However, a Lufthansa spokesperson told TPG that there are "no plans for the airline to open a vaccination center there." The airline said no additional input is available at this time, and media reports indicate that such a package would leverage existing facilities.

Like everything else related to vaccine tourism, details are sketchy and hard to come by.

It's no surprise that vaccine tourism conjures images of the wealthy elite. But as Rolling Stone pointed out in a recent feature on the topic, the average vaccine "tourist" is much less glamorous.

Crossing state lines

People aren't always crossing international borders to get the vaccine. Many are simply driving across the closest state border.

Dave Harbaugh and his wife live in South Carolina, just a few miles from the North Carolina line.

"My wife and I are both in our early 70s ... so we knew we would be eligible relatively early in the vaccination process," Dave Harbaugh told TPG on the phone. The Harbaughs were able to make vaccine appointments in Lancaster, South Carolina, for early March at a location 45 to 60 minutes from home and were slated to receive the second doses at the end of the month.

"We were hoping for better than that," Harbaugh said, "but we went ahead and locked those down."

Instead of waiting for vaccines in South Carolina, however, they were able to get vaccinated months earlier in North Carolina, after Harbaugh received an email from Atrium Health (the organization his doctor belongs to) saying vaccines would be available at North Carolina's Charlotte Motor Speedway. They hopped online and were able to make appointments for their first doses of the COVID-19 vaccine at the end of January. By mid-February, they had received both doses.

Harbaugh said the mass drive-thru vaccination program was "astounding" and an "amazing system." He and his wife didn't have to drive any farther to receive their vaccines than they would have if they'd stayed in their home state. In fact, they never even had to get out of their car. And after receiving their second doses, the Harbaughs immediately canceled their appointments in South Carolina to free up slots for others.

For some people, of course, finding a vaccine isn't such a seamless process.

One woman drove 17 hours from Florida to New Jersey, where she was eligible for a vaccine, and stayed with family for three weeks between doses. Another left her cabin in the Catskills of New York for a vaccine in New Jersey, too.

"Where I live, they're still saying fall [for vaccine availability] because it's a rural area," she told TPG. "So, I would basically be driving for hours wherever I found [a vaccine]. I feel bad for the older folks who live here and can't get a shot ... and can't get around to get one. It's terrible."

"But," she said, "every vaccination counts and helps the community."

More often than not, vaccine tourists aren't having lavish, international sojourns with first-class flights and five-star accommodations. Multiple people described traveling back home from abroad to their country of citizenship. Others recounted jumping on notifications about last-minute availability for vaccines that were set to expire in neighboring states.

But for people grappling with the idea of booking an international flight, crossing a state border or even driving to a different neighborhood for quicker access to a COVID-19 vaccine, it can be a difficult decision.

Ethical alchemy

Eric Mathison, the founder and CEO of health consulting firm Canmore Ethics (which partners with hospitals, hospital systems and other health care organizations to improve ethical outcomes), said that, in general, "Vaccine tourism is unethical when it involves deprioritizing the needy — but is acceptable if the person is vulnerable and won't be taking the place of someone with more need."

If you're "exploiting loopholes in the system," Mathison said, such as "lying about having a preexisting condition," you're taking that vaccine directly from a person who needs it more.

Vulnerable people in states that have "done poorly with their vaccine rollout and can travel to [a place] that is doing better, and if they qualify for the vaccine there, it's more excusable for them to travel," Mathison said. But this too comes with its complications.

"People who can travel and navigate the system are often people who have socioeconomic advantages," Mathison added. "The result of vaccine tourism is a further exacerbation of health inequalities, where disadvantaged people --- especially low-income individuals and people of color --- are made even worse off."

Mathison said states that have handled the vaccine rollout poorly "bear a lot of the responsibility for vaccine tourism."

Florida's lenient system may have made it easy for travelers from across the world to get vaccinated early — ahead, even, of permanent Florida residents — but some destinations have gone even further, promoting vaccine availability the way you might publicize a state fair or a natural attraction.

Arizona's health director told The Arizona Republic in December that vaccines would be available to snowbirds and visitors alike, according to Rolling Stone. And instead of Havana rum, there are reports that Cuba could entice tourists with shots of its domestic Soberana 02 vaccine.

Silverman concedes that vaccine tourism could "inject needed tourism dollars into local economies that have been devastated in the past year." But he warns that destinations could be "trading ... near-term tourism dollars from wealthy travelers for locals' access to the vaccine" — a "penny-wise but pound-foolish strategy that may ultimately slow down the overall recovery of the visited community from the pandemic."

Bottom line

With the frequent arrival of new vaccines and increasing supply, people may not have to wait as long as they initially expected to get vaccinated.

"It has been a long 12 months for everyone," Mathison admitted, "but people who are younger and less at risk should stick to physical distancing and mask-wearing until others with more need have been vaccinated."

Once the general public has access to COVID-19 vaccines — which, according to the Biden Administration, could be May — Mathison said the equation changes. "We want to vaccinate as many people as possible, so any unnecessary delays should be avoided. The states doing better will have more supply and will be able to handle more people, so it becomes acceptable to travel at that point if the difference is significant."

But travel of any kind is still not without risks, Silverman points out.

"By traveling ... people may increase the risks of catching and spreading the virus to another part of the country," Silverman warned. Even getting the vaccine, he said may not "eliminate your risks of catching or spreading the virus to others." Plus, it could be days, if not weeks, before the vaccine has taken full effect.

Of course, outside the U.S., the timeline for achieving widespread vaccine distribution is much grimmer.

"In many of the world's low- and lower-middle-income countries, it may be years before they have enough vaccines to distribute to their whole populations," Silverman said.

And even when COVID-19 vaccines are widely available and the global population has achieved some degree of herd immunity, this may not spell the end for vaccine tourism.

"Whenever there's a scarce resource with lots of demand," Mathison said, "some people will try to figure out how to get it."