As the CEO of Jetly, a private jet charter service, Justin Crabbe has facilitated countless types of travel over the years. But over the past two months, a new category has emerged: coronavirus medical tourism, which involves traveling outside your home state to receive the Covid-19 vaccine. “We are seeing this quite often across the United States,” says Crabbe. “Even travelers from select European countries are flying to the USA to get vaccinated.”
After researchers managed to develop a safe and effective Covid-19 vaccine in record time, it wasn’t too much of a leap to think that the rollout would be similarly swift. Clearly, that has not been the case, prompting some people to be more proactive about their vaccination, crossing borders to receive their doses of the vaccine sooner than they would at home.
The concept of medical tourism is not new — though it typically involves traveling internationally in order to get a treatment or procedure that is either unavailable or significantly more expensive in a person’s home country. (Think dental work, fertility treatments, or abortions.) But, as with nearly every other aspect of the pandemic, Covid vaccine tourism is somewhat uncharted territory. Like traditional medical tourism, it raises ethical and legal questions regarding equitable access to health care and services and patient safety.
At the same time, though, Covid vaccine tourism is different because it doesn’t involve cosmetic surgery procedures or experimental cancer surgeries that appeal to a limited number of people — in this case, the commodity is something sought after by most adults around the world. Complicating things further is that from a general public health standpoint, we know that the more shots-in-arms, the better — but where does fairness come into play? Here’s what to know about this facet of the vaccine rollout.
How widespread is vaccine tourism in the United States?
The short answer is that we don’t know, and it’s difficult to even estimate. Those traveling across state lines to get vaccinated aren’t exactly broadcasting the reason for their trip, in an attempt to avoid pushback for “skipping the line.” And many states don’t keep track of the number of out-of-state residents they vaccinate — making it easy for officials to say that vaccine tourism isn’t happening.
The data that do exist primarily come from Florida — the first vaccine tourism hotspot in the country, thanks to Governor Ron DeSantis’s executive order of December 23rd, 2020, permitting anyone over the age of 65 to receive the vaccine there, regardless of residency. As of February 9th, the Florida Department of Health reported that 61,875 out-of-state residents (which doesn’t include those with second residences in the state) have received the Covid-19 vaccine so far, out of a total of 2 million people.
Then, on January 21st, following outcry from Florida residents frustrated that out-of-towners were getting vaccinated before they were, the state’s surgeon general Dr. Scott A. Rivkees issued an advisory requiring those who wish to be vaccinated provide proof of residency. This policy leaves many of the state’s seasonal residents — also referred to as “snowbirds” — scrambling for documentation (like official mail and a lease agreement) if they don’t own their yearly home-away-from-home.
Now, the focus is on Arizona, which has the potential to become the next major vaccine tourism destination — given that like Florida, it sees a yearly influx in seasonal residents each winter. For this reason, Caitlin Uhlmann, CEO of Air Charter Service Illinois, says that it’s difficult to gauge how many flights the aviation consultants arrange specifically for the purpose of vaccine tourism, because this is the time of year when snowbirds typically head south. “We’ve known about a couple of cases recently when the clients have specifically told us that [traveling to get the vaccine] is what they were doing,” Uhlmann tells Rolling Stone. “Because obviously privacy is a big thing, it’s not something we outright ask.”
Warm weather aside, Arizona emerged as a possible destination for vaccine tourists back in early December, when Dr. Cara Christ, the state’s health director, told The Arizona Republic that vaccines would be available to residents, snowbirds and visitors alike — before the first doses even arrived in the state. Later, in a January 31st interview with CNN’s Dana Bash, Arizona Governor Doug Ducey said that the state was running out of vaccines, and has requested an additional 300,000 vaccines from the Biden-Harris administration, in order to accommodate their “winter visitors” (though it wasn’t clear whether he was referring exclusively to snowbirds, or any travelers to Arizona during the winter).
However, in a statement emailed to Rolling Stone, Holly Poynter, the public information officer at the Arizona Department of Health Services, says that “the Arizona Department of Health Services does not encourage ‘vaccine tourism,’ ” but also hasn’t observed it as a significant trend in Arizona at this point. Poynter says that the state does know that there is a fairly large population of part-time winter residents who rely on their health care institutions, and tend to be older adults, and thus more vulnerable to Covid-19.
“Our ultimate goal is to get as many people as possible in Arizona vaccinated,” she tells Rolling Stone. “Place of permanent residence does not factor into whether someone can get vaccinated in Arizona, but some sites may have specific identification requirements to get the vaccine. Part-time residents who are eligible for vaccination are able to sign up for appointments as these individuals are still living in the community.”
Who are the vaccine tourists?
While headlines about vaccine tourism typically focus on high-end getaways to warmer climes, the reality is that in most cases, it’s far more mundane. For example, more than 27,000 people have traveled to Ohio (in the winter) from out-of-state in order to get the Covid-19 vaccine. Two states over, in Roscoe, Illinois, Joyce and Dennis Bennett — who asked that their names be changed to protect their privacy — crossed the border into neighboring Wisconsin, something they do regularly while running errands.
“We decided to go to Wisconsin to get the vaccine because there were none available in Illinois that we could find. We looked everywhere within 100 miles of where we live,” the Bennetts, both 65, tell Rolling Stone via email. “Wisconsin had tons and tons of days, times, and locations available — the location we selected was 35 minutes from our house.” They have each received their first dose of the vaccine and will return to the same clinic for their second.
And while their drive across state lines was easy, getting the vaccine was less straightforward. In order to make an appointment in Wisconsin, the Bennetts used a “special code” they received from a friend who got it from their primary care practice in Wisconsin. “We did this out of convenience, safety, and timeliness, as Illinois has no idea when they will get the vaccine, or when it would be ‘our turn,’ ” the Bennetts explain. “Wisconsin seems to have all of that figured out.”
So far, the Bennetts haven’t gotten any pushback from fellow Illinoians who know about their trip across the border. “Everyone we’ve talked to says ‘good for you — do what you have to do to be safe,’ ” they say. “We are both 65 and have underlying medical conditions, so it was important that we be diligent.”
And while the locations and mode of transportation are different, Crabbe says that he has heard similar reasoning from those who book private jets in order to travel to get the vaccine. “A lot of our clients may have underlying medical conditions [or] may be fearful of the virus, and so they’re paying whatever it costs to get them to a country, location, specific doctor, or public official to be inoculated,” he tells Rolling Stone. So how much, exactly, is that? A light jet that seats between six and seven people costs approximately $5,000 per hour — making a trip from New York City to south Florida approximately $15,000 each way.
Finally, there those who are exactly the type you’d picture being vaccine tourists. “We have ultra-high net worth clients that have access to a vaccine in another country or state by special means, privy only to them,” Crabbe explains. “Think billionaires, Russian oligarchs, royalty, oil money, etc. These types of travelers are used to getting what they want when where and how they want it.”
In some cases, the vaccine tourists travel to their destination and back in one day, while others opt to stay long enough to get both doses. Crabbe estimates that over the past two months, between 200 and 300 of Jetly’s flights — out of approximately 10,000 of the company’s requested flights worldwide — have been booked for the purpose of getting a Covid-19 vaccine, based on indications from the bookers and/or travelers.
What are the legal and ethical challenges of vaccine tourism?
While at its core, Covid-19 vaccine tourism comes down to issues of supply and demand, it is reinforced by the patchwork of inconsistent state-level policies, appointment scheduling systems, and prioritized populations. Currently, states are permitted to pass laws giving preference to its residents over visitors to the state when distributing the vaccine. But, because vaccines are technically federal property, it makes individual states’ residency requirements difficult to enforce, Dr. Marissa J. Levine, a public health professor at the University of South Florida and former state health commissioner of Virginia recently told Bloomberg.
According to Dr. Govind Persad, assistant professor of law at the University of Denver, who specializes in the ethics of health care services, there is no existing federal law regulating physically traveling between states to receive the Covid vaccine. Nor, he says, is there a defined mechanism for the general public — outside priority groups — to get vaccines. Add to that the fact that the allocated amounts of vaccine vary between states, and many distribution sites don’t validate the addresses of people with appointments, and we’re left with conditions that give rise to vaccine tourism.
And while some think that having a single federal prioritization policy would eliminate these problems, Persad disagrees.“I think this would be a bad idea legally and ethically, because different states legitimately have different values,” he tells Rolling Stone. “It also wouldn’t solve tourism, because there will still be areas where vaccine uptake is higher and lower.”
Vaccine tourism can also exacerbate existing health disparities. “The same conditions that lead to higher Covid exposure and worse Covid outcomes — [including] poverty, crowded housing, medical conditions, or being very old — also make it harder to travel long distances,” Persad explains. “This means that travel is likely to both worsen disparities and save fewer lives, because having the resources to travel is a good proxy for being less at-risk of [contracting] Covid.”
In the meantime, until states receive more doses of vaccine to distribute, there are other ways to help make the process more equitable, according to Dr. Sonja Rasmussen, a professor in pediatrics and epidemiology at the University of Florida’s College of Medicine, and the former Director of the Center for Disease Control and Prevention’s Division of Public Health Information Dissemination. This includes “everything from making the computer scheduling system easier, to having more sites — including in disadvantaged neighborhoods — to having more vaccinators,” she tells Rolling Stone.
Whether landing in Palm Beach by private jet, or driving across a bridge spanning the Ohio River, vaccine tourism involves people crossing borders in order to get the Covid-19 vaccine sooner than they would where they live. Beyond that, it becomes more complex, taking into account the conditions that prompt — and permit — people to travel in the first place. But one thing vaccine tourism is not, according to Persad, is surprising. “Often when a product is available to people easily in one state but not others, people travel to get it,” he says. “As a Coloradan, we are familiar with this.”