COVID-19 vaccines, Pensacola, Florida
Teresa Hiller, Naval Hospital Pensacola’s (NHP) Immunization Program manager, administers one of the first COVID-19 vaccines to Lisa Fournier, a clinical pharmacist at NHP in Florida on December 16, 2020. Photo credit: Navy Medicine / Flickr

Flights. Accommodation. Vaccination. It’s time to put a trip to the doctor on your list of pre-travel tasks.

Questions continue to circle around the idea of mandatory COVID-19 vaccinations for international travel after a November press release from Australian airline Quantas Airways Ltd. announced that passengers would have to have received the COVID-19 vaccine before flying internationally once there is one that is “safe,” “effective,” and “well established.”

Currently, COVID-19 vaccines are not widely available, with a handful of countries beginning rollouts for frontline workers and the vulnerable, and the majority still waiting for approval and distribution. Once the vaccine becomes more widely available, it’s only a matter of time before they become expected within the aviation world. Compulsory vaccinations are unlikely to be imposed for domestic purposes; however, airlines may require a person to be vaccinated to fly, or a country may require proof of immunization in order for a visitor to enter as a tourist. 

Like many parts of this pandemic, we’ve seen this throughout history. In the years following the height of the Black Death, citizens of medieval Europe had to comply with travel restrictions. Even at that time, Italy printed travel exemptions, and Britain issued certificates of health to slow the spread of infectious disease. These practices led to the establishment of the modern passport. 

We need not look that far back in history, though, to find examples of health validation documentation for traveling. The World Health Organization’s International Certificate of Vaccination or Prophylaxis (ICVP), otherwise known as the “Yellow Card,” was established in 2005, and this was preceded by the requirement for a yellow fever-specific vaccination certificate in 1969. 

The ICVP is a small yellow booklet about the size of a passport that is provided by a health care professional documenting your vaccination history and medical exemptions, as required by border security in countries where import of or exposure to infectious agents is a concern. This is the case for the yellow fever vaccine in Brazil and parts of Africa. It’s also been suggested that an app could be used as an alternative validation method for those who have received the COVID-19 vaccine. 

WhoWhatWhy spoke to Australian travel health nurse Michelle Duley about the future of travel vaccines. “The World Health Organization will eventually make the decision for everybody,” she said. “People will need to have travel passports,” likely in a digital form. She believes Australia “won’t force people to be vaccinated, but there will be restrictions to certain places where there are vulnerable people, and there will be restrictions on getting on airplanes.”

A New Kind of Passport?

Most people are familiar with using a passport to prove one’s identity and ability to travel, as defined by the international standing of a person’s country of origin. But digital immunization passports may feel like an imposition for some who travel between parts of Europe and the US, where there are few or no vaccine requirements, and may also cause stress due to concerns of tying identity to one’s health record and potential electronic tracking. 

Many people have never encountered an ICVP, despite its necessity in some parts of the world. Duley noted that approximately only “one in 20 [Australian] people actually consider getting vaccinated before they travel internationally.” She was hopeful that the COVID-19 vaccine will lead to more consideration about getting vaccinated for other diseases prior to travel.

Greece has pitched a motion for the EU to consider vaccine passports. Prime Minister Kyriakos Mitsotakis told the European Commission that it is “urgent to adopt a common understanding on how a vaccination certificate should be structured so as to be accepted in all Member States.”  There was opposition from other parties based on a potential breach of privacy and restrictions on freedoms of movement. Exeter University law academic Dr. Ana Beduschi said that vaccine passports may “create a new distinction between individuals based on their health status, which can then be used to determine the degree of freedoms and rights they may enjoy.” The counterargument to this view is that mandatory vaccines are already required in some countries, and, thus far, this has not adversely impacted medical privacy. 

This Week in Pandemic: New Flavors of Coronavirus

Aside from concerns about invasion of privacy and personal choice, digital passports and requirements for COVID-19 and other infectious disease vaccines begs a question raised by World Travel and Tourism Council Gloria Guevara. “If you require a vaccination before travel, that takes us to discrimination,” she said. Guevara’s comments are not unfounded — we do not want to end up in a situation where travel is only accessible to those who are prioritized for vaccination or who can afford them. 

Some vaccines that are necessary for travel can cost hundreds of dollars, but with respect to the COVID-19 vaccine, at least for now, travelers need not worry about cost or prioritization. The immunization is free in the US and other countries, and prioritization is a short-term issue caused by vaccine shortages and limited manpower to administer the shots. Additionally, as with all vaccines, exceptions are made for people with valid medical exemptions.

Corporations Have an Opinion

While it is always important to acknowledge potential inequities, the motivation behind Guevara’s comments is far more likely to be commercial interest rather than concerns for the working class. With the tourism industry arguably one of the hardest hit during the pandemic, it is important to note that the World Travel and Tourism Council, composed of 200 CEOs, presidents, and chairpersons of the largest tourism companies, would likely advocate for an easier and quicker return to international travel.

International travel is currently heavily impeded by the systems put in place to mitigate the risk of importing COVID-19. Since the beginning of the pandemic, Australia and New Zealand have required both a valid travel exemption and mandatory hotel quarantine upon arrival. Similarly, President Joe Biden issued an executive order on Thursday mandating masks and self-quarantine for international travelers. Similar home quarantine measures are in place in Taiwan, and Hong Kong has raised its quarantine period from two to three weeks. 

Obviously, this is not conducive to a thriving tourism industry. Some have suggested requiring an immunity passport to identify people who have recovered from COVID-19, but its benefits have been challenged by experts who are not convinced that recovery prevents a person from becoming infectious again. There is too little data to support either conclusion at this time. Vaccines may be the answer to alleviating concerns around importing SARS-CoV-2 and its more infectious variants, and if so, the hope is that digital passports showing evidence of vaccination will be an additional tool to effectively control the spread of these infectious diseases.  

New mandates regulating travel and the spread of infectious diseases pose concerns and challenges. We can expect that if we want to travel safely and securely in the very near future, vaccination records and tracking apps will become a necessary part of our travel preparations and routines. If we look towards systems of ensuring privacy and equality of access to healthcare during the COVID-19 pandemic, we can look towards a safer and quicker return to travel.

Related front page panorama photo credit: Adapted by WhoWhatWhy from CDC.


Comments are closed.