Vaccination Tourism - The Dangers of A New Niche

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By Asaf Leshem and Matt Robinson

After more than a year of almost complete worldwide shutdown, the tourism sector is fighting for survival, more so than ever before faced with an ultimatum – adapt or die. Adaptability in the tourism industry is now a matter of life or death for the companies and millions of people who rely on this business sector for their livelihood, as the changing condition of the global pandemic provides no guarantee that traditional tourism will return any time soon. While the tourism sector is struggling to find its feet in these uncertain circumstances a newly coined term has entered the zeitgeist – Vaccination Tourism.

The term remains somewhat ambiguous, as it refers mostly to countries opening their borders only to tourists who will arrive already vaccinated. Though touching briefly on that interpretation, this article aims to focus more on the other, more controversial, type of vaccination tourism – countries that are now considering opening their borders for tourists to visit for a holiday for the explicit purpose of getting vaccinated.

While offering a potential lifeline to the ailing tourism industry, a growth in this tourism niche should be a reason for concern to policy makers and tourism leaders alike.

At the time of writing, there are a number of countries that are far outpacing others in vaccine distribution, among them the United States, Israel, and the United Kingdom. The situation in the European Union – with Germany in particular being highlighted as an example of inadequate vaccine policy – is far from satisfactory, as lockdown measures are being extended, infection numbers continue to grow, and the distribution of vaccinations has been severely hampered by logistical issues and political failings. In this current climate, the development of vaccination tourism would no doubt fuel EU citizens’ growing distrust in their own politicians, as a direct outcome of their inability to handle vaccination operations. Coupled with pandemic related growing unemployment, there is grounds for concern that this development will lead to further political estrangement, cynicism and radicalization; the very thing that has been at the centre of political concern in Germany and the rest of the EU in the past decade.

As more time passes, the chance of a person being exposed to and/or getting sick from the Covid-19 virus naturally increases, the appeal of travel abroad in these circumstances, where a vaccination can be purchased either individually or as part of a package-deal holiday, is certainly understandable.

Although as the financial viability of vaccination tourism for the tourism industry in certain countries where vaccine distribution is proceeding swiftly increases in time, the longer it takes for other countries – such as those in the European Union – to successfully vaccinate their own populations, the more the negative social and political impacts of this kind of niche travel will become apparent.

Therefore this article aims to analyse the various social and political aspects of this type of vaccination tourism. We will show the potential negative outcomes of this contemporary pop-up tourism niche, as well as the legitimate reasons that are the grounds for its development.

Through this analysis we aim to identify the risks policy makers may want to be cautious of, what potential conflicts to be aware of, and to point out the urgency of reaching international – in particular regional – agreements on vaccine distribution and acknowledgement.

An industry at breaking point

Those who have worked long enough in tourism (or are just old enough) will surely remember the severe economic effect SARS-Covid-2 had in early 2002, or the short lived crisis of the Icelandic volcano (Eyjafjallajökull) in 2010, as it completely emptied the European skies, and of course the damage caused to the aviation industry in the months that followed the 9/11 attacks. More profoundly, the Second World War brought an almost complete lockdown of the world for almost 6 years. The Cold War split the world in two blocs, bringing with it limited mobility for close to 45 years, and with it very limited options for those individuals and businesses that may have otherwise been able to make their livelihoods directly or indirectly from travel and hospitality.

Though the SARS Covid-19 virus was discovered in Wuhan in the autumn of 2019, the near complete shutdown of the global tourism industry was really felt outside of Asia only towards the beginning of March, 2020.

A year has passed and there are various estimates of between 100 Million and 174 Million travel and tourism jobs lost world wide (Statistica.com, 2021; The Economic Times, 2020). Why is there such a big discrepancy between estimations, you wonder? That has a lot to do with our perception of what exactly constitutes a ‘tourism job’. Surely hotel staff and tour guides fall into this employment category, but what about the tour bus driver who also drives children to school? And what about the waiter who also serves local residents? Or, perhaps, if we take this statistical challenge further, what about the worker who assembles trucks, the kind used to deliver supplies to the food and beverage sector? This worker would normally be considered as part of the auto industry, though at a time of significantly reduced orders factories would surely be forced to downsize their work-force as a result of tourism related shortfalls. Tourism industry losses are not limited merely to the tourism industry. Economists refer to this effect as economic slowdown; arguably an insufficient term to describe the difficulty in trying to estimate the real numbers of jobs lost when international travel comes to a halt.

The impact of the first Covid-19 year on this highly interwoven industry, then, is undeniable. Whereas Covid-19 had an immediate and devastating impact on tourism professionals, most countries will continue to feel the more macroeconomic impacts in the months, or even years to come. Most countries cannot wait that long if they want to avoid economic disaster, and as a potential consequence, dangerous political turmoil.

Talk of opening the skies is everywhere. In early March, Cyprus was one of the first countries to announce it will re-open to vaccinated tourists from the UK (its largest market, followed by Russia, Greece, Israel and Germany)(MOF Cyprus, 2020), and later to vaccinated tourists from other countries as well (The Guardian, 2021, March, 4th). Many countries in the region and elsewhere in the world have made similar statements. There are countries that will open their borders for the northern hemisphere summer – the most profitable season for the global tourism industry – regardless of whether visitors have been vaccinated or not. They are mostly likely to do it based on the conclusion that the financial consequences of keeping their countries closed to tourism are more damaging than the potential health risk of another surge of Covid-19 infections. A politically calculated risk, albeit also an ethically questionable one.

It is not difficult to understand the desire to re-open borders before the pandemic is over. While countless academic papers and books have been published about the negative impact of tourism on destinations (ironically, the term over-tourism is now over-used by people not necessarily familiar with the broader aspects of the analysis), zero travel is not a scenario anyone should really wish for.

The sooner a country can also open to tourism revenue, the sooner large scale economic recovery can begin. The transformative power of tourism revenue worldwide is not to be underestimated, and many countries will certainly be prepared to take greater risks in future as the pandemic and its negative effects continue, making the prospect of Vaccination Tourism even more appealing.

The failures in vaccination distribution

The political blunders leading to distribution problems and delays in vaccinations occupied the news in Europe, in and outside the EU throughout the early months of 2021. Germany in particular, where the first vaccine was announced by Pfizer and BioNTech on November 10th 2020 (https://www.bbc.com/news/health-54873105) is lagging behind, with many medical personnel still not vaccinated at the time of the writing of this article (in mid-February 2021 a researcher at the Charité University Hospital in Berlin explained to the author that although at risk working in a hospital, their institute is not considered front line medical staff).

The failure of Germany to vaccinate its own residents fast enough may lead to an increase in the distrust many already have in the federal government. In the last state elections in Baden-Würtenberg and Rheinland-Pfalz (March, 15^th, 2021), the far-right AfD went down by -5.4% (Baden-Württenberg Statistiches Landesamt, 2021) and by -4.3% in RP (RheinlandPfalz Landeswahlleiter, 2021), perhaps bringing a sigh of relief to those who were concerned the crisis will bring further rise to right wing populism in Germany. However, celebrating over the AfD losing voters may still be misplaced, as the leading CDU were also hailed as the losers of the elections (by -2.9% in BW and by -4.1% in RP), potentially indicating the growing mistrust and disappointment among their traditional voters, with the CDU-led coalition’s management of the Covid-19 crisis. If the voters of these two conservative states reacted like that with their votes, what are we to expect in places around Germany, where extremisms to both left and right thrives?

Vaccination tourism may also contribute to political tensions between Germany (the tourists’ country of departure or usual residence) and Israel or Serbia (the tourists’ countries of main destination). Contemporary Germany has always enjoyed the image of a well managed country. This image certainly sustained itself through the first half of 2020. How would the German political elite and their voters feel now that Israel and Serbia – with their image of chronic political chaos – are doing much better with their vaccination operations? And if that is not enough, what if vaccinating countries would invite Germans and other Europeans over? In all likelihood, the effect could carry beyond mere political bruised egos. As far as the German coalition parties are concerned, that may just be another destabilising factor, adding to already grown political tensions in the months leading to the next federal elections. Political tensions may also grow after vaccinated tourists return to their EU respective countries of departure.

When put in the broader political context, it is noteworthy that while the EU exported 34 Million (Stevis-Gridness, 2021, March, 10th) doses to the world it imported none back to its member states; a curious move from Brussels that EU voters will not forget so quickly.

The argument for vaccination tourism

As the numbers are already showing in the US, UK, and Israel (the fastest vaccinating countries), the majority of people in most countries would like to be vaccinated against a disease that has already led to more than 2.7 million deaths worldwide. There is no doubt that many more would have died without the lockdown measures implemented around the world to stop the spread of the pandemic. But with lockdown measures providing no permanent solution and countries and regions struggling to meet their own vaccination targets, many people are confronting the reality that seeking solutions elsewhere may be preferable. Such was the case in Florida, as residents of other states started flocking the Sunshine State to enjoy the early spring sun, as well as get vaccinated, with the hope of bringing at least some aspects of life back to normality. In January 2021, Francis Suarez, the mayor of Miami stated that he requested the district attorney to take legal steps to ensure that residents of Miami who now wish to be vaccinated and have not done so yet will receive priority over visitors from other states. The statement came after it was revealed that nearly 4% of people coming to get vaccinated were residents of other federal states (CBC, Miami, 2021).

Despite the turbulent political situation, with a fourth election in two years (March, 23^rd) Israel has so far managed a surprisingly successful vaccination operation. At the time of the writing of this article more than 5 million people have received their second jab (out of a population of 9 million people), and infection rates are already dropping. Emergency Covid-19 hospital wards started closing down on March, 16^th, as the number of patients hospitalised dropped significantly.

Slowly the country has started re-opening its skies to Israeli citizens, many of whom live in Europe – at a distance equal to flying from New York to Los Angeles. In the weeks prior many tried and were unable to visit their families, in some cases since the beginning of the pandemic. The surprising option of receiving the vaccine is now becoming an added bonus, even if accompanied still with some travel restrictions and a two week quarantine upon arrival.

At the moment of writing the airport in Tel-Aviv is currently open almost only to Israelis, and for only 3,000 passengers per day. Those measures were placed in order to control the physical distance between people not yet vaccinated and to allow for Covid-19 rapid testing upon arrival. As a result of these restrictions, flights are overbooked and crowded. On the flight the author took the captain was forced to announce that passengers not complying with the flight attendants’ instructions to wear masks will be arrested upon landing by local police (as per international aviation law).

Just like their colleagues around the world, Israeli tourism professionals are also eager to see tourists be able to visit again. Undoubtedly, the Likud leading coalition party hoped to gain more votes in the upcoming elections by giving the impression that foreign tourists will soon be able to return – bringing with them the highly sought after economic normality.

Early in January, Israeli Ministry of Health expressed its wish to vaccinate free of charge any person in the country over the age of 60 (Mako, 2021 March, 12th). After French parliament member Meyer Habib flew over to be vaccinated, rumours started spreading that Israel would offer tourists the option to be vaccinated upon arrival; a marketing gimmick that would certainly raise the attractiveness of the sunny destination. In a response to the publications, the Ministry’s Director General clarified: “the aim is not to vaccinate tourists” (Mako, 2021).

In February, Israelhayom (2021) explained that as the situation stands, there is no truth to the rumour, and only Israeli citizens, and foreign residents of Israel, who are insured in the country will have the option to be vaccinated.

Beside the political and economic considerations, medical experts have expressed their concern on election broadcasts that opening the skies could lead to the arrival of new Covid-19 variants. The pandemic, they warned, is not over. As humans we are travel hungry creatures, but whereas we have already grown tired of the virus, the virus, itself an avid traveller, has not yet grown tired of us.

The Serbian dilemma

In Serbia, a country similarly in desperate need of tourism revenue (and the only one in the region with a relatively efficient vaccination operation), rumours started spreading about the country allowing, and even encouraging visitors from the region to come over to get vaccinated. This was also helped by the announcement that Serbia will be the first European nation to soon manufacture the Chinese Sinopharm vaccine against Covid-19 (EuroNews, 2021 March, 11th). In early February, the Novosti news site published a column by Vedrana Rudan, a Croatian journalist telling of her experience crossing to Belgrade to get vaccinated (Novosti, 2021). In her column, titled “European in Belgrade”, Ms. Rudan tells of her surprise when a Serbian friend suggested she should come to visit and get vaccinated. Will vaccinations now turn into a commercial tourism commodity offered by countries already ahead of the game, such as Serbia, Israel, the US and Hungary?

There remains, however, for countries such as Serbia and Hungary, the additional problem of vaccine acceptance. Until now, the EU has not been able to reach an agreement as to an acceptable document that acknowledges vaccines administered outside the EU to be accepted. Will Germany or France allow their citizens to enter cinemas or theatres if they have been vaccinated with Sinopharm’s BBIBP-CorV or the Russian Sputnik V?

The negative impact of vaccination tourism in the Covid-19 era

A common argument against medical tourism in general is that the availability of medical resources will be reduced in the destination country as medicine and medical staff are re-allocated to deal with health tourists, clearly a demographic richer and smaller than the local residents at the destination. Health policy makers may argue that the revenue made from these tourists can often sustain whole hospital departments, indirectly benefiting local people. This leads to several important questions. If and when Vaccine Tourism becomes more common, would countries invite tourists to be vaccinated only if they have a surplus of the vaccines? If the number of tourists grows, would there be pressure on the already overworked medical staff at clinics and hospitals?

Beyond the typical medical tourism issues at the destination country, there is also the further problem of the negative impact Vaccination Tourism could have on source countries, from where the tourists will originate. For instance, the resulting distrust in politicians for their inability to handle vaccination operations at home, as multilateral relations suffer from the public humiliation of the EU, can only be exacerbated by any trend towards Vaccination Tourism. The inability of the European states to effectively deal with its own vaccination programme is likely to result in a drift towards political extremism; the very thing that has been at the centre of political concerns all across member states of the EU. Lastly, a niche tourism developed specifically for the financially able may contribute to the already grown social rift of the pandemic, a result – among other things – of higher than usual unemployment rates in all OECD countries due to the pandemic (See https://www.oecd.org/newsroom/unemployment-rates-oecd-update-october-2020.htm)

Ethical considerations

Beyond the practical issues to consider, there are additional ethical questions. First, as travel is still limited and flights are still few and far between, airlines may significantly increase prices to destinations offering vaccination tourism, such as Tel-Aviv or Belgrade, or others that could soon consider this new tourism niche. Early in March 2021, only 5 days after Israel opened its airport for partial operations, flight prices to London shot up from the usual 400 US Dollars to around 900. And the flights filled in minutes (Mako, 2021 March, 12th). The potential for growing demand, coupled with relatively low supply in the coming months, is not a temptation that the airlines will be able to resist. Going on a holiday, and getting vaccinated may – at least in the short term – turn into health tourism for the rich only.

Second, the risk of a burgeoning black-market of vaccination package holidays could bring about the spread of the disease to those not yet vaccinated at the destination. And in addition to that there is the risk of those tourists who may wish to save money potentially buying fake vaccination holiday packages or even fake vaccines. Already in the autumn, EU Parliament medical authorities voiced their concern that once different vaccines go into mass production and are sold on the internet, there will be little anyone can do to supervise their quality. Such vaccines, sold outside official medical facilities, could at best be placebo or in the worst case scenario actually cause harm.

Conclusion – a warning for policy makers in Germany and the EU

The financial temptation to offer such package holiday options could certainly be made more credible in the face of widespread reports of countries possessing a surplus amount of viable vaccines. Although the reallocation of these vaccines for tourism purposes must inevitably be weighed against the need for the doses to be offered to the country’s own citizens first – and the calls for a worldwide distribution process to send surplus vaccines to poor countries that are suffering from a lack of market access.

As a customer-focused industry, the tourism sector by definition excels at prioritising the demands of travellers and catering for their expectations. Vaccination tourism seems like a logical step forward for those travellers who are willing to pay the price and for an industry eagerly looking to regain a modicum of financial stability.

The viability of vaccination tourism will only increase as the EU countries in particular struggle to implement their own vaccine policies, although whether the countries that are currently outpacing the rest of the world in their vaccine distribution will choose to promote – or even allow – vaccination tourism remains to be seen.

Thus, tourism to destinations outside the EU (especially to Israel) will contribute to undermining the credibility of governing bodies of the EU and its member states; providing further political fodder to its usual populists to prosper.

In particular from Brussels, Paris and Berlin, faster decision making is required, agreeing on conditions for acknowledgement and acceptance of the various vaccines already distributed globally; decisions that ought to be made based on scientifically valid knowledge rather than current bilateral or multilateral relations (for example, with Russia or China). Finally, transparent and clear communications inside EU member states will go a long way in reducing citizens’ incentive to travel abroad to get vaccinated or respond by veering further towards extremism as faith in the current political status quo is eroded.

References

Baden-Württenberg Statistiches Landesamt (2021). Landtagswahl, 2021. https://www.statistik-bw.de/Wahlen/Landtag/02035000.tab?R=LA

CBC, Miami (2021). Covid-19 Vaccination Tourism? https://miami.cbslocal.com/video/5200578-covid-19-vaccination-tourism/

EuroNews (2021). Serbia to produce Chinese COVID-19 vaccine. https://www.euronews.com/2021/03/11/serbia-to-produce-chinese-covid-19-vaccine

Israelhayom (2021). It’s real: Vaccination Tourism. https://www.israelhayom.co.il/article/841751

Mof Cyprus (2020). Statistical Service, tourism. https://www.mof.gov.cy/mof/cystat/statistics.nsf/services_71main_en/services_71main_en?OpenForm&sub=1&sel=2

Mako (2021). Waiting to fly? Bear in mind your holidays are going to get more expansive. https://www.mako.co.il/travel-world/magazine/Article-497b8d531381871026.htm

Novosti (2021). Vedrana Rudan Vaccinated in Belgrade! What is this, a buffet full of vaccines in Serbia? And Croatia is sitting...

https://www.novosti.rs/amp/vesti/drustvo/960453/vedrana-rudan-vakcinisana-beogradu-sta-ovo-srbiji-svedski-sto-krcat-cepivima-hrvatska-sedi

Rheinland-Pfalz Landeswahlleiter (2021). Landtagswahl 2021: Vorläufiges Endergebins. https://wahlen2021.rlp.de/de/ltw/wahlen/2021/

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Stevis-Gridness, M. (2021). E.U. Exports Millions of Covid Vaccine Doses Despite Supply Crunch at Home. https://www.nytimes.com/2021/03/10/world/europe/eu-exports-covid-vaccine.html. The New York Times.

The Economic Times (2020). 174 Million Travel and Tourism Jobs Could be Lost in 2020 due to Covid-19 and travel restrictions. https://economictimes.indiatimes.com/jobs/174-million-travel-and-tourism-jobs-could-be-lost-in-2020-due-to-covid-19-and-travel-restrictions-wttc/articleshow/78948740.cms?from=mdr

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https://www.theguardian.com/world/2021/mar/04/cyprus-will-allow-vaccinated-british-tourists-from-1-may

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