Does It Make Sense To Require Being Vaccinated Against COVID-19 Disease To Be Able To Take An International Flight?

Yesterday’s post discussed plans some airlines are studying that would require that passengers present proof of being vaccinated against COVID-19 disease and what such proof might entail. This post looks at the issue of whether requiring vaccination against COVID-19 disease makes sense for (1) individuals, (2) airlines and other businesses, and (3) improving public health outcomes.

Initially, I need to point out the obvious. I’m not an epidemiologist or an expert on vaccines, and I don’t even play one on TV (ha ha). The thoughts expressed in this post are based on information about the virus and the vaccines that have come from sources that appear to be reasonably credible. Others can come to different conclusions or rely on different facts or opinions. This post doesn’t attempt to cover all of the bases on this topic. Constructive criticisms or dissenting opinions are welcomed.

What I know about COVID-19 vaccines comes from reading a few articles on the web, news reports, and an excellent virtual presentation and question and answer session with epidemiologists and other experts in the fields of COVID-19 testing, vaccines, and safety onboard commercial airliners. The presentation, sponsored by Alaska Airlines, took place on November 23, 2020. It is presently available here if you would like to view it. Click on “watch on the web” and then “join anonymously.”

These are some of the general points I gleaned during that session and through other sources that are the basis for the opinions I offer in this post.

1. When a vaccine is deemed 95% effective that means there is a 95% chance the vaccine will prevent severe COVID-19 disease.  COVID-19 vaccines that may soon be available prevent serious illness not infection by the SARS-CoV-2 virus. 
2. Anyone who is infected can spread the infection.  Vaccinated people can be dangerous to others.   Vaccines, then, are not the “SARS-CoV-2 get out of jail free and travel the world” cards I’d hoped for. 
3. Much about SARS-CoV-2 and COVID-19 disease and treatment remains unknown.  Experts readily admit it.  The good news is that the experts know a lot about how to prevent transmission of the virus.
4. Tests are being developed that are inexpensive and easy enough to be used at home daily.  Production of sufficient quantities of these tests may be an issue.
5. It is suspected that people who get coronavirus can get it again. A recent article in National Geographic article confirms that people can get infected more than once but it is not known how easily a re-infected person could transmit the virus to others.
6. Scientists do not know how long the protection from the vaccines will last.

Individuals Should Get Vaccinated Irrespective Of Airline Requirements

No matter what airlines require, getting vaccinated against COVID-19 makes sense for most people. Vaccines provide the best chance of avoiding the serious symptoms of COVID-19 disease if one becomes infected with the SARS-CoV-2 virus. The Pfizer and Moderna vaccines currently seeking approval for emergency use in the U.S. are reported to be 90% to 95% effective at preventing severe disease. From an individual standpoint, that accomplishes the main goal — giving yourself the best chance of staying out of the hospital and surviving this pandemic.

Because current vaccines are not 100% effective at preventing severe COVID-19 disease, it still would be prudent for people who are vaccinated (especially those with other risk factors) to maintain the same level of precaution against infection as people who aren’t vaccinated. All those who want to voluntarily engage in an activity where there is a 5% to 10% chance you will die or get terribly sick please raise your hand. There would have to be an awfully important reason to assume that kind of risk. I wouldn’t get on an airplane if there was a 5% or 10% chance it would crash.

Vaccines involve unknown but likely limited risks. Drug companies are applying for “emergency use authorization.” In other words, but for the dire circumstances we are in, the Food and Drug Administration (FDA) and the applicable governmental authorities in other countries wouldn’t permit using these vaccines at this point.

I believe the FDA normally approves vaccines only after reviewing data showing safety and effectiveness from Phase I through Phase IV studies. The vaccines that will be available soon have completed only Phases I and II. While the experts feel confident about general safety and effectives, the additional data that studies from Phases III and IV will provide isn’t available. For example, precise information about short-term and long-term side effects, if any, and the effectiveness and safety of particular vaccines for particular groups of people categorized by age, race and other factors may not be ascertained until the Phase III and IV studies are completed and analyzed or even later.

All that being said, as an older travel-starved person (dare I say senior citizen) who has had well controlled asthma most of my life, I will gladly get vaccinated at the first opportunity understanding that not everything is known about the side effects. I think many will do so, but it is a personal decision we all must make. Governments and businesses can deny access to various things to people who aren’t vaccinated, but no one can be forced to be vaccinated against their will.

A Personal Anecdote

The funny thing is there is a very small chance that I might have had COVID-19. I was in Milano and the Lombardy Region of Italy in the first part of November 2019. The weather was cold and rainy most of the time. I developed sniffles and a cough there that continued after I got home on November 5. It seemed like a run-of-the-mill cold. On November 8 things changed, and I struggled to breathe. For the first time my asthma inhaler had no effect. I’d never experienced something like that and was concerned that if it got any worse I might pass out.

I drove to a nearby urgent care center. The receptionist took one look and brought me to an examination room immediately. Pulse oximeter readings were around 89 or 90, low but not life threatening. Even though breathing medication through a nebulizer brought great relief and elevated the pulse oximeter readings to near normal, the staff thought there was a serious medical issue like a heart attack and called paramedics and an ambulance. I drove myself to the hospital but was still stuck with the bill for the outrageous cost of the ambulance and paramedics that I never asked for or was informed about in advance (grr). The people at the urgent care center said to be prepared to be in the hospital at least overnight.

To make a long story shorter, at the hospital, consultations with doctors, examinations, an EKG, and chest x-rays showed no detectable heart attack or pneumonia. I was released after about four hours with a prescription for steroids I think. There was no specific diagnosis or prognosis. The doctor basically said ‘we’re not sure what happened but you seem to be better now.’ This incident was the only time I’ve been treated in a hospital.

In November 2019, the terms SARS-CoV-2 of COVID-19 disease hadn’t been invented. In March 2020, some were starting to suspect that SARS-CoV-2 may have been spreading outside China before December 2019. I read a story about an Italian doctor, Prof. Giuseppe Remuzzi, director of the Mario Negri Institute for Pharmacological Research in Milan, who contended that a spike in cases of severe pneumonia in the region around Milan in November 2019 may have actually been caused by SARS-COV-2 infections.

This is the post I wrote about it. Milan and Lombardy have Italy’s highest concentration of Chinese and Chinese/Italian residents. The Milano area was the part of Italy that COVID-19 hit first and hardest.

It seems highly unlikely that what I experienced had anything to do with SARS-CoV-2 because of the short amount of time it took for my symptoms to develop after possible exposure, I was in Milan very early in November when there was no detected spread, and lab techs detected no pneumonia. Still the coincidence is suspicious.

But if what I experienced wasn’t COVID, I sure as heck don’t want to see what the real thing is like. I’m getting a vaccine as soon as I can.

Requiring That All Passengers Be Vaccinated Doesn’t Appear To Make Sense For Airlines Or Other Businesses

Airlines and other businesses are concerned about profits not public health. Requiring that all passengers be vaccinated limits the number of people who can buy tickets. The way such a requirement would be implemented and a passengers vaccination status verified hasn’t been published, but it is hard to see how limiting potential customers to those who have been vaccinated would increase profits for airlines and most other businesses compared to not having such a requirement. Most people who will get vaccinated will do so regardless of the requirements of an airline or other business.

Currently, people aren’t flying out of fear of contracting SARS-CoV-2 on a plane, in an airport, or otherwise through travel. Once I’ve been vaccinated, I won’t fear the disease as much and will be more likely to get on an airplane when I have the desire or need to travel. A requirement that everyone else on board must also vaccinated won’t encourage me to fly more than if other passengers weren’t vaccinated.

Any requirement that all passengers be vaccinated couldn’t be implemented for a long time. Even in countries where vaccine distribution is beginning, it will be at least six months or longer before most people will be able to get one. It will be longer than that in other countries.

Vaccinations won’t help an airline much in terms of by reducing potential liability for to a non-vaccinated passenger who claims to catch SARS-CoV-2 on board because there isn’t much liability in that regard anyway: (1) proving where someone catches coronavirus is difficult, (2) because of things like hospital-grade HEPA air filters and enhanced cleaning, airplanes are regarded as safer than many other places, (3) airlines have affirmative legal defenses to passenger liability such as assumption of the risk, and (4) at least in the U.S., legislation may exempt businesses from liability. Furthermore, requiring vaccines might even present potential liability for discriminatory issues if certain classes of people are disparately impacted. At the very least, such a requirement would likely lead to litigation.

Given my analysis that requiring all passengers be vaccinated won’t help airlines, it seems strange that Qantas intends to make it a requirement for international flights at some point in 2021 and U.S. carriers are thinking about doing the same.

Requiring That All Airline Passengers Be Vaccinated May Have Little Benefit For Public Health But Be Required Anyway

Unless it is proven that a vaccine prevents contracting and spreading SARS-CoV-2, requiring that all airline passengers be vaccinated won’t stop the spread of COVID-19 disease. There could be health benefit in having more people protected against the development of severe disease, but people who would get vaccinated to get on a plane would probably get vaccinated even without such a requirement.

Even if vaccines aren’t guaranteed to limit spread, as a way to satisfy local concerns some countries that have done outstanding jobs in protecting their populations may require that all passengers travelling from certain countries submit proof of vaccination against the coronavirus. That could be likely for people arriving from places where spread has been rampant such as the U.S. and Europe who are travelling to countries in Asia that have had a handful of cases comparatively. It could also apply to countries that are afraid of an outbreak necessitating shutting down their economy or overwhelming the healthcare system.

Developing strong testing protocols may be more important than requiring vaccinations. Delta Air Lines recently announced quarantine-free travel to Italy and has expanded the program to Amsterdam. Testing has limitations, too. There are false positives and negatives, and someone could be recently infected but test negative because the virus hasn’t yet reproduced enough to register on a test. Testing and vaccinations might be the best way to make some countries feel safe about admitting foreigners.

Final Thoughts

Do you think airlines should require that all passengers be vaccinated against SARS-CoV-2 infections, or that countries should require proof a vaccination to enter? What other observations and thoughts do you have about this topic? As stated above, I think it is in the best interests of most people to get vaccinated at their earliest opportunity, but I don’t see why airlines would make being vaccinated a requirement to fly.

Thanks for getting through this long post and considering the points herein. I look forward to your thoughts and perspectives on vaccines, travel and the current coronavirus pandemic.