How important is mass vaccination for travel recovery? What should our approach be toward mandatory vaccination and vaccine passports?

Whatever your position on the COVID-19 vaccines, there is no question that a country’s rate of vaccination will play a crucial role in travel recovery, traveller confidence, and positioning of the country as a ‘safe’ tourism destination.

For many, this is a simple case of doing what is best for business and making sure everyone gets their #jab4tourism. Others are more cautious and less enthusiastic about vaccine mandates.

Some operators have already published vaccination policies supporting mandatory jabs (they require all their staff and customers to be fully vaccinated, despite the current COVID-19 vaccines having emergency use authorisation only and still being trialled). We can’t blame them for being proactive with such a policy, because many customers are asking about their vaccination policy, and some vaccinated travellers want assurances that everyone they will come into contact with during their trip has also been vaccinated. (Not that this offers any guarantee of protection, as we saw with the COVID-19 outbreak on board the HMS Queen Elizabeth, despite everyone having been fully vaccinated. But I will get back to this point.)

It seems clear that the global trend is to push for mandatory vaccination and to require proof of vaccination in order to travel and participate in society.

Whether we like it or not, vaccine passports are coming. And even if South Africa or other destinations in our region never make vaccinations mandatory and don’t require tourists to be fully vaccinated in order to enter South Africa, it is highly likely that the vaccination policies of individual companies will become an important differentiator in customers’ buying decisions.

We need to think very carefully as an industry about the way forward and how we want to position ourselves with regard to COVID-19 vaccinations and vaccine policies.

Vaccine hesitancy is widespread, and many people (including within our industry) have expressed concern about the trend toward mandatory vaccination and the introduction of vaccine passports, even before these vaccines have final regulatory approval. I am totally in favour of vaccines, but in the case of COVID-19 jabs I am opposed to vaccine passports and having to show proof of vaccination in order to travel. I am, however, in support of being able to show proof of vaccination in order to not have to show a negative PCR test.

Let me outline a few starting points which I believe should inform our response to these vaccines and to the question of mandatory vaccinations and vaccine passports.

1. COVID-19 is not a hoax. It is a serious global threat that presents a high risk of severe disease and death to some individuals, in particular the elderly and those with existing health problems such as obesity, diabetes, hypertension and vitamin D deficiency.
2. COVID-19 is deadly to some but a mild disease to most people. The Infection Fatality Rate (percentage of those infected who die from the disease) is age graduated and has been estimated to be around 0.15% overall. The risk of death for people under 65 is well below 0.5%, and for healthy people under age 35 the risk is close to zero.
3. The COVID-19 vaccines being trialled at the moment have proved effective in reducing the risk of severe disease and death. Countries that have high rates of vaccination have seen sharp declines in hospital admissions and deaths due to COVID-19. The vaccines work, and that is very good news. Get vaccinated!
4. The COVID-19 vaccines being trialled at the moment appear to be reasonably safe for most people, at least in the short term. All vaccines carry some risk. It is concerning that the number of vaccine-related deaths and serious side effects reported on VAERS (the US Vaccine Adverse Events Reporting System) is much higher for the COVID-19 vaccines than for all previous vaccines, but it remains true that the number of deaths caused by these vaccines is still far below the number of deaths caused by COVID-19. There is no question that these vaccines save lives.
5. Recovery from COVID-19 confers robust natural immunity, represented not only by antibodies (which wane over time) but also by memory B-cells and T-cells to offer long-lasting, broad protection against variants of concern. In the case of Delta infections, there is evidence that natural immunity appears to offer broader and more effective protection than the COVID-19 vaccines give you (although there are also some earlier studies that conclude vaccine-induced immunity is better and longer lasting than natural immunity). As with vaccine-induced immunity, natural immunity is not foolproof. You can get infected again. But ‘breakthrough’ cases of the Delta variant among fully vaccinated people appear to be more common than reinfections among those with natural immunity. In Israel, the Pfizer vaccine is now said to be only 39% effective and there have been many breakthrough cases.
6. None of the current COVID-19 vaccines have final regulatory approval. They are still being trialled and have emergency use authorisation only. Every person who gets vaccinated is participating in an ongoing Phase 3 vaccine trial.
7. Due to the speed of development, we do not have adequate long-term safety data. The initial trials excluded certain cohorts such as children, pregnant women, immune-suppressed individuals, and those who’ve recovered from a previous COVID-19 infection. As part of the ongoing Phase 3 trial during real world use, researchers are monitoring for possible long-term side effects. These may include auto-immune disorders, thrombosis, cardiovascular and neurological disorders, interactions with other drugs and diseases, possible effects on reproductive health, as well as Antibody-Dependent Enhancement (ADE) also known as Vaccine-Associated Enhanced Disease (VAED). We are still learning daily and nobody can say definitively that these vaccines will have no long-term side effects.
8. To varying degrees, the COVID-19 vaccines have all been shown to reduce the risk of severe disease and death, but they do not stop transmission of the virus. Fully vaccinated people can and do still get infected, and can spread the virus to others. Recent research on the Delta variant suggests that the rate of infection, the viral load and the risk of spread is not any lower for vaccinated than for unvaccinated people. This is very significant.

Point 8 above is clearly illustrated by several recent real-life examples. We have seen many highly vaccinated countries with significant outbreaks of infection, despite high rates of vaccination. The UK is a prominent example. Gibraltar and Iceland have both seen a surge of Delta infections despite over 99% of adults being vaccinated. The Seychelles is another similar example.

The HMS Queen Elizabeth example I referred to earlier is a very significant case study. All 1600 crew were fully vaccinated when they boarded. Following a brief port call in Cyprus (where Delta cases had begun to surge and at the time around 0.3% of the population were infected), around 100 vaccinated crew members were reportedly infected with COVID-19. The rate of infection among these fully vaccinated sailors was much higher than the peak background rate of infection back home in the UK, even during the worst seven weeks of the pandemic. How could this happen, if everyone was fully vaccinated before boarding?

The answer is simple. The vaccines do not stop you from getting infected and spreading the virus to others. They merely reduce your symptoms and lower your risk of ending up in hospital or in the morgue.

Do the unvaccinated present a risk to the vaccinated?

Unlike with many other vaccines, the main benefit of COVID-19 vaccination is to protect the individual, not to protect society. Vaccinated people can and do spread the virus at the same rate as unvaccinated people.

This destroys the argument that getting vaccinated is everyone’s civic duty to protect society. It is not. It remains and should always be a personal choice. Vaccination is important, but the principles of informed consent, bodily autonomy and medical freedom trump any argument that we should get jabbed for the sake of others.

Having said that, in the context of tourism recovery, while the overwhelming sentiment and the (incorrect) public perception is that unvaccinated people present a risk to vaccinated people, there is no doubt that getting vaccinated, and asking all your staff to get vaccinated, will benefit our destination and your company’s reputation, and will help tourism recovery.

I don’t agree with that perception, and I believe the unvaccinated are unnecessarily vilified, but changing this public perception is near impossible because the mainstream media perpetuates the false idea that unvaccinated people present a risk to vaccinated people.

Ongoing research

There are a few other issues at play which will take too long to cover in detail in this article, but they warrant further research and a full understanding before one can make an informed decision about these vaccines and whether or not to make them compulsory. Among these is the claim by some experts that the spike protein itself is pathogenic and is causing disease; the evidence that getting vaccinated suppresses the immune response and temporarily puts someone at higher risk of infection; and the mechanism by which new variants evolve. Expert opinions are divided on whether the unvaccinated act as a reservoir for the virus to mutate and develop new variants (a popular but unproven accusation against the unvaccinated), or whether vaccination itself in fact drives new variants, as a few prominent virologists have claimed, including French virologist and Nobel Prize winner Prof Luc Montagnier. To cover these points in detail is beyond the scope of this article.

The WHO has published a very useful document outlining the ethical considerations and caveats to be considered before making COVID-19 vaccines mandatory. It is clear from these guidelines that compulsory vaccination for travel purposes at this stage would be unethical.

Aren’t COVID-19 Vaccine Passports similar to yellow fever certificates?

In principle, I am opposed to COVID-19 vaccine passports, but not to yellow fever certificates. How are they different? The points I listed above make the differences very clear. Yellow fever is not a global threat, and the main purpose of showing proof of YF vaccination is to prevent the virus from being imported from tropical countries where YF is endemic, to countries where it is not endemic. COVID-19 is already endemic everywhere. Importing the virus is less of an issue, and such cross-border spread can, in any case, occur via a vaccinated person as well.

In addition, the case fatality rate of yellow fever is somewhere between 20% and 50%. Yellow fever is far more deadly than COVID-19. Thirdly, the YF vaccine is 99% effective after 30 days and, unlike the COVID-19 vaccines, it actually stops the spread. The YF jab has an excellent long-term safety record and, most importantly, the YF vaccine has been fully approved and is not in a Phase 3 clinical trial with emergency use authorisation only, as the COVID-19 vaccines are.

COVID-19 passports should therefore not be viewed the same as yellow fever vaccine certificates. If you have a YF medical exemption certificate, you are allowed to travel without a vaccine and without having to prove you don’t have a yellow fever infection.

So how do we respond? What is the way forward?

Firstly, we need to encourage (not force) people to get vaccinated. In particular, those in high-risk categories. Older people, obese people, smokers, drinkers, those with hypertension or diabetes or other health conditions that put them at higher risk should be encouraged to get vaccinated. If you know you are at risk, rather go and get the jab. If you’re in doubt, get vaccinated.

Secondly, I believe it is perfectly reasonable to encourage (but not force) frontline tourism staff to get vaccinated. Despite the fact that their vaccine does not really protect others, there is no doubt that having fully vaccinated frontline tourism staff inspires confidence among travellers and will be good for our destination. It becomes a selling point and will help your marketing. For those who have no valid reason not to get vaccinated, I support the drive to get your #jab4tourism.

Thirdly, having said that, we need to respect the fact that the risk vs benefit calculation is not the same for everyone. Younger, healthy people are at very low risk and might feel that the risk posed by the vaccine is a greater (or unknown) health risk to them, compared with the risk of contracting COVID-19. It should be entirely their choice. No employer should force a young tour guide or receptionist to get the jab against their will, under threat of being fired if they don’t. And I believe no lodge or tour operator should turn away a traveller on the basis of not being vaccinated.

Next, we need to respect the fact there are people who have valid medical objections or contra-indications to getting vaccinated. For them, the risk of taking the vaccine might also outweigh the risk presented by COVID-19. People with a history of allergies, thrombosis, stroke, anaphylaxis, auto-immune disorders, cardiovascular disorders, as well as pregnant women, people on immune suppressing drugs, or those who had a severe reaction to the first jab or a previous vaccine might be hesitant or be advised by their doctor not to get vaccinated. They should consult with their doctor whether to risk taking the vaccine or not. Nobody has the right to put pressure on these people to get vaccinated ‘for the sake of society’ or ‘for the sake of tourism’. Whether medical exemptions will be allowed and confer the same rights and freedoms as being vaccinated remains to be seen. Most likely, such people will continue to have to show a negative PCR test to travel internationally.

We also need to respect the fact that these vaccines are still in trial phase, without final regulatory approval. Nobody has the right to force someone to participate in a vaccine trial, when no long-term safety data are available. This is a valid reason why many people are hesitant to take the vaccine, or prefer to wait. Others might have religious objections or conscience objections. We may not agree with their hesitance or their reasoning. But given the realities outlined above, we have no right to demand that they get vaccinated ‘for the greater good’, under threat of being excluded from society if they don’t. Contrary to the mainstream narrative, our health, our future and our freedom are not threatened by the unvaccinated. They are threatened by those who continue to impose draconian regulations, business closures and travel bans.

Lastly, we need to respect the fact that there are hundreds of millions of people who have recovered from COVID-19 who have little to no medical benefit from getting vaccinated. They already have robust immunity. By getting vaccinated, they only face the risk of possible side effects from the vaccine. Perhaps their only benefit is societal approval, and getting a vaccine passport that allows them to travel and dodge the questionable restrictions that are increasingly being imposed on the unvaccinated.

Conclusion

It is my view that the vaccines are great and should be celebrated, but the tourism industry should not be too quick to welcome vaccine passports or vaccine mandates as the only way forward. We’ve already seen that even highly vaccinated countries have reimposed lockdowns and been placed on red lists again, which proves that vaccines alone will not help us return to normal.

In my view, COVID-19 vaccine mandates are unethical at this stage, and the global tourism industry should unite in its condemnation of the disproportionate response we have seen to this pandemic, which has decimated the travel industry. Recovery is critical, and digital vaccine passports for travel purposes are inevitable as the industry starts to recover. They will be implemented. But perhaps with some lobbying we can ensure they will allow anyone to travel who is vaccinated, or has a negative test result, or a medical exemption, or proof of recovery from COVID-19.