ETHICS: Who’s in? Who’s out? COVID-19 travel rules

Omicron, the latest COVID-19 variant dubbed a “variant of concern” by the World Health Organization, has prompted new travel restrictions in many nations. Although little is known about omicron, scientists have expressed concern that it may be more transmissible or vaccine-resistant than previous variants.

On Nov. 26, 2021, the United States joined a growing list of nations banning travellers from countries in southern Africa, where the variant was first identified. The U.S. decision followed another recent change, which went into effect on Nov. 8, 2021, requiring non-citizens entering the U.S. by plane to be fully vaccinated, with limited exceptions. Everyone entering by plane, including citizens, must provide a negative COVID-19 test.

As bioethicists based in the U.S. and Ghana, we explore the intersection of global health and ethics in our research. In the U.S. government’s recent rules for entry, we see far-reaching consequences that should prompt policymakers to consider not just science, but ethics.

Buying time?

There are multiple arguments to support travel rules imposing bans or requiring full vaccination. U.S. policy aims to “prevent further introduction, transmission, and spread of COVID-19 into and throughout the United States,” President Joe Biden said as he introduced the vaccination requirement. He noted that the Centers for Disease Control and Prevention “has determined that the best way to slow the spread of COVID-19, including preventing infection by the delta variant, is for individuals to get vaccinated.”

Ethically, the reason to contain the spread is to protect health and save lives. It could be argued that a country’s first duty is to keep its own people safe. However, many countries manage to protect their people while building in flexibility, such as by testing and quarantining visitors in lieu of travel bans or strict vaccination requirements. France, for example, tailors requirements to infection rates. It considers the U.S. an “orange” country, meaning unvaccinated Americans must show negative COVID-19 tests and self-isolate for seven days.

One argument in favor of travel bans holds that they could slow the spread of the virus and buy time while scientists learn more. Anthony Fauci, the U.S. government’s top infectious disease advisor, reportedly told the president it would take two weeks to have definitive answers about omicron. A travel ban gives scientists more time to assess how well existing vaccines fare against new variants, and to begin reformulating vaccines if needed.

An ethical argument for vaccine requirements is that people should be held accountable for their choices, including refusing vaccination. Yet throughout much of the world, particularly poorer regions, people cannot access vaccines. On average, only 6% of people in low-income countries have received a dose of a COVID-19 vaccine, compared to 74% in rich countries.

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