Vaccine tourism in the United States sparks ethical debate on inequalities in the pandemic – 07/05/2021 – Worldwide

The stay of the engineer from São Paulo Felipe, 51, in Punta Cana could be part of a vacation trip to the most visited tourist destination in the Dominican Republic, without the coronavirus pandemic that has killed more than 3, 2 million people in the world. .

Felipe, who prefers not to be identified by his last name, fulfills this Saturday (8) the eighth day of quarantine before being allowed to take a flight to Miami, where he intends to receive the vaccine against Covid-19.

Like him, there are other Brazilians who are resorting to the advanced pace of vaccination in the United States in an attempt to protect themselves against the disease that continues to kill thousands of people in Brazil in the face of a slowly progressing vaccination program.

“You can’t trust the government and this immunization schedule that we don’t even know if it can be sustained,” he says. His goal is to take the vaccine produced by Janssen, in a single dose, so that he does not have to wait any longer on American soil until he receives a possible second dose.

Acknowledging that he is “super privileged” because he can travel to the United States to research the vaccine, Felipe estimates the company’s total cost to be around $ 12,000 (R $ 67,200) – or nearly 450 payments for new emergency aid to deal with the crisis.

“I don’t do anything that I consider unethical. I think it would be a problem if I disrupted the schedule in any way or took doses from someone, ”he says.

Curitibana’s lawyer Francisca, 35 – who also prefers not to say her last name – has plans similar to Felipe’s. The idea was to take advantage of a vacation trip to Mexico to, from there, also embark in Miami, where she has an apartment, and receive the vaccine. She says she knows several people who have made similar routes, on routes whose values ​​are estimated between R $ 15,000 and R $ 20,000.

“Here in Brazil, I am against a private vaccine. This creates inequality, ”says Francisca, who classifies so-called“ vaccine tourism ”as“ a very elitist situation ”. But the perception that younger people, in their age group, have increasingly fallen victim to Covid-19, and even the desire to travel has prompted them to consider the option.

“I went to American schools, I went to college there, so I’m desperate to go to America,” she says. “And this pretext to take the chance to get vaccinated is the best of all!”

The lawyer was afraid to travel due to the 16-week pregnancy, but did not abandon the plans once and for all until the Paraná health department announced that pregnant women would also become priority groups for vaccination. – there is still no fixed schedule, but pregnant and postpartum women should become eligible in the coming weeks.

Maceió’s engineer Fernanda, 33, told Folha she had bureaucracies to solve in Miami and used the trip to receive the single-dose coronavirus vaccine. Dual citizenship (American and Brazilian) allowed her to travel to the United States and return to Brazil without completing her quarantine.

“I did not see any prospect of vaccination, in the short term, for people my age. Since I had this opportunity, I thought it was better to take advantage of it.”

International travel, she said, was much safer than the domestic flights she was on during the pandemic period. Plane “almost empty”, more serious safety protocols, all “very calm”.

From a legal point of view, there is no irregularity in traveling to the United States to receive the vaccine, say two lawyers working in international relations consulted by the report.

“Countries, in the exercise of their sovereignty, define the criteria for the movement of people on their territory. There is no legal offense. Public health policy is the prerogative of the state, and each state does his own, ”explains Karla Borges, professor of international law at ESPM.

Once the traveler has a valid passport and the necessary visa, there are no ethical hurdles, explains Gisele Mendes of the Andersen Ballão office in Curitiba. “Everyone has free will and everyone knows what is best for their health. If the person has the opportunity to get the vaccine without queuing, then go for it. At least it’s one more person who will be vaccinated. “

For epidemiologists, however, the logic must be different. “Those who can leave the country to be vaccinated in other countries do so at the expense of the vast majority who cannot. So it is more of a model of inequality,” says Ethel Maciel, post-doctoral fellow in epidemiology and professor. at the Federal University of the Holy Spirit.

According to the specialist, in addition to a greater exposure to the risks of contamination during the trip, the person who travels to be vaccinated abroad and returns to Brazil always finds the same epidemiological scenario of high transmission rates, so that, collectively , she is also prone to contagion – although this greatly reduces your chances of developing serious illness.

“It is a practice that reinforces inequalities when we should fight together now to emerge from this pandemic,” Maciel says. “The vaccine is a collective strategy. We have to think collectively and act the same.”

For Marina Borba, lawyer and researcher in bioethics at the USP’s Center for Studies and Research on Health Law, there is a legal conflict between the individual and the social in matters of the right to health, provided for by the Constitution. .

While article 196 states that “health is the right of all and the duty of the State”, article 6 classifies health as a “social right”. In other words, for the specialist, although the people who travel to the USA to be vaccinated are acting in the name of an individual right to health guaranteed by the Constitution, this should not trump the collective right. .

The researcher also rejects the argument that vaccinating a Brazilian abroad would help relieve the SUS (Unified Health System). The same reasoning is commonly used to defend that private companies can negotiate the purchase of Covid-19 vaccines to immunize their employees and accelerate economic recovery.

According to Borba, when people with purchasing power get vaccinated outside the public health system, they end up making the immunizer an even scarcer material resource in the world. “The price is increased, access is reduced for those who no longer have it and a kind of competition is created with the Brazilian government in the acquisition of vaccines.”

Nor should the conduct of the federal administration, seen as silent and denial, be used as a pretext for researching vaccines by private means in the United States or in other countries. “If the government made a mistake and remained silent, we must use the appropriate ethical and legal measures to correct this failure, and not seek other means and subterfuge which, from a collective and ethical point of view, are so questionable, ”says Borba.

Although she was immune to Covid-19 in a different context from “vaccine tourism,” musician Maya Salles, 26, says she received the doses in Trinidad, Colorado, with a sense of guilt.

“I was a little ‘bad’ when I took it because I was like ‘hey, there are a lot of people in my country in dire need of vaccines’,” he says.

She traveled to the United States in 2020, before the borders closed and the health crisis worsened. She spent the last year on American soil and, working as a caregiver for the children, she became eligible to receive the vaccine in March.

With that, he walked past the family that remained in Brazil, in Guarulhos: the 83-year-old grandmother, who only received her doses in April; the 59-year-old mother who, despite being a health professional, did not receive the vaccine because she was absent from work; and his father, a 57-year-old bus driver who remains at risk of contamination.

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