Pre-pandemic, health tourism was booming in emerging markets. Hotspots such as Thailand, India, Turkey and Colombia (to name but a few) competed to attract tourists to their state-of-the-art medical facilities. Discrete procedures such as cosmetic surgery/aesthetics, eye surgery, bariatric surgery, dentistry, gender reassignment and fertility treatment were particularly well suited to package ‘sun, sea and surgery’ style deals.
Source of business was both from mature markets such as the US, where emerging market health facilities promised tourists comparable quality at competitive rates, and from low-income countries where a wealthy minority opted to receive higher quality care overseas. Aggressive year-on-year growth of the health tourism market was forecast, with an estimated double digit compound annual growth rate set to increase the market from generating around $60 billion a year in 2018 up to over $150 billion a year by 2026.
COVID-19 has halted these figures in their tracks, as international travel stalled almost overnight back in March 2020. The travel industry in general has been one of the hardest hit sectors over the last year. Coupled with many countries restricting healthcare to essential services only, and postponing elective surgeries, health tourism has suffered a double whammy. For medical facilities that were reliant on tourists as a key source of their income, their finances have been crippled.
In 2021, as governments across the world start to navigate a vaccination-induced roadmap out of the pandemic, medical tourism faces an uncertain future. Access to, and roll out of, Covid-19 vaccinations, has been highly uneven globally, leading to fears about travel. Inbound and outbound restrictions, such as costly hotel quarantine, and rapid changes in international travel requirements and travel corridors, are inhibiting a smooth return to normality for the industry and generating considerable ongoing uncertainty. Government support – which varies in its generosity across countries – has been necessary to prop up institutions that are struggling.
Vaccine passports have been touted as a means of jump starting worry-free travel. Multiple digital initiatives are currently being proposed by both governments and private actors such as airlines and cruise ships as a means of providing evidence of vaccination. However, these are not without issues. The WHO has spoken out against imposing such schemes, in the context of the global shortage of vaccines and given unresolved questions around duration of immunity conferred by vaccines, as well as ongoing uncertainties about transmission of the virus among those who have been vaccinated. Presenting a negative antigen test result is an alternative option, but again there are issues associated with requirements for costly multiple tests and risks of false positives slipping through the net.
With traditional health tourism therefore remaining ‘on ice’ as these debates rage on, several examples of ‘vaccine tourism’ have hit the headlines recently:
Reports surfaced last month of a London-based upmarket concierge service, the Knightsbridge Circle, offering their members the opportunity to book luxury holidays to Dubai that – for the cost of £10,000 on top of their annual membership fee – included China’s Sinopharm vaccination as part of the package. While the reports have been denied for now, various other reports of wealthy elites using their connections with senior officials or royalty to travel to the UAE for vaccination abound.
Cuba, which is developing its own Soberana 2 vaccine, has offered “the beach, the Caribbean sea, mojitos and a vaccine” to tourists who visit its shores. Phase III trials of the vaccine commenced at the beginning in March, with mass production planned from next month.
German travel agency Fit Reisen has recently started advertising for ‘Impfreisen’ or ‘vaccine vacations’, following the country’s struggle with its domestic vaccination roll out. The Austrian website Impfreisen.at welcomes visitors with the slogan ‘First come. First go. Freedom for you.’ and offers a range of packages tailored to meet various budgets.
Talk of German national air carrier Lufthansa setting up a vaccination lounge within Moscow airport for travel packages to receive the local Sputnik V vaccine that don’t require navigating Russian visas, while not yet supported by any hard evidence, is perhaps the most extreme and outlandish vaccine tourism suggestion we have come across to date, and perhaps a sign of what might follow – unprecedented measures for unprecedented times.
Enterprising, unethical or a bit of both? While perhaps not as controversial as the millionaire Canadian couple who in January disguised themselves as hospital workers to receive vaccines intended for vulnerable and elderly Indigenous residents after chartering a private jet to the remote Yukon territory, commentators have been critical of the ethics of the underground international market emerging for Covid-19 vaccines, while also accepting its inevitability given the challenges associated with their equitable global distribution. Even allowing people to travel from their country of residence to their country of origin to get the vaccine, or crossing State lines to obtain the vaccine from another State in the US, have raised uncomfortable questions about eligibility and coverage, which have seen some countries and territories implement restrictive residence policies.
The recent offers by Bahrain and Qatar to vaccinate the Formula 1 and Moto GP grids, respectively, as they arrived ahead of upcoming races, divided team and paddock personnel. Decisions were often made along national lines depending on the success of the roll out in their home country. Some were keen to taking advantage of the generous offer, not knowing when the vaccines would be made be accessible to them back home. Others were more focused on the potentially inflammatory PR implications of being seen as jumping the queue ahead of more vulnerable local people still waiting to be vaccinated.
When considering the global power dynamics and balance of power at play, what is striking is that emerging markets are at the forefront. In many of the examples above, tourism destinations are offering vaccines that have been designed in emerging markets, building their own markets, as opposed to relying on the traditional (Western) vaccine manufacturers.
It remains to be seen the extent to which vaccine tourism will take off, and how widespread it will transpire to be, or the degree to which it will exacerbate existing health disparities. Reliable data will likely prove elusive. The other burning question is how long this phenomenon will last. Vaccine hesitancy and lower than expected uptake in some Western markets currently struggling with supply may soon result in a surplus of vaccines, obviating any need to travel. Reports surfacing of vaccines being sold on the darknet may offer an alternative, potentially even riskier black market source for those unwilling to cross international borders. The limited window of intense demand for vaccine tourism is a situation without obvious analogues, making it a high-risk venture offering the potential to yield high rewards for those daring enough to try.
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