COVID-19 Vaccine Tourism: Comparison
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Please note this is a comparison between Version 2 by Conner Chen and Version 1 by peter ractham.

Vaccine tourism is a novel health tourism concept, which provides an opportunity for countries with a vaccine surplus to offer medical tourism packages to entice international tourists from countries with vaccine shortages to visit for sightseeing and receive vaccine inoculations. 

  • medical tourism
  • vaccine tourism

1. Introduction

“Never before in history has international travel been restricted in such an extreme manner” [1].
In early 2020, the World Health Organization (WHO) declared the COVID-19 (sars-CoV-2) outbreak a pandemic. Since then, COVID-19 has rapidly spread through 188 countries and had catastrophic consequences for most of the world. COVID-19 has particularly dramatically affected tourism. Countries around the globe have placed strict restrictions on national and international travel [2,3,4,5][2][3][4][5]. These unprecedented restrictions have caused stakeholders to reduce or halt their operations within the tourism supply chain. This has resulted in significant losses for countries that rely heavily on tourism as an integral part of their economy [6,7][6][7].
As the number of COVID-19 cases fluctuated throughout 2020, countries were forced to close their borders and place strong restrictions for inbound and outbound tourists. According to the United Nations World Tourism Organization (UNWTO), between January and October 2020, there were 900,000,000 fewer international tourists, a reduction of 72% from the pre-pandemic period in 2019 [8]. Tourism industries from all continents were affected with an 82% reduction in international tourists in Asia, 73% in the Middle East, 69% in Africa (69%), Europe (68%) and America (68%). The estimated reduction in international tourism in 2020 is equivalent to a loss of about 1 billion arrivals and $1.1 billion in international tourism receipts. Ultimately, the decline in international tourism from the COVID-19 pandemic could potentially result in a more than 2% decrease in global GDP for the year 2020 [8].
Before the COVID-19 pandemic, the tourism industry represented one of the most robust and complex industries in the world [9,10][9][10]. Tourism represented the third-largest export economic sector and accounted for 7% of all global trade [8]. Tourism has also helped to transform the world into a global village, as first envisioned by McLuhan [11]. Global mobility, ease of travel, and increased awareness of new destinations are some of the factors that formed an integral part of the rise in global tourism activities in recent decades [12,13,14,15][12][13][14][15]. The tourism industry often includes different stakeholders from the tourism supply chain, such as transportation, lodging, food, and entertainment [16]. Worldwide, these sectors provide more than 320 million jobs and account for 10% of the GDP [17]. Hence, the effects of the COVID-19 pandemic have negatively impacted a broad economic spectrum. For example, several airlines, such as Thai Airways, Air Asia, Flybe, and South African Airways, have declared bankruptcy or downsized their workforce to stay afloat. Throughout Europe and United States, bars and restaurants were closed as part of the COVID-19 lockdown measures [18]. Hotel bankruptcy in Japan increased by 57% in 2020, and 47% of hotels in Thailand were expected to close by the end of 2021.
International tourism is expected to be back to pre-COVID-19 levels by 2024 [8]. For this to happen, tourists must feel safe to travel. At present, a significant portion of tourism demand is delayed due to health-related safety concerns [19,20][19][20]. As the COVID-19 pandemic persists, international tourists will be skeptical of health-related issues when traveling or enjoying hospitality-related activities [21]. At present, most airlines require different COVID-19 preventive measures before passengers can board. For example, the Center for Disease Control and Prevention (CDC) requires inbounding passengers to the United States to be tested for COVID-19 before they leave their country, wear a facemask on the plane, and be tested 3–5 days after their arrival to the United States [22]. In addition, some countries, such as France, Israel, Thailand, and the Maldives, have started to explore the idea of requiring COVID-19 documents such as vaccine passports. These documents would ensure that tourists have received the COVID-19 vaccination before leaving their country [23]. Regardless of whether vaccine passports will become universally accepted, it is becoming clear that the COVID-19 vaccination will play an integral role in reviving the tourism industry in future.
As of September 2021, the World Health Organization (WHO) has approved 22 COVID-19 vaccines. A total of 43.3% of the world population has received at least one dose of vaccine, 6 billion doses have been administered globally, and 29 million doses are being administered today. The number of vaccinated people has also steadily increased in many developed countries. However, only 2% of people in low-income countries have received at least one dose of the COVID-19 vaccine. The WHO Africa has reported that they will face a COVID-19 vaccine shortfall of almost 500 million in 2021 and fall short of their year-end target of fully vaccinating 40% of Africa [24].
There is a large discrepancy in the number of available COVID-19 vaccines between developed and developing countries. This discrepancy is called “vaccine privilege,” and refers to the fact that wealthy countries have access to an ample supply of COVID-19 vaccines compared to the number of vaccines available to less developed countries [25]. For example, as of September 2021, more than 56% of the American population are vaccinated (386 million doses), 67% of British citizens are vaccinated (93 million doses), and 64% of French citizens are vaccinated (92 million doses). With the growing supply of COVID-19 vaccines in developed countries, many are facing a growing surplus of vaccines. For example, 10 American states reported that about 1 million doses have gone to waste since the United States began administering COVID-19 vaccines in early 2021. The United States has since wasted over 15 million COVID-19 vaccines due to expiration dates. Logistic bottlenecks, legal troubles, and expiration dates are some of the obstacles that have prevented the redistribution of the vaccine to less developed countries [26,27,28][26][27][28].
The COVID-19 vaccine surplus, in some countries, may turn into an opportunity for the tourism industry. Countries that have surpluses of COVID-19 vaccines can employ vaccine tourism to promote local tourism where tourists can get vaccines while they are on vacation. Since popular COVID-19 vaccines such as Pfizer, Sputnik V, and Johnson & Johnson are not available in all countries, organized vaccine tourism travel to the United States, United Arab Emirates, India, and Cuba is becoming popular [25].

2. Medical Tourism

Medical tourism has been defined as a vacation that involves traveling across international borders to obtain non-emergency medical services, such as cosmetic surgery, dental care, tissue or organ transplantation, or fertility treatments [32,33][29][30]. Medical tourism usually includes relaxation activities and healthcare-related services where medical tourists can receive medical treatments and enjoy traveling in exotic destinations [34][31].
Allied Market Research [35][32] reported that the medical tourism industry has been rapidly growing in the past decade. In 2019, the global medical tourism market reached $104.68 billion and was projected to expand to $273.72 billion by 2027. Driven by high healthcare costs and a long waiting list in their countries, medical tourists can seek out destinations with emergent and affordable medical services, and competent medical teams with new technologies that can cater to their medical needs [36][33]. The growth in international travel, advances in telemedicine technologies, and internet marketing have contributed to the popularity of medical tourism [37][34]. Awadzi et al. [38][35] posit that medical tourism represents one example of how the world has become more globalized. The interdependence of the world’s economies, cultures, and populations has come to existence with the international trades of goods and services.
In recent years, many countries have marketed themselves as medical tourism destinations. Singapore, Brazil, Thailand, Panama, South Korea, India, and Japan are some of the top medical tourism destinations for medical tourists from the United States and Europe [39][36]. Medical tourists from these affluent countries usually seek medical care in Asia or Latin America. The privatization of the medical industry in those destinations has led to international medical standards and affordable prices compared with the medical services in their own countries. These tourists are usually wealthy and can afford alternative medical services to cater to their medical needs [40][37]. However, with the emergence of vaccine tourism, medical tourism could potentially be reversed, with tourists from less developed countries travelling to a more developed country to receive a COVID-19 vaccine that is unavailable in their country. Thus, vaccine tourism could be deployed as a post-COVID-19 crisis destination recovery strategy for countries that want to revive their tourism sector [41][38].

3. Vaccine Tourism

Higgins-Desbiolles et al. [30][39] defined vaccine tourism as “the actions of wealthy individuals to travel to locations where they are able to more readily access the vaccine ahead of others.” Vaccine tourism during the COVID-19 pandemic can be considered a type of medical tourism where tourists gain access to popular COVID-19 vaccines, such as Pfizer, Sputnik V, and Johnson & Johnson [42][40]. Vaccine tourism packages have developed as one-way tourists participate in vaccine tourism. They are often marketed through social media and include COVID-19 checkups, quarantine in a hotel and sightseeing activities. Tourists from Asia are one of the major target groups for vaccine tourism packages due to COVID-19 vaccine shortages in their countries. Vaccine tourism packages have been offered in India, Taiwan, Thailand, and Vietnam [43][41].
The COVID-19 pandemic has continued to persist, as well as the vaccine privilege for wealthy countries. Vaccine tourism has attracted tourists from countries with COVID-19 vaccine shortages. According to Bloomberg’s vaccine tracker, 27% of wealthy countries (11% of the global population) have received 40% of the existing vaccines. However, 11% of the poorest countries have received only 1.6% of the vaccines [44][42]. For example, the U.S. has 24% of the world’s vaccinations and just 4.3% of the population. In contrast, Pakistan has 2.7% of the global population, but only 0.1% of its population is vaccinated [45][43]. The unequal distribution of vaccines also appears within wealthy countries. The vaccine surplus in some American states (e.g., Florida) has attracted tourists from other states to travel for vaccine inoculation. With the continuous spread of COVID-19, there is a growing demand for vaccine tourism from regular tourists [46][44].
Governments with excess vaccines are trying to revive their local tourism industry and see vaccine tourism as an opportunity to bring back tourists. An increasing number of government and travel agencies offer lucrative vaccine tourism packages to people who may lack access to popular COVID-19 vaccines in their countries. As of September 2021, some countries have begun offering the COVID-19 vaccine to foreign visitors to boost the local economy. According to [47][45], vaccine tourism has yielded positive results for local businesses (e.g., restaurants and grocery stores). In the United States, New York has employed a mobile vaccine truck at popular attractions such as Times Square and Brooklyn Bridge Park, encouraging international tourists to receive the COVID-19 vaccination. In other states, such as Alaska, California, Arizona, and Texas, tourists can receive COVID-19 vaccinations at airports and popular chain stores, including Costco and Walmart. Another example is Guam, a United States territory that offers tropical vacations along with the COVID-19 vaccination for tourists [48][46]. In Russia, COVID-19 tour packages are also offered to international tourists. Travelers are now being offered COVID-19 vaccine packages with prices ranging from $1500 to $2500, in addition to flight and transportation costs. The tour package can last up to three weeks: international tourists travel to Moscow for sightseeing and receive the Sputnik V COVID-19 vaccination. Even countries without a vaccine surplus, such as the most popular island destinations with an economy that relies on tourism, such as The Maldives and Bali, offer the COVID-19 vaccination for tourists upon arrival. The United Arab Emirates (UAE) has developed a COVID-19 vaccination app to help tourists book free vaccination appointments before arriving to Abu Dhabi [49][47].
The demand for vaccine tourism will continue to rise for as long as there are discrepancies in the availability of COVID-19 vaccines around the world. However, the implementation of vaccine tourism is relatively new. Uncertainties remain, such as the effectiveness of vaccines against different COVID-19 variances i.e., Alpha, Beta, Gamma, and Delta. Additionally, medical tourists usually travel from more developed countries to less developed ones for cheaper, quicker, and better services [39][36]. However, vaccine tourism appears to be different. The countries with an excess of vaccines can attract tourists from other countries to their destinations. The availability of the vaccine is thus a key to the reverse traveling pattern that might occur.

4. Young Tourists and Medical Tourism

According to the UNWTO [50][48], young travelers represent more than 23% of the tourists traveling each year internationally, and this segment is growing. This growth has provided ample opportunities to stimulate local tourism businesses, as young travelers tend to stay longer (over 50 days) than the average tourist. Young travel has been defined in a variety of ways. The UNWTO [51][49] defined young travel as independent trips by people aged 16–29. Later studies used different age ranges to define young travelers. Yousaf et al. [52][50] defined Generation Y (millennials), aged from 25 to 40, as the strongest sub-segment of young travelers. Lee et al. [53][51] included only travelers aged 20–39 when studying young Chinese travelers’ intention to travel. Our study agrees with the UNWTO report [50[48][52],54], suggesting expanding the age range spectrum to encompass people aged 15–39.
Due to the growth in the young traveler segment and their contribution to the economy, recent studies on tourism have focused more on this segment. Veiga et al. [55][53] found that young tourists usually seek and require peer approval for their travel choices and tend to have higher self-esteem when their travel choices receive more ‘likes’ on social media. Yousaf et al. [52][50] added that Millennials are usually concerned about their health and well-being; therefore, they choose destinations that satisfy their health or well-being needs. Other destination-related factors, such as food, culture, reputation, and perceived value, are also known to motivate young travelers [56][54]. The need to ‘relax’ and ‘escape’ from the ordinary was the essential motivation by young travelers in the U.K. and U.S. [57][55]. Similarly, relaxation is a crucial motivation for young travelers in the Middle East [58][56].
Few studies have investigated young travelers in the context of medical tourism. While Reddy et al. [59][57] found that young travelers did not have a positive intention to seek more information about medical tourism, the young travelers in the study by Gan and Frederick [60][58] found medical tourism appealing. However, they seemed to have economic concerns. Lee et al. [53][51] surveyed young Chinese travelers aged 20–39 to understand the factors influencing their selection of medical tourism destinations. Safety was the most crucial factor when choosing a medical tourism destination. The small number of previous studies on young travelers in medical tourism and their mixed findings revealed the gap for this research.

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