Vaccination, Quarantine & Travel

The Centers for Disease Control and Prevention recently updated its Interim Clinical Considerations to address what those who have been fully vaccinated should do in cases when they have been exposed to the virus. According to the CDC:

Vaccinated people with an exposure to someone with suspected or confirmed COVID-19 are not required to quarantine if they meet all of the following criteria:

• Are fully vaccinated (i.e., ≥2 weeks following receipt of the second dose in a 2-dose series, or ≥2 weeks following receipt of one dose of a single-dose vaccine)
• Are within 3 months following receipt of the last dose in the series
• Have remained asymptomatic since the current COVID-19 exposure

The CDC still advises against interstate travel during the pandemic, and it is worthwhile, if you are considering traveling, to read this guidance to minimize your risk of contracting and spreading the virus. However, some states have begun to update their interstate traveler quarantine rules to reflect these CDC quarantine rules, and the lower risk vaccinated individuals have of contracting symptomatic cases. New York, for example, will not require quarantine for individuals traveling from noncontiguous states who have been fully vaccinated within the last 3 months (fully vaccinated meaning at least two weeks after the person receives their final dose).

While questions arise about what the “new normal” will look like (see this recent JAMA piece arguing that the virus likely will become a recurrent, seasonal disease, like the flu), legal, ethical, and policy debate has begun over the implementation of so-called “vaccine passport” programs. It is looking increasingly likely that such programs will see widespread adoption by governments, institutions, and businesses in the months ahead, as such programs offer a streamlined process through which those who have received the vaccinations (and therefore pose a lower risk for infection spread) can more freely travel and congregate.

However, there are numerous critiques that can be leveled at such programs. Access to vaccination is not equitable within countries or around the globe, which would further divide society into “have” and “have not” categories on a fundamental human rights issue.  Furthermore, while there remains significant vaccine hesitancy in parts of society (including disproportionately high levels of hesitancy within communities of color), the implementation of vaccine passports may create situations where people feel compelled to receive the vaccine in order to have an opportunity to participate in society. Finally, on the question of enforcing passport rules, reasonable concerns arise about the likelihood that black and brown populations will be disproportionately targeted for policing and exclusion, which would reinforce the types of discriminatory practices and disproportionate negative experiences felt by such communities throughout the pandemic. As one commentator stated, “You could easily see a situation where it’s creating discrimination, prejudice and stigma.”

Vaccine Choice

All three vaccines are extremely safe and effective at preventing Covid-19 cases that cause hospitalizations and death. That said, some people might prefer one vaccine over the others. Should the vaccine allocation process facilitate public choice on such matters? (Note: Indiana’s program does indicate which vaccine is being distributed at each clinical site) A new New England Journal perspective by leading public health lawyers, bioethicists, and health care practitioners, “Choices in a Crisis — Individual Preferences among SARS-CoV-2 Vaccines,” recommend restricting choice, for reasons of

• Expediency – “If allowing choice of vaccines means that some currently eligible Americans will wait longer, there could be a consequential delay in protecting the most vulnerable and achieving herd immunity. With new variants on the march, time is of the essence….Situations of emergency, shortage, and overwhelmed hospitals are not compatible with receiving access to care completely on a patient’s own terms. “
• Equity, as “accommodating individual vaccine preferences would most likely exacerbate current inequities in vaccine administration and the pandemic burden,” and
• Equanimity – “Though they may not have identical efficacy profiles, the public should nonetheless be reassured that, within the context of a historic crisis, each authorized vaccine works. A forceful statement from public health officials affirming this efficacy may help to promote equanimity, offering a calming antidote to the inevitable misinformation maelstrom about vaccines….In promoting equanimity, health officials can also help the public avoid taking an overly narrow view of risks and benefits: otherwise, some people may focus only on the vaccines, overlooking the harms of delaying vaccination until their preferred product is available.”