Dr. Anthony Fauci has been making the rounds on public affairs programs for several days talking up vaccination requirements for domestic travel. He emphasizes in each case that it makes sense for international travel to keep virus cases out of the country (but unvaccinated Americans are allowed to return, and the virus is already spreading here rapidly).
Fauci then goes on to suggest that a domestic vaccine travel requirement would make sense, not to ‘keep the virus out’, but to serve as an incentive to get vaccinated. Fauci has headed the National Institute of Allergy and Infectious Diseases for 37 years. His comments are not by accident. However in addition to being legally questionable, such a requirement may wind up having the opposite effect Fauci hopes.
In case you missed it this morning, Dr. Fauci talking on @MSNBC @Morning_Joe about the potential for a vaccination requirement for domestic air travel: "If you want to do that with domestic flights, I think that's something that seriously should be considered." pic.twitter.com/NZVDmt8UYK
— Ross Feinstein (@RossFeinstein) December 27, 2021
I would personally love this because those who are vaccinated and boosted with mRNA vaccines are less likely to get infected, clear the virus more quickly, and have virus coated in antibodies when they are infectious. In other words being surrounded only by vaccinated passengers would mean a safer environment within which I could travel.
However I do not favor it because,
- The U.S. is not pursuing, and has never pursued, a zero covid strategy which would at least make domestic travel restrictions coherent
- The virus is already spreading widely in the country, limiting travel to those who are vaccinated won’t ‘prevent spread’
- And breakthrough cases are real, those who are vaccinated do get and spread the virus, just at lower rates than those who are not
- Flying isn’t a less safe environment than other indoor congregant activities that have no such legal restriction
- And the Supreme Court has consistently held that there’s a fundamental right to interstate travel. Cf. Crandall v. Nevada, 73 U.S. 35 (1868); United States v. Guest, 383 U.S. 745 (1966). While the court hasn’t found a specific right to particular modes of transportation, placing restrictions on air travel from New York to California or Miami to Seattle would represent a substantial burden on these rights.
Since there are fundamental rights involved, at a minimum there would have to be carveouts to avoid infringing on religious liberty as well as those unable to obtain protection from vaccines. That means either placing a burden on airlines to grant or deny vaccine exemptions, or creating a federal vaccine passport and exemption system.
Of course the data behind who is and isn’t vaccinated is generally held at the state level, and there’s no good way to do this federally. The CDC can’t even keep track of boosters versus first doses. Our federal system and data issues make this impractical.
Ultimately though Fauci’s ‘incentive to get vaccinated’ argument falls flat. And that’s because he’s no longer talking about the science of vaccines, but about human psychology and about marginal benefits of political actions. U.S. public health authorities have consistently messed up the messaging, which has led to counterproductive results, and they’d be doing the same here.
- There’s little marginal vaccination left to encourage. Ninety percent of Americans aged 65-74 are fully vaccinated while the figure for those 75 and older is 85%. Over 80% of U.S. adults have taken a shot. As existing vaccine mandates kick, and as Omicron spreads, that’ll probably rise to 85%. In any setting there’s always going to be some vaccine refusals – that was true pre-pandemic. And not everyone flies.
- This could backfire with even more skepticism – including for other vaccines. Fauci is right that there would be some people along a certain margin who would get vaccinated if there was a domestic air travel requirement. But that comes at a significant cost to rights, creates a significant bureaucracy to fly, all for little marginal benefit. And it likely creates even greater vaccine resistance not just to this vaccine, but as spillover to all vaccines. So there’s a public health cost.
- There may be more effective means available. Early in the year when Congress voted stimmies to most Americans I wrote that payments should be tied to vaccination. Fauci focuses on domestic air travel because there’s some federal authority here, not because it’s the strongest lever to pull. The Biden administration is pursuing a number of other mandates, which the Supreme Court will consider in early January. They haven’t yet tried large dollar incentives for remaining holdouts to pick up a similar marginal increment.
- Boosters are a better strategy for public health than forcing vaccines on remaining holdouts. At this point there’s far more benefit to clear, coherent messaging on booster shots than there is trying to force a first shot on those unwilling to take one. And the government has already screwed that up, since the FDA advisory committee initially voted against boosters for everyone because Biden had promised them, appearing to undercut their authority.
We know from the data on Omicron that boosters do more than first and second doses to generate protection, and boosters can have an effect on the current Omicron wave while putting needles into the arms of those who haven’t yet had a first shot likely will not (because of the waiting period after each shot to get the next dose).
Mostly a domestic air travel vaccine requirement would be for show, in the face of a federal inability to take decisive action that ameliorates the pandemic. It’s taken 21 months for the government to prioritize testing, and they’re still moving too slowly. How the government didn’t step in with multibillion dollar at-risk orders for Paxlovid to speed up production months ago is hard to even fathom.
I would love to fly only with those that are vaxxed, and by the way only with those that are tested same day (not previous day) as well. However as a matter of public policy this isn’t the best way to manage air travel or the pandemic. Let’s focus on encouraging boosters, fast-tracking multivalent boosters, and on researching next generation vaccines (including pan-coronavirus vaccines). And let’s quickly approve billions of tests, not hundreds of millions, so that we can all test regularly before interacting with others. Airlines might even consider waiving penalties on basic economy tickets for passengers who test positive.