Beginning in February, Jose Andres Marroquin, a 56-year-old pilot from Monterrey, in northern Mexico, began receiving up to 50 anxious calls a day from people asking if he could fly them to Texas on a private jet. These were not his usual clients visiting properties or businesses in the U.S.—they were people desperately seeking a ride to Texas for a precious COVID-19 vaccine.
There is an old Mexican joke: God tells a Mexican he has only a week left to live but can ask for one final wish, no matter how outrageous. So the Mexican asks for a ticket to Houston—for a second opinion.
Houston’s impressive medical facilities have long been a global hub for medical tourism, especially from neighboring Mexico, drawing patients in need of cancer treatment, heart surgery, and other necessary treatments. Mexicans with means (from the expanding middle class to billionaire families) also often head northward for shopping, entertainment, and investment.
So it is not surprising that with their own federal government failing to contain the virus or provide vaccines in a timely manner, even as the country has one of the highest COVID-19 fatality rates in the world and ranks third in total number of deaths, Mexican elites are once again looking north for their safety net. But it’s one thing to fly into Houston to pay top dollar for cancer treatment at MD Anderson (and be welcomed for all your other spending that will benefit the Texan economy). It’s quite another to fly in to vie for a free vaccine that is currently in limited supply.
There is little that is fair about the global race for the COVID-19 vaccine, despite international attempts to avoid the current disparities. In Israel, a country of 9 million people, half of the population has received at least one dose, while plenty of countries have yet to receive any. While the U.S. could vaccinate 70 percent of its population by September 2021 at the current rollout rate, it could take Mexico until approximately the year 2024 to achieve the same results. These inequities in vaccine access have made the United States a prime destination for vaccine tourism. The phenomenon takes place within the country as well: Disparate vaccine strategies in different states have led many to travel across state lines for a shot. Inequities in vaccine access occur on a local and global scale: Considerably fewer Black Americans have been vaccinated than whites even though people of color die of COVID-19 at almost three times the rate. The same goes for Mexico, where research shows low-income neighborhoods in Mexico City have been harder hit by the pandemic.
The federal government struck deals with international pharmaceutical companies early on, but doses haven’t materialized according to plan. Mexico was the first country in Latin America to launch vaccinations starting with health care workers. The rollout slowed down after Pfizer announced delays and stopped sending the shots in mid-January. The setback in vaccine supply means Mexico has only vaccinated less than 2 percent of its population of roughly 126 million.
But Mexico scrambled to secure other deals and recently approved the emergency use of Russia’s vaccine, Sputnik V, and China’s CanSino and Sinovac vaccines to continue inoculation of people over 60. Once the government announced the website’s URL for vaccine registration, the site immediately crashed under the weight of nearly 70,000 visits per second. The rollout to inoculate the elderly in Mexico kicked off on Feb. 15 in marginalized, impoverished areas according to the government’s national vaccination plan. While the rollout has picked up speed recently, doses are still an uncertain possibility for those who qualify for the shot. Some critics are even calling the rollout arbitrary.
With the line moving slowly, frustrated Mexican elites are looking north. It’s not surprising in one of the world’s most unequal countries. The top 1 percent holds 43 percent of the nation’s wealth, and 61.1 million people live below the nation’s poverty line.
San Pedro Garza García, a municipality within the sprawling metropolis of Monterrey, is one of Mexico’s wealthiest enclaves. As soon as the U.S. rolled out the COVID vaccines, many residents of San Pedro saw a window of opportunity. WhatsApp groups, social media, and news outlets have been inundated with gossip mixed in with news of people flying to Texas to get the shot. Many were people with businesses in Houston or San Antonio, beach houses in South Padre Island, or properties along the border; some had blue passports or residence permits. All of them had the resources to take the plunge.
“Claudia” is a 58-year-old resident of San Pedro who’d rather not share her real name with me to discuss the vaccine issue. She tells me that for a while it has been the topic of conversation among her circles. People share stories, rumors, tips, and encouragement about the quest for vaccines. She recognizes that vaccine tourism holds a degree of stigma, as seen when celebrities and politicians have posted about getting the vaccine. Mexican TV host Juan José Origel, who posted on social media about receiving the shot in Miami, was criticized on both sides of the border and became the subject of heated public debate. A candidate for mayor of San Pedro also generated controversy after announcing he got the shot in Fresno, California, and calling on his local officials to step up. (He claimed he was only curious to see how the rollout worked, and once there seized the opportunity.) The state’s health minister called vaccine tourism among the elites a matter of survival and encouraged it, while advising people to be aware of U.S. regulations.
Claudia flew with her mother and sister, both over 65 years old, to San Antonio recently to try their luck at getting the shot. They succeeded after waiting in a line of cars for about 12 hours near the coastal town of Corpus Christi, where her mother has an apartment. They did not have to prove residency, but because they have property there, they could have if asked.
“We didn’t do anything against the rules. We didn’t lie about where we worked, our ages, or our health,” Claudia told me over the phone from her mother’s apartment. But she admits that she is uncomfortable about the fact that she got the vaccine before someone of her age and health was officially eligible. She is aware the shot could have gone to someone else who needed it more.
Vaccine tourism has already resulted in public policy shifts that could affect the most vulnerable. After Florida received thousands of out-of-state residents and foreign travelers because of its open registration system allowing anyone older than 65, the state changed course and implemented new rules that require people to show proof of residence.
If such a backlash to vaccine tourism went national, with states requiring—or just talking about the possibility of requiring—an official state ID or proof of residence, many of the 10.5 million undocumented immigrants across the U.S. could be discouraged from seeking the vaccine. Nebraska Gov. Pete Ricketts went as far as saying undocumented workers would be excluded from the vaccine plan, though he eventually walked back that statement. The Department of Homeland Security said it “encourages all individuals, regardless of immigration status, to receive the COVID-19 vaccine once eligible under local distribution guidelines.” The Mexican government also said it would make sure Mexican undocumented workers are included in the rollout by calling upon labor laws under the free trade agreement between the two countries.
Carolina Viera, 34, always knew she would get the COVID-19 shot in the U.S. once it became available, no matter the price. She didn’t trust the Mexican government’s capacity to carry out a national vaccination plan, and as a dual citizen who has spent her entire life on the Mexican side of the border, she had options. At the end of January, Viera spent a week refreshing a score of vaccine registration sites in San Antonio, Laredo, and McAllen, Texas, to try to register her parents, both Mexican citizens only. She wasn’t holding her breath after days slipped by and slots filled up in a matter of seconds. But then she got lucky. Viera and her elderly parents all got vaccinated on Feb. 1. “If you have an open appointment system, I don’t think it’s fair to turn people away,” she said over the phone from Monterrey.
One Texas state senator, Borris Miles, said in an interview with a Houston TV station that there is no excuse for vaccine tourism: “It’s wrong. It shouldn’t happen. … We can’t let our tax dollars go to their parts of the globe.” However, vaccine tourism also brings money into the U.S. Mexicans traveling to Texas for the vaccine contribute to the local economy, same as they do when they come for other medical treatment. They shop, go out to eat, rent cars, pay for hotel nights—and plenty of taxes on all of the above. The practice of medical tourism precedes the COVID-19 pandemic, and it’s only natural that it will continue in a global crisis. But it’s not that simple; ethics, nationalism, and diplomacy throw this phenomenon into murky territory.
There have been global efforts to counteract inequalities in vaccine access like COVAX, an initiative led in part by the World Health Organization. It is one of the biggest international efforts to ensure that middle- and low-income countries have equal and fair access to the vaccine, asking wealthy countries to invest in vaccine development for all in exchange for doses for them as well. The U.S. under the Trump administration decided not to participate, and the move by wealthy countries to buy enough doses to vaccinate their populations several times over is so far undermining the initiative’s goal. A study by the Economist Intelligence Unit revealed that middle-income and low-income countries could take until 2024 to achieve mass immunization. Meanwhile, high-income countries continue to look after their own by making pre-purchase deals with pharma companies before the vaccines hit the market. The European Union is also looking to create an “export transparency mechanism” to ensure its right of first refusal on any vaccine manufactured within its boundaries to guarantee supply to the bloc.
Marroquin, the pilot, believes vaccine tourism is not about ethical or moral conundrums, but political shortcomings. He holds his government accountable for its deadly mishandling of the pandemic and argues that Mexicans will cross borders as a means of self-preservation even if vaccine tourism is not the solution for Mexico.
“Americans are doing the right thing by vaccinating as many people as possible,” he said, and if that includes Mexicans, so much the better.