How the Surge in Summer Travel is Causing Vaccine Shortages in Some Countries

Irene and her partner have had to change their travel plans for this summer. They planned to go to Colombia and, from there, fly to Brazil for excursions in the Amazon. But they have canceled this last stage. To cross that border, the yellow fever vaccine is mandatory and, despite the fact that the trip is in July and they have been trying to make an appointment since May at an international vaccination center, they have not gotten one….

Irene and her partner have had to change their travel plans for this summer. They planned to go to Colombia and, from there, fly to Brazil for excursions in the Amazon. But they have canceled this last stage. To cross that border, the yellow fever vaccine is mandatory and, despite the fact that the trip is in July and they have been trying to make an appointment since May at an international vaccination center, they have not gotten one.

Some of the big Spanish cities have months of waiting. According to the website of the Ministry of Health, the first in its centers in Madrid and Barcelona is for mid-September. In Seville or Bizkaia they arrive a little earlier, in the second half of August. But these are too late dates for many of those who have not been vaccinated to arrive in time for their summer trips.

The administrations and hospitals consulted justify that demand usually increases when the summer dates approach. During the pandemic it had dropped drastically, which picked up somewhat last year and this year has definitely exploded, when trips to more exotic places have returned en masse, where vaccines such as yellow fever and others (cholera, hepatitis, measles…) are more recommended. Some Southeast Asian countries, for example, were closed to tourists in 2022 and are now open for the first time since covid.

The International Air Transport Association (IATA) conducted a survey that revealed that travel reservations from May to October had risen 35% compared to last year. The travel technology company Kiwi has recorded an even bigger increase for this summer: more than double the number of bookings than in 2022.

Jose Muñoz, ISGlobal researcher and head of the International Health Service at Hospital Clínic Barcelona, ​​explains that the passenger units have a very seasonal activity and that, despite the reinforcements when summer approaches, it is impossible to cover all the demand. “It had been growing steadily since around 2005, with the rise of cheap flights and the fashion of traveling. It peaked in 2019 and plummeted during the pandemic. For this year we expected the recovery, and in the absence of closing the season, we believe that we will have reached the figures for that year”, he points out.

Marta Arsuaga has the same impression, specialist in tropical medicine at Hospital Universitario la Paz, in Madrid: “Last year, mostly people who had to spend reimbursements due to cancellations from the pandemic traveled, but it was not massive. In 2023 we are seeing full consultations and very lively people since Christmas. And, since March, the consultations are full. In May we were making an appointment for August; Now for October. Those who have not planned ahead of time will not arrive”.

The solution they have adopted is to refer users to other nearby provinces. In the case of Irene, she tried in all the adjoining Madrid and none gave her an appointment before the trip. “In desperation I went to the Francisco Silvela vaccination center [en Madrid] at seven in the morning [abre a las 9.00]. I had heard a rumor that if you went early you could catch an appointment without a reservation. But there they told me that this is no longer done, that I could spend the whole day there, but that they were not going to take care of me, ”she explains.

If you traveled to Brazil from Spain, you would have no problem entering, but when arriving from Colombia, a country endemic to yellow fever, they require a vaccination certificate. As Muñoz explains, this obligation is not made for the health of tourists, but for the protection of the country itself. “They don’t want you to arrive from an endemic area with the disease, get bitten by a mosquito and start to spread,” he reasons.

There are very few countries that are prohibited from entering without this international vaccination certificate from any destination: about twenty, the vast majority in Africa. But many others are endemic and yellow fever immunization, without being mandatory, is recommended. It happens with a good part of Latin America and Africa itself.

Yellow fever is by no means the only health risk for international travelers. “There are vaccines like the one for hepatitis A that we give to practically everyone who travels [a destinos tropicales]because here [en España] there is very little exposure, but there is plenty outside and it is a very safe vaccine whose efficacy lasts a lifetime”, explains Muñoz.

The risk of other diseases, such as Japanese encephalitis, is restricted to very specific areas —in this case, Asia—, so doctors assess how much time will pass and where the traveler is going to decide whether to prick or not. “It is not the same for a person to go to a five-star resort as for another to cooperate in a rural area,” Arsuaga exemplifies.

To the arsenal of vaccines that already existed, this year one more has been added: that of dengue, which has been approved by the European Medicines Agency this year and has been available in travel medicine units since May. It is an injection that has been shown to be 80% effective against this tropical disease transmitted by mosquitoes that can have serious complications.

Not just vaccines

Vaccines are just one of the tools used in the units, but not the only one. “We make an evaluation of the traveler, the area he is going to, his previous illnesses, and there we assess what he needs. They can be vaccines, antibiotics, prophylaxis against malaria or, for example, prescribing a diuretic if you go to a site more than 2,800 meters above the level of the disease to minimize the risks of altitude sickness”, adds Muñoz.

This doctor defends that the travel units also have the utility of advising users on the risks they may run in the areas they go to, what kind of precautions to take, and what to do in compromising situations, such as being stung by an animal. Or, as Arsuaga comments, warning about the dangers of bathing in fresh water in certain destinations or recommending mosquito repellents that really work, “and not supermarket citronella bracelets that many carry.”

Being very seasonal units, which concentrate most of the activity around summer, they cannot cope. This specialist in tropical medicine recommends that travelers make an appointment as soon as the trip is closed, the sooner the better, and not leave it until the last minute.

And what happens if a sudden trip arises? In a vaccination center in Madrid, this Thursday, a nurse explained that if it is tourism there is nothing to do: they do not contemplate exceptions. And that if it is work and it is duly justified, the specific situation can be studied, but it will depend on the will of the health workers of the health center in question.

In the case of Irene, when she encountered obstacles to getting vaccinated, she wrote to the Ministry of Health, which replied that it regrets the inconvenience. “During the summer season, the demand for appointments at the International Vaccination Centers is very high and sometimes they have difficulties in fully responding to them. We provide you with the link to the International Vaccination Centers that exist throughout the national territory, in case you could get an appointment at one close to the Community of Madrid ”, the department stated in an email.

“At the moment we only have the return ticket from Madrid to Bogotá. We have given up going to Brazil. But there we will visit places like the Tayrona National Park, where the risk of yellow fever is high, and we will not be protected. We will not go to the Amazon, where it is even bigger, ”he laments.