Nobody denies the primary priorities of vaccination for COVID-19: almost universally, both governments across the world and civil society have joined hands to agree that front-line workers (who have been suffering and dying while caring for their populations) and the elderly, who are overwhelmingly at risk of death by COVID.

But vaccination efforts worldwide have also created fissures: vaccination is messy. Vaccine can spoil once removed from refrigeration. When dealing with what may be the single most valuable substance on planet earth at this time, governments have adopted wildly varying measures to enforce their will: in Israel, vaccination clinics have a mandate to distribute leftover shots to literally anyone, to prevent waste at the end of each day. In New York State, any deviation from the order of vaccination is barred by law, and punishable with financial sanction.

But all of this pales in comparison to the problems which will need to be dealt with when a country achieves the magical 85% community vaccination rates which confer “herd immunity”.

Any government would be punished severely by their domestic populations if they were to give lifesaving vaccine to foreigners before their own citizens. But at that point, the value flips: vaccine is suddenly nearly worthless domestically, and dramatically valuable to outsiders.

Enter vaccine tourism.

It is useful, when discussing vaccine tourism, to consider a few unassailable facts. First, the global 1% are mobile, wealthy, and motivated – especially when considering their own lives and health. Tightening rules and restrictions to prevent vaccine tourism will have negative knock-on effects, especially when it comes to wasting valuable vaccine supplies. Finally, while there is a very real political difference in domestic vs. foreign lives, there is not a moral difference. A life is a life.

Those countries that internalize these realities will come to the same conclusion: there is very real value in considering vaccine tourism as a coming reality. Give the ultra-rich their vaccine, after taking care of your own population. Soak them for it; make them pay through the nose, and then drive that money into public health measures, or supporting those third world countries which are suffering most acutely from a lack of COVID-related resources.

Those governments which take a puritanical approach will fall prey to a greater moral hazard: wasting the most valuable medicine on planet earth to appease the gods of “fairness” and “equity”, and prolonging human suffering in the process.