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Illustration: Sarah Grillo/Axios

Americans who are highly motivated to get vaccinated are traveling across state lines after hearing about larger vaccine supplies or loopholes in sign-up systems.

Why it matters: "Vaccine tourism" raises ethical and legal questions, and it could worsen the racial socioeconomic and inequalities of the pandemic.

  • "People are getting anxious and frustrated with the system, and the system is how it is because there’s just not enough vaccine for everybody who wants it," Marcus Plescia, chief medical officer at the Association of State and Territorial Health Officials, said.

The big picture: Reports of wealthy couples taking private jets to Florida to get vaccinated have made national news, but Wendy Parmet, law and public policy and urban affairs professor at Northeastern University, said the problem is much deeper than a few ultra-rich skipping the line.

  • "If there’s not a lot of transparency and trust in the system, in its fairness and equity, then there are always going to be some people to game the system," creating a "vicious cycle of inequity," she said.

What's happening: States like Tennessee that allocate doses by county population, rather than risk groups, forced essential workers to travel to rural counties with excess supply.

  • Immunocompromised Louisiana residents traveled to Mississippi, where the state was prioritizing their illness.
  • States are legally allowed to prioritize residents over visitors, asking for proof of address or a form of ID. The influx of "winter visitors" in Arizona caused Gov. Doug Ducey to request more shots earlier this year.

By the numbers: In the few states that are tracking out-of-state vaccinations, tens of thousands of visitors have been given shots.

Yes, but: It's important for states to get shots to the people who may be less motivated to seek them out on their own, and when that requires a broad brush, easing up on residency requirements may be worth it.

  • "If you’re doing a mobile site in a hard-hit community, I wouldn’t worry about verifying residency at all. I think it’s at the larger scale sites maybe that makes sense while also giving an opportunity to access it somewhere else," said Govind Persad, a law professor at the University of Denver who specializes in health care ethics.

What to watch: More supply in the next month could also clear up some of these issues, Plescia said.

  • "If you told somebody, 'We can get you a vaccine, it’s just going to be a week or two from now,' most people are probably going to wait for that. But I think some people are getting frustrated and anxious that it might be longer," he said.

Go deeper

Dave Lawler, author of World
Mar 4, 2021 - World

In AstraZeneca spat, EU fights hard for a vaccine it's hardly using

Macron, Merkel and European Council President Charles Michel (R) at a summit in October. Photo: Yves Herman/Pool/AFP via Getty

Italy on Thursday blocked the export of 250,000 AstraZeneca doses to Australia, becoming the first EU country to exercise an export ban due to a vaccine shortfall in the bloc.

Why it matters: The controversial step exposes multiple major challenges to distributing vaccines — even among the world’s richest countries.

Mar 4, 2021 - Health

U.S. ahead of pace on vaccines

A health care worker administers a dose of the Moderna vaccine in Ruleville, Mississippi. Photo: Rory Doyle/Bloomberg via Getty Images

The U.S. is now vaccinating an average of 2 million people a day, up from 1.3 million in early February.

Why it matters: That puts us on track to hit President Biden's goal of 100 million doses a month ahead of schedule.

Mar 5, 2021 - Health

Cuomo advisers reportedly altered July COVID-19 nursing homes report

New York Gov. Andrew Cuomo. Photo: Seth Wenig/AFP via Getty Images

New York Gov. Andrew Cuomo's advisers successfully pushed state health officials to exclude certain data on the number of COVID-19 nursing home deaths from a July report, the Wall Street Journal reported late Thursday.

Why it matters: The changes resulted in a "significant undercount of the death toll attributed to the state’s most vulnerable population," WSJ wrote.