Can Vaccinations Reopen International Travel?

(Bloomberg Opinion) -- After more than a year of sheltering at home, people are itching to travel internationally again — especially those who’ve been sitting on credits from trips canceled in 2020. Airlines would like nothing more than to see borders reopened. While the industry supports continued mask mandates, physical distancing and other safety measures, they are banking on vaccinations to loosen the more cumbersome international testing and quarantine requirements.

In the U.S., the airline industry has called on the Biden administration to update Centers for Disease Control and Prevention guidance to exempt vaccinated international travelers from current Covid testing requirements. In Europe, Michael O’Leary, the CEO of Ryanair Holdings Plc, argues that the litmus tests for maintaining travel restrictions should be hospitalizations and deaths. “Once you’ve eliminated that risk with vaccinations, frankly I think people are going to rebel. They’re not going to be willing to be locked up,” O’Leary said in an interview with Bloomberg TV last month. “Covid will become — I mean it will still be with us — but it will be much more I think similar to the annual flu, the annual cold, because of the success of vaccinations.”

Is he right? Can vaccines be the turning point that airlines hope they’ll be? Bloomberg Opinion industrial columnist Brooke Sutherland discusses with Sam Fazeli, a pharmaceutical industry analyst for Bloomberg Intelligence. Their conversation has been edited and condensed.

BS: If a certain percentage of the local population is vaccinated — particularly the older and most vulnerable — is it safe to reopen borders?

SF: The aim of vaccination is to return the world to as normal a place as possible. But there are too many unknowns to rush this. O'Leary is right that we shouldn’t be focusing on case counts as a barometer of success. Vaccines are not 100% effective against infections. We shouldn’t care as much if this becomes just another coronavirus that people catch as part of their normal lives — as long as vaccines keep any serious manifestation of the disease under control. But we need to do this slowly to be sure we are not sleepwalking into a new disaster. It’s too early to declare a victory based on hospitalizations or deaths. Remember, we only identified the virus just over a year ago. There's much we still don't know about this virus and how it interacts with our immune systems.

As an example, few people thought variants would develop as quickly as they have. The virus has already evolved to a point where it has become more transmissible and potentially more deadly, as well as possibly capable of evading some of the immunity afforded by the vaccines. We want infection rates moving down before opening up travel so that we don’t give the virus the opportunity to become even more difficult to manage.

BS: Data from a CDC study last week showed that two doses of the Covid-19 vaccines from Pfizer Inc.-BioNTech SE and Moderna Inc. provide as much as 90% protection against infection and therefore may help reduce the spread of the disease. Does data such as that change the calculus on travel? 

SF: This is indeed excellent news and yes, it would. It is what we all want. We have seen similar readouts from Israel and the U.K., with the real-life efficacy for the AstraZeneca vaccine about the same as that of Pfizer-BioNTech. But remember, all of this is being measured very shortly after the second dose of the vaccines, when immune response is at a maximum. As the months pass, the protection vaccines offer against catching the virus and spreading it may wane, even if you’re still less likely to get sick from the disease yourself. We just don't know how quickly this would happen and whether variants will have an impact on that decline in immunity. A paper recently published in the Lancet showed the AstraZeneca vaccine’s efficacy against symptomatic infections from the B.1.1.7 variant first identified in the U.K. dropped to 70.4%, compared with 81.5% for older virus lineages. The Novavax vaccine saw a similar drop. So we need to be on our guard for now, until we know more.

BS: The EU and certain U.S. entities are working to develop digital travel certificates that would show proof of vaccination status or test results to immigration officials. What needs to be included in such health "passports" to make them effective at containing the spread of Covid?

SF: This is a very tough subject, though I expect such certificates are going to come in one form or another. The issue is that if the documentation is based on vaccination status, do we know how long the vaccines are effective and protective? Is one vaccine better than another? What if someone wants to travel to a country that hasn't yet reached a high enough vaccination status or has an active rise in cases? Basing certificates on overall immunity — whether from a vaccine or because someone has already had the disease — may be a bit easier. That would give a read as to how protected someone is without having to worry about which shot they took or how long ago they took it. But we still need to prove that blood antibody levels are a good sign of protection and determine what the benchmark should be for immunity. And then there is the risk of fraud. I think vaccine certificates need to be thought through in detail to make them effective and foolproof.

BS: How can concerns about variants be balanced with lockdown fatigue? Is there a risk, as O'Leary of Ryanair suggested, that people — or even governments — start to rebel? Greece has been particularly vocal about wanting to reopen tourism.

SF: I think people will line up to take the vaccines as their family and friends get inoculated and their worries and inhibitions erode. And if vaccination status is a ticket not just to travel, but to visit local cultural and sporting events, then more and more people will be motivated to get their shots. We just have to make sure the messaging is clear about the risk and rewards of vaccines. We should try very hard not to oversell the benefits of vaccines. No one should be shocked if they hear of people who have been vaccinated and then still test positive for the virus, variant or otherwise. Vaccines provide a high degree of protection against symptomatic disease, but not 100%, as we saw from the clinical trials. As time passes and immunity wanes, then it’s likely we will see more infections, but hopefully very few resulting in serious disease. The key is to keep an eye on the final prize: a massive reduction in severe illness, hospitalizations and deaths and proof that we have the variants under control. I do not believe we’ll have that in the next few months. But once we do, to O'Leary's comment, we should eventually be out of the lockdowns.

BS: When do you think someone from the U.K. might reasonably hope to visit Europe without a quarantine? What about a traveler coming from the U.S.?

SF: I think the summer is too early for unrestricted travel, given all the uncertainties I have listed above. There may be exceptions for those fully vaccinated who have a good reason to travel — potentially including weddings, funerals or visits with close family. I am then looking forward to finding out how many close relatives I had that I didn't know about, given that I live in the sunny southwest of France :-).

This column does not necessarily reflect the opinion of the editorial board or Bloomberg LP and its owners.

Brooke Sutherland is a Bloomberg Opinion columnist covering deals and industrial companies. She previously wrote an M&A column for Bloomberg News.

Sam Fazeli is senior pharmaceuticals analyst for Bloomberg Intelligence and director of research for EMEA.

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