Like billions of people around the world, lockdowns throughout the pandemic caused Courtney Shay deep frustration. The American expat who has lived in Istanbul for nearly nine years wasn’t only exasperated by indefinite timelines or feeling trapped at home — it was the incoming tourists, too.

By April 2021, all of her friends and family in the United States were getting vaccinated while she continued to deal with curfews and restrictions, waiting for her own shot. Unable to fly or drive out of town, Shay watched tourists stroll the city, sightseeing.

“Imagine yourself not vaccinated and random people from out of the country are coming to your street and eating and being tourists as you’re literally inside watching them from the window,” Shay said.

That sentiment may be echoed on a global scale. While at least 171.3 million people have received one or both doses of the vaccine in the United States, only about 6 percent of the world’s population has been fully vaccinated, leaving billions waiting for doses.

Since the Centers for Disease Control and Prevention said fully vaccinated people can travel with less risk, and coronavirus cases and deaths continue to decline, many are ready to make up for lost time and begin taking trips again. Hoping to capture those tourist dollars, more countries are opening their doors to vaccinated travelers — even if their own populations are being inoculated at a slower pace.

Those open borders are a signal to some to visit ASAP. But is it fair, or safe, to travel to places where locals remain mostly unvaccinated? We asked health experts, bioethicists, travelers and locals to share their perspectives.

The traveler’s dilemma: “I would love to go and help out these local economies.”

Alex Howard is fully vaccinated, loves to travel and hasn’t seen his family members in Nicaragua for more than two years. But as the D.C. graduate student and communications professional thinks about traveling again, his ideas don’t venture beyond the United States — maybe a drive to a cabin with other vaccinated people rather than a flight to another country where large swaths of the population haven’t had access to the shot yet.

Howard, 30, understands that many countries are dependent on tourism.

“I would love to go and help out these local economies,” he said. “But at the same time, the risks outweigh the rewards in my mind.”

He is concerned about encountering variants of the virus that are more prevalent in other countries. Also part of his reasoning: We’re still figuring out how vaccinated people transmit covid-19.

“It’s both for my personal care but also for the care of other folks who might not be vaccinated,” he said.

An ethics author’s insight: “It’s hard to justify.”

Arthur L. Caplan, the Drs. William F. and Virginia Connolly Mitty Professor of Bioethics in the department of population health at New York University Langone Medical Center and author of the book “Vaccination Ethics and Policy,” said Howard’s concerns are valid.

Caplan doesn’t believe tourism revenue is impactful enough to offset the threat of variants derailing global pandemic progress or the risk of harming local communities.

“Tourism doesn’t seem to be contributing much, it’s doing a little bit for the maid, a little bit to the restaurant, but it’s not the kind of systematic rebuilding of infrastructure or economy,” he said. “I know locals are grateful sometimes that they’re doing it, but given the minor impact, it’s hard to justify.”

An infectious-disease expert’s take: “There is some uncertainty.”

Henry Wu, an associate professor of infectious diseases at Emory University School of Medicine and director of Emory TravelWell Center, also supports Howard’s concerns. He said travelers should consider their own safety, that of the place they’re visiting and their community when they return home.

“We don’t know how well these vaccines necessarily work against some of these newer variants, particularly some of the ones overseas,” Wu said. “There is some uncertainty even though we think they are quite effective here in the U.S.”

He cautioned that travelers should find out how the country they want to visit is coping with the pandemic and be especially cautious if the area is struggling.

“Even if you’re well protected against covid, their infrastructure is a bit overwhelmed right now,” he said. “You’d add a potential burden to that if you were to get sick or injured for other reasons.”

Wu said he would advise potential travelers that going to faraway places now is more complicated, so they should make sure a trip was worth the trouble and risk.

“My personal opinion is I still think we’re in a situation where even if you’re vaccinated, your threshold should be higher to travel,” he said.

A local tour guide’s point of view: “If the travel industry comes back fast, our economy is going to recover much faster.”

For Oli Esquivel — a Costa Rican tour guide who has been working in travel since 2000 with international companies like Contiki — the return of tourism outweighs the risks to locals awaiting vaccination.

In 2019, Costa Rica attracted more than 3 million international visitors — more than half of its population. When the pandemic shut down the country and prevented tourists from traveling to the Central American paradise, Costa Rica’s unemployment skyrocketed.

“We understand that the economy will go back to normal, probably fairly slowly,” he says. “But if the travel industry comes back fast, our economy is going to recover much faster.”

From a global tourism executive: “You can provide opportunity for the locals to have some sort of source of income.”

According to research from the World Travel and Tourism Council (WTTC), 1 in 4 jobs before the pandemic were tied to travel and tourism or its impact. Last year, 62 million travel and tourism jobs were lost. And more than 100 million more are missing thanks to pandemic adjustments such as furlough plans, said WTTC chief executive Gloria Guevara, who says vaccinated travelers should visit unvaccinated destinations.

“There are people right now that cannot put food on their table, that cannot provide for their families,” Guevara said. “You can provide opportunity for the locals to have some sort of source of income for them to survive … If you just decide not to go to those destinations because they haven’t been vaccinated, you are actually penalizing them because you are not providing the income that they need to survive.”

Should international mobility continue to improve, Guevara says, WTTC forecasts estimate that millions of tourism jobs can be recovered, impacting more than just those working directly in the travel industry.

“Tourism has an endless chain of benefits when it’s fully operating, from the person that sells coffee and souvenirs, tour guides, transporters, restaurants, hotels — it’s endless,” Esquivel, 41, said.

Esquivel welcomes tourists regardless of their vaccination status.

“If people are ready to travel, it’s not their fault that we’re rolling out the vaccination slowly,” he said. “We’re welcoming them here, and the fact that they’re vaccinated is going to make them feel much better.”

An epidemiologist’s warning: “Be cognizant that other places are struggling.”

Saskia Popescu, an infectious-disease epidemiologist and infection preventionist at the University of Arizona and George Mason University, says there is no magic number of vaccinations in a community to look for when thinking about what destinations are best to visit. Instead, travelers should examine the guidance that authorities are giving to locals. Those will reflect vaccinations but also community case counts, she said.

“When you’re thinking about traveling, think about where you’re going and what public health mandates they still might have in place because of the covid numbers or the vaccination rates,” she said. “Regardless of your vaccination status — that’s your comfort and that’s a really important thing — you need to be mindful of where you’re going and what they might require you to do still.”

Popescu said she wants people to get vaccinated and enjoy more flexibility. But she also doesn’t want Americans to forget — especially as they’re considering traveling outside the country — that they’re in a position that much of the world envies.

“Be cognizant that other places are struggling,” she said.

A bioethics expert’s thinking: “Are we exploiting those vulnerabilities or are we doing people a favor?”

Nancy S. Jecker, a professor of bioethics and humanities at the University of Washington School of Medicine, said vaccinated travelers can defer to their best judgment — not every scenario comes with the same ethical dilemmas.

For example, if you’re going from a low-risk area to a low-risk vacation destination, the stakes aren’t as high as traveling from a high-risk area to a vulnerable area. No matter where you’re traveling, Jecker said, following coronavirus precautions is the ethical thing to do.

A bigger concern for Jecker is the structural inequalities the pandemic has amplified. While the fortunate could protect themselves by staying home and working remotely, others — at home and abroad — have been forced to work in jobs that come with much higher coronavirus risks.

“They have to go to work to clean a hotel room, to cook for a restaurant, and they have to do that in a sense that they can’t feed their family otherwise,” Jecker says. “Are we exploiting those vulnerabilities or are we doing people a favor because we’re helping them put food on the table in the sense that we’re creating revenue for the people in the tourist industry and the communities that cater to them?”

How do we decide?

Popescu said we’ll be dealing with the issue of vaccination disparity for the foreseeable future.

“Until you have worldwide access and adequate distribution of vaccines, then it’s going to inherently create inequity,” Popescu said.

For those grappling with the question of where to travel, Guevara said, travelers should do their homework before choosing somewhere to visit, learn about a destination’s coronavirus response and rules not only countrywide, but by specific regions. Buy travel insurance, then pay attention to spikes in cases and whether a place is battling new variants before leaving for your trip.

Take a local’s position into account as you decide. Even after her months of frustration, Shay still understands the tourist perspective in Turkey, despite the country’s local coronavirus challenges.

“I actually do get if someone needs a trip, because we’re all going crazy,” she said. “I’m trying not to blame people. But still, let’s be smart.”

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