New vaccine rules for visitors flying into the US kick in on Nov. 8 : Goats and Soda - NPR

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International visitors who fly into the U.S. will have a new set of rules and requirements regarding COVID-19 vaccines, starting Nov. 8. Angus Mordant/Bloomberg via Getty Images

Angus Mordant/Bloomberg via Getty Images

The U.S. has come up with new rules and regulations for travelers flying in from other countries, to take effect on Monday, November 8.

In a nutshell, if you've got a WHO-approved vaccine you're welcome. If not you may find yourself in pandemic limbo — and feeling very frustrated.

"Some parts of the policy are fair and some are burdensome and exclusionary, but overall the revised guidelines are based on clinical and public health evidence," says Dr. Junaid Nabi, a senior researcher in health-care strategy at Harvard Business School.

Here's a rundown of the new protocols for those coming from abroad for a job, to study, to visit family – or to find a new home for humanitarian reasons. We'll also look at obstacles that loom.

Which vaccines are on the OK list

If you've been vaccinated, you'll have to show a digital or paper version of the card along with ID that matches all of your personal information on the vaccine card. But not all versions of the vaccine qualify. Under the new rules, accepted vaccines for travel to the U.S. are limited to those currently on the World Health Organization or U.S. Food and Drug Administration authorized or approved lists. That includes Pfizer-BioNTech, Moderna, Janssen (Johnson & Johnson), AstraZeneca-Oxford and the two Chinese vaccines, Sinopharm and Sinovac.

But it leaves out, for example, the widely used Russian vaccine Sputnik V. India, Mexico, Turkey, Honduras, Iran and the Palestinian territories are among the places that have used the Sputnik vaccine to vaccinate millions. The CDC hasn't said why Sputnik didn't make the cut but WHO raised concerns about the vaccine's manufacturing plant this summer. What's more, an Associated Press report noted that some countries that received the first of Sputnik's two doses had trouble getting all the second doses needed.

Exceptions for the unvaccinated

Much of the world is not vaccinated. According to current information from Our World in Data, 49.4% of the world's population has received at least one dose of a COVID-19 vaccine, but only 3.6% of people in low-income countries have.

For those who aren't vaccinated (or didn't get a vaccine from the approved list), a trip to the U.S. is still possible – but only if they meet one of the conditions for an exception as detailed on lists from the U.S. State Department.

Perhaps the most sweeping exception is for travelers with passports from any country where fewer than 10% of the country's population has been vaccinated. That list willbe regularly updated, according to the State Department. Currently, there are 50 countries on the list, 34 of them in Africa.

Other exceptions for unvaccinated travelers include:

• Persons on diplomatic or official foreign government travel
• Children under 18 years of age
• People who are allergic to the COVID-19 vaccine
• Participants in certain COVID-19 vaccine trials
• Persons issued a humanitarian or emergency exception (such as someone evacuated for medical reasons or accompanying someone who will be getting life-saving treatment in the U.S.)
• Members of the U.S. Armed Forces or their spouses or children (under 18 years of age)
• Sea crew members traveling with to a C-1 and D nonimmigrant visa
• Persons whose entry would be in the national interest, as determined by the Secretary of State, Secretary of Transportation, or Secretary of Homeland Security (or their designees)

The perhaps to-do list for the unvaccinated

But just being on the "exception" list doesn't guarantee easy entry. That's where the "burdensome" and "exclusionary" elements come in, says Nabi.

First of all there's the matter of getting a COVID-19 test before flying to the U.S. Vaccinated foreign travelers have to take a test within three days of their flight, but unvaccinated travelers have to do their testing within a single day of travel with a product that provides results in a timely enough fashion to present at the airport.

"For many countries, COVID testing continues to be limited and inaccessible," says Nabi, "often a result of low resources or ongoing political conflict that makes widespread testing difficult."

And even if tests are available in theory, that doesn't always make it easy to get one.

"People in many low-income countries have to cover so much distance to get to the airport," Nabi says. "They may not have a lab in their home village and won't necessarily have the time to go [for a test] when they get to the airport city or be able to afford the expense." He also notes that it can be a challenge to find a vaccine clinic in an unfamiliar city, noting that travelers from his birthplace, Kashmir, could find it "hard to do if they don't know someone or where to go."

Left unanswered for now is whether the U.S. will raise the current percentage threshold or drop countries from the list when vaccination rates hopefully climb above 10%.

And once you arrive, there are more rules to follow

The new Biden administration rules also address protocols after arrival in the U.S., including more testing, isolating if you do contract COVID-19 and a strong nudge to get the vaccination for people who will be in the country 60 days or longer. Here's a link to everything U.S. citizens and foreigners need to know about what's expected of them in the days after travel to the U.S. from another country.

The CDC does not say how it will enforce these post-arrival rules although the Departments of Transportation and Homeland Security can deny airplane boarding to anyone not in compliance.

As the countdown to the November 8 start date begins, some medical authorities are concerned that the swift timing will add to the confusion felt by potential visitors from overseas.

But at least one public health specialist thinks the new rules could bring a quick public health benefit. Dr. Ifeanyi Nsofor, director of Policy and Advocacy at Nigeria Health Watch says "there are vaccination sites in every state in Nigeria, including rural primary health centers. Anyone who wants to get vaccinated now can walk in. [But] because of vaccine hesitancy few people are."

Many people in Nigeria have family in the U.S. and hope to travel there for holidays, Nsofor says, so he hopes that the new rules could encourage them to overcome any hesitancy or procrastination: "If you want to go, get vaccinated."

Fran Kritz is a health policy reporter based in Washington, D.C., who has contributed to The Washington Post and Kaiser Health News. Find her on Twitter @fkritz

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