Past Presidents' Council: Letter to The New York Times

Here is the PPC Letter:

To The New York Times,

As past presidents of the American Travel Health Nurses Association (, we write to you with our collective concern that the American press, and your paper in particular, has failed to provide adequate coverage of the yellow fever vaccine shortage. Now in its third year, the continuing lack of this vaccine is impacting travelers, clinicians and communities.

As travel health professionals, we are coping with the consequences of this shortage daily and believe it is a crucial issue in travel health today. There are many obstacles travelers are facing in order to get the vaccine, most travel clinics are no longer able to provide it, and people are traveling to endemic areas unprotected. Now we must include yellow fever in the differential diagnosis if these travelers develop a febrile illness, knowing that the U.S. has competent mosquito vectors that could precipitate local transmission.

The New York Times Company certainly supports international travel. As you are well aware, the company produces your highly popular Sunday Times Travel Section, hosts a yearly travel show at the Jacob Javits Center, and increasingly, sponsors dozens of international tours through its Journeys program. We believe a comprehensive article on the yellow fever shortage and its impact is long overdue. As the winter travel season approaches, we ask that you assign a reporter to alert the public to this shortage and give the ongoing lack of this vaccine the full attention it deserves. Unlike many public health concerns, this one actually has a solution well within our reach, yet this "shortage" persists, putting travelers and communities at risk. We would like to enlist the full support of The New York Times to provide some transparency on all the aspects of this issue - including the financial forces at play.

Yellow fever vaccine is the only WHO "required" vaccine; countries in the so-called Yellow Fever Belt of tropical South America and Sub-Sahara Africa may require immunization documentation before persons may enter their borders. In addition, there are other countries where the vaccine is not required for transit but where there is a real risk for contracting the potentially fatal yellow fever hemorrhagic illness. Here in the United States, clinics designated by their state health departments are the only approved providers of this vaccine; only clinicians at these "yellow fever sites" are permitted to order and administer the vaccine and to issue the official ICVP, International Certification of Vaccination and Prophylaxis document, also commonly referred to as the "yellow card".

Sanofi, the only U.S. producer of YF 17D vaccine, labelled YF-vax in this country, ceased production at their Pennsylvania facility in 2016. Since that time international travelers to yellow fever regions have been significantly challenged to obtain this necessary immunization. An alternative YF 17D vaccine, Stamaril, also produced by Sanofi in France and used safely for years elsewhere, has had limited availability as a designated investigational vaccine in this country.

This shortage raises many questions. We hope The New York Times will soon address these and other elements of this important issue:

  1. Impact on leisure travelers and travelers visiting friends and relatives (VFR travelers)
  2. Failure of the FDA to approve Stamaril as a licensed (not investigational) alternative as they quickly did with the two Meningitis B vaccines Bexsero® and Trumenba®
  3. Paucity of Stamaril sites around the country
  4. Burden of clinician paperwork required to administer Stamaril as an investigational vaccine
  5. Burden of "double billing" for patients who receive some pre-travel care at a travel clinic or primary care site and then must pay a second consultation fee when referred to a site that offers Stamaril
  6. Lack of state and federal public health service announcements to alert the public to shortage
  7. Lack of state and federal public health communications to providers as this shortage continues with no end date
  8. Burden on travelers to locate clinics with vaccine supply
  9. Lack of vaccine means some travelers go to regions unvaccinated where the yellow fever immunization is only recommended for protection, but not required, so these travelers are at risk for contracting the disease
  10. Impact on clinicians who specialize in travel medicine but now cannot provide this important required vaccine
  11. The risk of potential local transmission in the U.S. after being essentially free of yellow fever since the turn of the last century.
    The New York Times has set the standard for decades for revealing the truth to the public. We hope you will join us in this public health effort and explore this matter in detail to affect positive change once again.

The Past Presidents' Council, American Travel Health Nurses Association

Charlotte Katzin, RN, BSN, FATHNA
Austin, TX

Julie Richards, RN, MS, MSN, FNP-BC, WHNP-BC, FATHNA
Menlo Park, CA

Elaine Rosenblatt, RN, MSN, FNP-BC, FATHNA
Madison, WI

Briarcliff Manor, NY

Sandy Weinberg, RN, BSN, MA, FATHNA
Bethel, CT

November 12, 2019