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The journal PLOS published a cost-effectiveness analysis on March 11, 2021, using models that are part of the Cancer Intervention and Surveillance Modeling Network (CISNET) to evaluate the cost-effectiveness of extending HPV vaccination in females and males up to ages 30, 35, 40, or 45 years.

This study found HPV vaccination of women and men aged 30 to 45 years provides limited health benefits at the population level, at a substantial cost (HPV vaccine prices).

This sensitivity analysis revealed that assumptions about cervical screening compliance, vaccine costs, and the natural history of noncervical HPV-related cancers could have major impacts on the vaccination strategies' estimated cost-effectiveness.

However, even with the most extreme assumptions, both models almost universally found that the cost-effectiveness of HPV vaccination for adults aged 30 to 45 years was greater than $200,000 per QALY.

'Where possible, we erred in the direction of making assumptions that were favorable to increasing the age of vaccination, including assuming no delay between the reduction in HPV infections from vaccination and the reduction in genital warts,' concluded these researchers.

A nonavalent human papillomavirus vaccine (Gardasil 9) has been licensed for women and men up to age 45 years in the USA. 

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The US Transportation Security Administration (TSA) screened 1,543,115 air travelers on Sunday, March 21, 2021. This data indicates the business day for the TSA in 2021. 

However, this travel volume is about 69% of air travel in 2020 when the TSA screened 2,227,181 people.

Local media sources say this year's Spring Break may be why this increased number of travelers. As an example, the city of Miami announced a curfew to control the vast number of out-of-state visitors. 

"I love that this is a beautiful place, that people come here to gather and enjoy our weather and our beaches," Miami Beach Mayor Dan Gelber said at a press conference when the curfew measures were announced. "But right now, it has become too challenging in the tourism industry to continue that way."

Miami Beach Police Tweeted 'causeways will be closed until 6 AM except to City residents, guests of hotels in the City, and employees of business establishments in the City on March 21st.

While Miami is getting most of the attention during Spring Break, Florida's Gulf Coast beaches are generally ranked as 'the best in the USA.'

The State of Florida government recommends but does not require face coverings for the general public. Several cities, including Miami, have mask requirements, but local governments are barred from assessing fines and penalties for noncompliance.

A Florida statute issued in 2011 says 'No person or persons over 16 years of age shall while wearing any mask, hood, or device whereby any portion of the face is so hidden, concealed, or covered as to conceal the identity of the wearer, enter upon, or be or appear upon any lane, walk, alley, street, road, highway, or another public way in this state.'

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The Municipal Corporation of Greater Mumbai (MCGM) and the Chhatrapati Shivaji Maharaj International Airport (CSMIA) in Mumbai confirmed to Gulf News on March 21, 2021, that a new Standard Operating Procedure was issued by MCGM, which exempts certain air passengers from seven-days’ institutional quarantine.

As an example, passengers from the UAE to India’s financial capital Mumbai will be exempted from mandatory institutional quarantine if they have completed COVID-19 vaccination and fall under certain other categories of flyers.

A spokesperson of the CSMIA stated the exemption process is independently handled at the airport, and the self-declaration form can be availed at BMC exemption counters at the airport.

As of March 22, 2021, there are eleven different COVID-19 vaccines available globally.

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Israel's High Court recently ruled that the person quota for arrivals and limitations on leaving the country for those who have not yet been vaccinated for the SARS-CoV-2 coronavirus is unconstitutional, reported Haaretz on March 17, 2021.

However, all passengers arriving in Israel with a travel itinerary 72 hours or longer must present a negative COVID-19 PCR test result to airline staff. The test must be taken within 72 hours before the scheduled departure to Israel. This requirement applies to people with a vaccination certificate or a certificate of recovery. 

Entry to Israel depends on complying with this requirement, stated the Israeli government on March 21, 2021.

And, all outbound passengers who stay in Israel longer than 72 hours must present airline staff with negative COVID-19 PCR test results taken within 72 hours prior to the due time of departure. This requirement does not apply to people who have Israeli vaccination or recovery certificates.

Foreign nationals who display COVID-19 related symptoms must contact the Emergency Medical Services Hotline at 101 or the Ministry of Health Hotline at *5400 for advice.

Previously, the U.S. CDC issued a Level 4 Travel Alert on February 2, 2021, stating 'Travelers should avoid all travel to Israel, including the West Bank and Gaza, because of the COVID-19 pandemic.'

Furthermore, 'If you get sick with COVID-19 or test positive for the virus that causes COVID-19 while abroad, you might not be permitted to return to the USA until you can end isolation. If you are exposed to someone with COVID-19 during travel, you might be quarantined and not be permitted to return to the USA until your quarantine is lifted,' says the CDC.

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Travel Vaccine Certificates, Passports, Visa

Travel Vaccine Certificates, Passports, Visa, Green Card 2025

Various countries require proof of immunization as a prerequisite for obtaining a visa or entering their territory. Vaccine passports are digital credentials that confirm a person has been vaccinated against particular diseases. The World Health Organization (WHOGlobal Digital Health Certification Network (GDHCN) became effective in Europe on July 1, 2023. The GDHCN's digital capabilities may include verification of vaccinations, the International Patient Summary, verification of vaccination certificates within and across borders, and certification of public health professionals through the WHO Academy. The WHO published the Digital Documentation of Certificates: Vaccination Status and Test Results in 2021 and 2022, respectively.

In 2023, the WHO endorsed the European Union (EU) digital certification system. The EU Digital Certificate has been issued across 51 countries.

U.S. Passport, Security Notices, Health Advisories

The U.S. Department of State publishes information for visa and passport applications, as well as for countries, to help travelers assess their risks. If Americans are overseas and need emergency assistance, they should contact the nearest U.S. embassy or consulate, says the State Department. From Overseas, call +1 202-501-4444. Updated FAQs about U.S. passport and visa operations are on this State Department webpage. In addition, view travel requirements for countries edited by Sherpa. Choose a country on this map to begin your search.

The State Department launched the Bureau of Global Health Security and Diplomacy on August 1, 2023. The Bureau's overarching mission is to fortify the global health security architecture to effectively prevent, detect, control, and respond to infectious diseases, including HIV/AIDS. By leveraging and coordinating U.S. foreign assistance, the Bureau aims to foster robust international cooperation and enhance protection for the United States and the global community against health threats through strengthened systems and policies.

U.S. Transportation Security Administration

The U.S. Transportation Security Administration (TSA) provides a range of customer service resources to support travelers. PreCheck lanes are available at your airport; you can search for them using this link. The TSA has a team dedicated to answering questions related to prohibited and permitted items, identification requirements, and other related topics. AskTSA is available 365 days a year on these social media networks: X (@AskTSA), Facebook Messenger (www.fb.com/AskTSA), Apple Business Chat (AskTSA), and by texting "Travel" to AskTSA (275-872).

On May 6, 2025, the Turkish Directorate General of Civil Aviation issued a statement (UOD-2025/01warning airline passengers that standing up before the plane has come to a complete stop and vaping or smoking on board are prohibited. Turkish Airlines may fine violators around $70 per violation.

A 2023 report from the International Air Transport Association indicates an increase in the rate of reported unruly passenger incidents. Based on over 24,500 incident reports from more than 50 operators globally, there was one incident for every 480 flights in 2023, compared to one incident for every 568 flights in 2022.

U.S. Visa Waiver Program

The U.S. Visa Waiver Program is an international travel facility that allows citizens of select countries to visit the U.S. without requiring a traditional visa. Under this program, a person can stay in the U.S. for a maximum of 90 days. Under this program, even without a visa, there are certain conditions, such as possessing an e-passport and obtaining prior permission online through the Electronic System for Travel Authorization. Visitors must meet all of the requirements to travel to the United States on the VWP.

U.S. Green Card Applications

Effective January 22, 2025, the United States Citizenship and Immigration Services (USCIS) waived the requirement that applicants for adjustment of status to lawful permanent resident present documentation on their Form I-693, Report of Immigration Medical Examination and Vaccination Record, indicating that they received the COVID-19 vaccination. USCIS will not issue any Request for Evidence or Notice of Intent to Deny related to proving a COVID-19 vaccination. USCIS will not deny any adjustment of status application based on the applicant's failure to present documentation showing receipt of the COVID-19 vaccination.

International Certificates of Vaccination or Prophylaxis

The International Certificate of Vaccination or Prophylaxis (ICVP), also known as the yellow card, is required to enter various countries internationally. The WHO published a Country List to identify which countries require an ICVP.

REAL ID Act

All U.S. states, the District of Columbia, and four of five U.S. territories covered by the REAL ID Act and related regulations are issuing REAL ID-compliant licenses and identification cards. In addition, the Department of Homeland Security (DHS) announced in December 2022 its intent to extend the REAL ID full enforcement date by 24 months, from May 3, 2023, to May 7, 2025. The REAL ID Act establishes minimum security standards for state-issued driver's licenses and identification cards. Under the new regulations, beginning May 7, 2025, every traveler 18 years or older will need a REAL ID-compliant license or identification card, a state-issued enhanced license, or another TSA-acceptable form of identification at airport security checkpoints for domestic air travel. 

U.S. Customs and Border Protection

If you are a U.S. citizen planning to travel abroad, you must comply with the document requirements for that country. Each individual arriving in the U.S. must complete the CBP Declaration Form 6059B. Examples and a sample declaration form can be found on the Customs Declaration Form. Additionally, the U.S. Customs and Border Protection (CBP) One app serves as a single portal for mobile applications and services. 

As a result of the Bipartisan Budget Act of 2018, the Electronic System for Travel Authorization (ESTA) travel promotion fee was increased from $10 to $17, in addition to a $4 operation fee. CBP began collecting the new fee amount on May 26, 2022. Individuals with an approved ESTA do not have to reapply, as an ESTA is valid for up to two years. ESTA is an automated system that determines the eligibility of visitors to travel to the United States under the Visa Waiver Program (VWP). Authorization via ESTA does not determine whether a traveler is admissible to the United States. Instead, U.S. CBP officers determine the admissibility of travelers upon their arrival.

Global Entry Program

Global Entry is a U.S. Customs and Border Protection program that allows expedited clearance for pre-approved, low-risk travelers upon arrival in the USA. Members enter through automatic kiosks at select airports. Additionally, the Enrollment on Arrival (EoA) program enables Global Entry applicants who are conditionally approved to complete their interviews upon arrival in the United States. A list of participating EoA airports is posted on this webpage. While Global Entry aims to speed travelers through the process, members may still be selected for further examination when entering the USA.

United Kingdom Electronic Travel Authorization 2025

As of June 2025, the UK Global Health Insurance Card (GHIC) enables UK residents to access necessary state healthcare in the European Economic Area (EEA) and certain other countries on the same basis as a resident of those countries. In 2025, all individuals wishing to travel to and through the United Kingdom, except British and Irish citizens, will be required to obtain an Electronic Travel Authorization (ETA). You can get an ETA instead of a visa if you're coming to the UK for up to six months for tourism, visiting family and friends, or business purposes, or if you're transiting through the UK for up to three months. ETAs for the last two years, enabling you to travel to the UK as often as possible. Prospective travelers should apply for the United Kingdom ETA using this IVISA link. The application costs £10 (about $12.50) to apply. As of 2025, the UK offers information on passport eligibility, fees, and the application process, including renewal and update procedures.

Western Hemisphere Travel Initiative

The Western Hemisphere Travel Initiative (WHTI) is a joint plan between the U.S. Department of State and the Department of Homeland Security to implement the recommendations of the 9/11 Commission and the statutory mandates of the Intelligence Reform and Terrorism Prevention Act of 2004. As a result, U.S. citizens can present a passport, a Passport Trusted Traveler Program card (such as NEXUS or SENTRI), or a U.S. military ID. Military identification card when traveling on official, oral orders; U.S. Merchant Mariner Document when traveling with official maritime business.

Note that children must also present their passports when traveling by air. Lawful permanent residents must continue to carry a valid Permanent Resident Card. A visa is not required. However, the Indian tribal card cannot be used for air travel.

Pet Passport and Tips

An EU Pet Passport is a universal document issued by an official veterinarian in a European Union (EU) Member State or another designated country, containing official health information related to a specific pet. A passport is issued to a dog, cat, or ferret after it has been taken to an EU veterinarian and vaccinated. The purpose of the EU Pet Passport is to simplify travel between the EU Member States. An EU Pet Passport cannot be obtained in the U.S.

On December 14, 2022, the TSA offered tips for traveling with small pets through security checkpoints this holiday season. Furthermore, the USDA has requirements for importing pet dogs from foreign countries. In particular, dogs traveling to the U.S. from countries affected by specific diseases may need additional inspection and/or quarantine. Use this digital menu to determine if your destination State has particular import requirements.

Airline Compensation Policies

Issued by the U.S. on August 29, 2022, a digital dashboard ensures that travelers have access to U.S. airlines' services to mitigate passenger inconveniences when the cause of a cancellation or delay was due to circumstances within the airline's control.

Traveler-based Genomic Surveillance

The CDC's Traveler-based Genomic Surveillance (TGS) program anonymously collects two nasal swab samples from consenting international travelers arriving at U.S. airports. The nasal sampling multipathogen pilot program tests people for Flu A/B, RSV, SARS-CoV-2, and 30 additional priority pathogens. As of September 2023, the TGS program had enrolled more than 360,000 air travelers from more than 135 countries. As of November 6, 2023, Ginkgo Bioworks and XpresCheck will implement the program in selected airports. 

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Vaccine certificates, digital passports and visas are required in 2025
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The International Olympic and Paralympic Games announced on March 20, 2021, Japanese parties had decided not to allow entry into Japan by overseas spectators for the Olympic and Paralympic Games Tokyo 2020.

This decision is due to the ongoing COVID-19 pandemic, said the IOC in a press statement.

“We share the disappointment of all enthusiastic Olympic fans from around the world, and of course the families and friends of the athletes, who were planning to come to the Games,” stated IOC President Thomas Bach.

The 2020 Summer Olympics, officially the XXXII Olympiad Games and known as Tokyo 2020, is a delayed international multi-sport event now scheduled during July and August 2021.

Olympic tickets purchased from the Tokyo 2020 Organising Committee will be refunded. The International Olympic Committee is a not-for-profit, civil, non-governmental, international organization.

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Olympic Games Tokyo 2022 ban overseas spectators 
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The International Air Transport Association (IATA) announced the arrival at London’s Heathrow Airport of the first traveler using the new Travel Pass app to manage their travel health credentials.

Passengers flying with Singapore Airlines to London, England during the trial were able to use IATA Travel Pass to:

  • Create a secure digital version of their passport on their mobile device,
  • Input their flight details to learn of travel restrictions and requirements,
  • Receive verified test results and a confirmation that they meet all travel requirements.

“The successful implementation of IATA Travel Pass in this trial with Singapore Airlines passengers demonstrates that technology can securely, conveniently, and efficiently help travelers and governments to manage travel health credentials, commented Alexandre de Juniac, IATA’s Director General and CEO, in a press statement issued on March 17, 2021.

To gain maximum benefit from IATA Travel Pass and avoid confusion and inconvenience for passengers, the standardization of test or vaccination certifications and their acceptance by authorities is key. A recent IATA poll of travelers announced on March 15, 2021, found that 89% agree with the need for global standards, and 80% are keen to use a mobile app to manage their travel credentials.

JoAnn Tan, Acting Senior Vice President, Marketing Planning, Singapore Airlines, said: “Digital health credentials will be essential as borders reopen and travel restrictions get progressively lifted worldwide."

The IATA's mission is to represent, lead and serve the airline industry.

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The Himalayan country of Nepal's Department of Drug Administration announced on March 19, 2021, India's Bharat Biotech COVID-19 vaccine known as Covaxin has been issued Conditional Emergency Use Authorisation.

Covaxin (BBV152) is an inactivated vaccine that uses adjuvant Alhydroxiquim-II to boost immune response for longer-lasting immunity. The Indian Council of Medical Research created the Covaxin vaccine.

On December 22, 2020, Pennsylvania-based Ocugen, Inc. announced that it had signed a binding letter of intent to co-develop Covaxin for the United States market. 

“We are actively working with U.S. regulatory authorities to develop a plan around Emergency Use Authorization in the United States for COVAXIN™ and are preparing to file an Investigational New Drug application to initiate our first two clinical trials for OCU400 in the second half of this year. Proceeds from our recent registered direct offering provide the financial resources to drive our COVAXIN™ development efforts and ophthalmology pipeline forward,” said Dr. Shankar Musunuri, Chairman, CEO, and Co-Founder of Ocugen, in a press statement issued on March 18, 2021.

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The U.S. Centers for Disease Control and Prevention (CDC) reported on March 19, 2021, 'Between October 2020, and March 13, 2021, FluSurv-NET sites reported 203 laboratory-confirmed influenza hospitalizations for an overall cumulative hospitalization rate of 0.7 per 100,000 population.

The CDC says this 'is much lower than average for this point in the season and lower than rates for any season since routine data collection began in 2005. The current rate is about one-fourth the rate seen at this time during the 2011-12 season.'

Furthermore, (1) influenza-associated pediatric fatalities occurring during the 2020-2021 flu season in the USA have been reported to CDC. This data was a significant improvement from last flu season when 196 influenza-associated pediatric fatalities were confirmed.

The most common flu shot for the 2020-2021 influenza season in the Northern Hemisphere are quadrivalent vaccines that protect people against four viruses; influenza A (H1N1) virus, influenza A (H3N2) virus, and two influenza B viruses, said the CDC.

Most people over 6-months of age are encouraged to get vaccinated every flu season since influenza infections can create severe consequences. 

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