their home country. in this case, some countries have the jurisdiction to prosecute their citizen once they have returned home, or in extreme cases extraterritorially arrest and prosecute. in ireland, especially, in the 1980s-90s there were cases of young rape victims who were banned from traveling to europe to get legal abortions. ultimately, ireland's supreme court overturned the ban; they and many other countries have since created "right to travel" amendments. ethical issues there can be major ethical issues around medical tourism. for example, the illegal purchase of organs and tissues for transplantation had been methodically documented and studied in countries such as china, pakistan, colombia and the philippines. the declaration of istanbul distinguishes between ethically problematic "transplant tourism" and "travel for transplantation". medical tourism may raise broader ethical issues for the countries in which it is promoted. for example, in india, some argue that a "policy of "medical tourism for the classes and health missions for the masses" will lead to a deepening of the inequities" already embedded in the health care system. in thailand, in 2008 it was stated that, "doctors in thailand have become so busy with foreigners that thai patients are having trouble getting care". medical tourism centered on new technologies, such as stem cell treatments, is often criticized on grounds of fraud, blatant lack of scientific rationale and patient safety. however, when pioneering advanced technologies, such as providing "unproven" therapies to patients outside of regular clinical trials, it is often challenging to differentiate between acceptable medical innovation and unacceptable patient exploitation. medical volunteerism as tourism the field of the medical tourism (referring to volunteers who travel overseas to deliver medical care) has recently attracted negative criticism when compared to the alternative notion of sustainable capacities, i.e., work done in the context of long-term, locally-run, and foreign-supported infrastructures. a preponderance of this criticism appears largely in scientific and peer-reviewed literature. recently, media outlets with more general readerships have published such criticisms as well. employer-sponsored health care in the us some us employers have begun exploring medical travel programs as a way to cut employee health care costs. such proposals have raised stormy debates between employers and trade unions representing workers, with one union stating that it deplored the "shocking new approach" of offering employees overseas treatment in return for a share of the company's savings. the unions also raise the issues of legal liability should something go wrong, and potential job losses in the us health care industry if treatment is outsourced. employers may offer incentives such as paying for air travel and waiving out-of-pocket expenses for care outside of the us. for example, in january 2008, hannaford bros., a supermarket chain based in maine, began paying the entire medical bill for employees to travel to singapore for hip and knee replacements, including travel for the patient and companion. medical travel packages can integrate with all types of health insurance, including limited benefit plans, preferred provider organizations and high deductible health plans. in 2000, blue shield of california began the united states' first cross-border health plan. patients in california could travel to one of the three certified hospitals in mexico for treatment under california blue shield. in 2007, a subsidiary of bluecross blueshield of south carolina, companion global healthcare, teamed up with hospitals in thailand, singapore, turkey, ireland, costa rica and india. a 2008 article in fast company discusses the globalization of healthcare and describes how various players in the us healthcare market have begun to explore it. impact of covid-19 on medical tourism the growth of global medical tourism in the last decade has influenced overall growth of health care sector. due to the multidimensional impact of the pandemic covid-19 in the form of a global healthcare crisis, falling global economy, restricted international travel, the medical tourism industry is undergoing a substantial decline. the cdc has listed various levels of different destinations or countries that are ranked from 1 to 3, with 1 and 2 considered safe to travel. a destination ranked level-3 is considered a warning not to travel to that area. according to the latest imtj global medical travel and tourism, it is expected that medical tourism industry will be affected until 2021. covid-19 vaccine tourism in the later half of february 2021, it was reported that wealthy and influential people from canada and european countries flew to the united arab emirates to secure early access to the covid-19 vaccine. the uae has been promoting dubai as a vaccine holiday hub for the wealthy, who can pay large sums of money to get inoculated before they become eligible. in january 2021, canadian snowbirds travelled to the united states (specifically florida and arizona) via air charter for quicker access to the covid-19 vaccine. destinations south africa south africa is the first country in africa to emerge as a medical tourism destination. tunisia on the african scale, tunisia ranks second in the field of health tourism. it is also named the world's second best thalassotherapy destination, behind france. jordan jordan, through their private hospitals association, attracted 250,000 international patients accompanied by more than 500,000 companions in 2012, with total revenues exceeding 1b us$. jordan won the medical destination of the year award in 2014 in the imtj medical travel awards. israel