Traveler’s guide to vaccine-maxing
18 Apr 2024This guide is for a mainly US (possibly Canadian) audience who travels to much less developed countries in (generally) Africa, Asia, and South America and wants to save thousands of dollars by getting their travel vaccines at Costco’s Pharmacy.
You should start thinking about this at least a month (maybe two) before you leave. Time gives you the option to use the much cheaper Costco instead of a last-minute travel clinic that will charge you 10x. If you’re planning to travel many many months in advance your primary care physician could also help you get these shots closer to Costco’s pricing.
Updated September 2024
🧑⚕️ This guide’s whole point is to encourage you to work with the medical staff at Safegard to create a customized plan for your own travel needs. You should take their advice over anything I say here — this guide isn’t medical advice I’m just some internet person with a vaccination hobby!
🗺️ Some travelers have had success getting vaccinated in their destination countries (J got a full rabies set for <$5 by getting bit by a dog in India!). I don’t think this is a good plan A — it doesn’t sound very fun to spend days of my life navigating an unfamiliar medical system that may have lower standards for transporting, storing, and administering death-preventing care.
At the same time, if you have some hack to do this stuff for much cheaper in a super developed country, email me and I’ll add that here!
See you at Costco!
How to quickly/cheaply get vaccine-maxed with Costco
Available in Alabama, Alaska, Arizona, California, Colorado, Delaware, Florida, Hawaii, Idaho, Illinois, Maryland, Montana, Nevada, New Jersey, New Mexico, Oklahoma, Oregon, Pennsylvania, Texas, Virginia, Washington & Wisconsin.
Not available in NYC but Bayonne NJ Costco (where we got the shots) is a ~35 minute Uber from midtown).
Step 1: Safegard
Buy a virtual consolation from Costco’s Safegard partner for $40. Fill out a questionnaire about your vaccination history and all the places you’re planning to travel (I was very liberal in sharing where I might go in the next five years) and they prescribe you the vaccinations and other travel pills appropriate for those locations.
I got the vaccines listed below by sharing that I was planning to travel to: Brazil (Amazon rain forest), India, Indonesia, Kenya, Nigeria, Philippines, Tanzania (Mt. Kilimanjaro) for over a month each.
On the form you list the Costco you want to get the vaccines at. You can call the Costco pharmacy and they can transfer it to another Costco (maybe somewhere else too..?)
Step 2: Coordinate with Costco’s Pharmacy
Safegard ~faxes Costco’s pharmacy your Safegard form and their recommendations. Their pharmacist will call you a few days later to figre out which of Safegard’s recommendations you want to receive. If you give them your insurance info they should be able to tell you your out of pocket cost for each vaccine. All of this stuff should also be HSA eligible (ask). All of the vaccines are special order from a wholesaler so they’ll schedule you for an appointment a few days or even a week later.
Step 3: Get vaxxed
Pretty self explanatory. Some vaccines require multiple doses spread 1-3 weeks apart. They’ll typically only give you ~five? shots at a time. The pharmacists are all very friendly and good at doing the shot thing but they didn’t know much about the diseases since they’re not really found in the US.
Vaccinations to consider
I got all of these. I have weird last minute travel habits and didn’t want to think about this very often.
Your recommendations could include a bunch of other vaccines if you aren’t current on the standard recommendations. You should probably get those whether or not you’re going to travel…
Typhoid (Vivotif)
Highly contagious bacterial infection from contaminated food or water. Particuarly common in South Asia (Pakistan, India, Bangladesh), Africa, and Latin America.
| Amount I recommend | Get it. |
|---|---|
| How long does it last? | Pill: 5 years Shot: 2-3 years |
| How much at Costco? | $110 before insurance - $0 with |
| How much at other clinics? | ~100 |
| Covered by insurance? | Not by mine |
| How painful / annoying is it to get vaxxed? | One shot or four pills taken over a week |
Yellow fever
This is the (probably along with possibly Cholera) the only one you’ll ever be asked to show proof of having to enter a country (especially in Africa).
The disease itself is pretty bad and super common in Africa and South America.
| Amount I recommend | Get it. |
|---|---|
| How long does it last? | Lifetime |
| How much at Costco? | $182 |
| How much at other clinics? | $150 - $350 |
| Covered by insurance? | Not by mine |
| How painful / annoying is it to get vaxxed? | One shot |
DPT / Tdap (Diphtheria, Pertussis (whooping cough), and Tetanus) Booster (Boostrix)
This will probably be a booster for you — most people get those every ~10 years or after a big cut / burn. One shot, three pretty bad diseases. Tetanus is everywhere in the world if you get a contaminated wound.
| Amount I recommend | Boost if needed |
|---|---|
| How long does protection last? | 10 years |
| How much at Costco? | $60 before insurance — $0 with |
| How much at other clinics? | $40 - $100+ |
| Covered by insurance? | Mine covered 100% |
| How painful / annoying is it to get vaxxed? | One shot |
ACWY Bacterial Meningitis (Manquadfi)
This will probably be a booster for you — most people get those every ~5 years.
This is a hard-to-diagnose brain infection that kills 10%-15% of people infected in 24-36 hours after infection. Another 20% lose their hearing, lose a limb, or have brain damage.
| Amount I recommend | Probably should boost - especially if going to Africa |
|---|---|
| How long does it last? | Lifetime — high risk people boost every ~5 years |
| How much at Costco? | $200 before insurance - $0 with |
| How much at other clinics? | $150 - $250++ |
| Covered by insurance? | Mine covered 100% |
| How painful / annoying is it to get vaxxed? | One shot |
Japanese Encephalitis (JE)
This is an incurable virus that kills up to 30% of the people it infects and leaves most survivors with brain damage.
Everyone in East Asia / Australia gets this as a kid and you probably should to if you’re going to these places.
| Amount I recommend | Get it if you’re going to East / Southeast Asia — especially rural areas. |
|---|---|
| How long does it last? | Lifetime - high risk people boost every ~10 years |
| How much at Costco? | $620 |
| How much at other clinics? | $400 - $1,000 |
| Covered by insurance? | Not by mine |
| How painful / annoying is it to get vaxxed? | Two small shots given 7-28 days apart. |
Polio Booster
This will pretty much certainly be a booster for you.
Polio is almost exterminated (only endemic in Afgahnastan, Pakistan; occasionally found in some South East African countries) but it also can paralyze you.
| Amount I recommend | Not strictly necessary but why not |
|---|---|
| How long does it last? | Lifetime |
| How much at Costco? | ~$50 before insurance - $0 after |
| How much at other clinics? | $50 - $100 |
| Covered by insurance? | Mine covered 100% |
| How painful / annoying is it to get vaxxed? | One shot |
Rabies (Rabavert)
This is by far the most expensive and annoying one. Three expensive doses, each a few weeks apart. Rabies is pretty horrible though (once you have symptoms you are going to die) and you need the shots ASAP if you’re ever bitten by a mammal and don’t know 100% it doesn’t have Rabies. It can be extremely hard to get this even in the US and there are horror stories of people spending >$10k to get this in major US metros. Typical pre-exposure dose is two shots for ~5 years of protection or three shots for lifetime protection.
I’ve almost been bitten by a dog while traveling a few times and have two friends who have been bitten.
| Amount I recommend | Depends on your tolerance for getting a bunch of shots… You should probably get this if you’re going somewhere really remote with animals or like to pet third world floofs. |
|---|---|
| How long does protection last? | Lifetime if 3 doses |
| How much at Costco? | $390 x 3 = $1,170 |
| How much at other clinics? | $1,200 - $5,000 for all three doses |
| Covered by insurance? | Not by mine as prevention |
| How painful / annoying is it to get vaxxed? | 3 (very high volume) shots over the course of 3 weeks |
Cholera (Vaxchora)
This is a bacterial infection from contaminated water. It’s usually treatable but is like super extreme food poisoning.
The vaccine in the US (Vaxchora) is kind of weird. It’s a drink, and it wears off after about 90 days. I got this right before going to India for a month, but I don’t think I’ll get it again.
| Amount I recommend | Only if you’re about to travel to a super high risk area. |
|---|---|
| How long does it last? | 90 days |
| How much at Costco? | $275 |
| How much at other clinics? | $315 ++ |
| Covered by insurance? | Not by mine |
| How painful / annoying is it to get vaxxed? | One easy drink |
Travel pills to consider
Traveler’s diarrhea (Azithromycin)
If you didn’t grow up or take extremely long trips to the developing world, your gut will fail you at some point. This antibiotic will help you quickly recover and keep going.
| Amount I recommend | Get it |
|---|---|
| Dose schedule | Daily for 1-3 days depending on severity |
| How much at Costco? | Maybe $1 / pill? |
| How much at other clinics? | $0.70 - $4.00 / pill before insurance |
| Covered by insurance? | Not by mine |
Altitude sickness (Diamox)
If you’re planning to do strenuous activity above ~8,000 feet (and definitely above 11,000 feet) Diamox has been shown to reduce altitude sickness by ~50% by helping your body breathe faster/deeper and get the oxygen it needs. This is particularly helpful if you don’t have a ton of time to acclimate.
| Amount I recommend | Useful if you’re going above 8,000 feet to hike / work hard. Especially important if you don’t have much time to acclimate. |
|---|---|
| Dose schedule | 2x daily for 1-2 days before ascending and for 2-3 days after reaching peak elevation |
| How much at Costco? | ~$1.50 / pill |
| How much at other clinics? | $1.40 - $2.20 / pill before insurance |
| Covered by insurance? | Not by mine |
Malaria (Doxycycline, Malarone, or Mefloquine)
Malaria is horrible but the prophylaxis for Malaria can also have strong side effects.
Research the places you’ll be going and the activities you’ll be doing— cities are usually better, mosquitos usually don’t live above 6,000 feet elevation, and Malaria doesn’t typically spread below 68 degrees Fahrenheit.
All Malaria prophylaxis seem to require continued dosing for at least a week after leaving the Malaria area. This can make it hard to use these for shorter trips.
There are three major options available to prevent Malaria:
Malarone (Atovaquone/Proguanil) - my prophylaxis of choice
Malarone generally has the fewest side effects — especially when taken with a large meal. I have taken ~50 doses of Malarone and have only ever had a bit of nausea when I took it on an empty stomach.
| Dose schedule | Daily starting 1-2 days before entering the Malaria area. Take for 7 days after leaving the Malaria area. |
|---|---|
| Side effects | Generally well-tolerated. It may cause nausea, vomiting, and abdominal pain. Take with milk |
| How much at Costco? | ~$110 / month before insurance |
| How much at other clinics? | ~$270 / month before insurance |
| Covered by insurance? | Mine covered enough for up to a 30-day trip. |
Doxycycline - cheaper but longer end-of-trip dose requirement
I haven’t taken this, but it seems fairly similar to Malarone. If you need to refill a prescription while abroad Doxycycline is generally much more available.
- Not for children <8 or pregnancy
| Dose schedule | Daily starting 1-2 days before entering Malaria area. Take for 28 days after leaving the Malaria area. |
|---|---|
| Side effects | Sun sensitivity, gastrointestinal upset, yeast infections |
| How much at Costco? | Unsure |
| How much at other clinics? | $120 - $180 / month before insurance |
| Covered by insurance? | Mine covered enough for up to a 30-day trip. |
Mefloquine - not recommended
Some Southeast Asian strains of Malaria are resistant to Mefloquine, and it anecdotally has the worst side effects.
The major benefit is that you only need to take this once per week, so if you’re really bad at remembering to take medication, this might be a good option.
- Safe for pregnancy
- Not for those with psychiatric/seizure disorders.
| Dose schedule | Weekly starting 2-3 weeks before entering the Malaria area. Continue for 4 weeks after leaving the Malaria area. |
|---|---|
| Side effects | Higher risk of neuropsychiatric side effects like anxiety, depression, and vivid dreams |
| How much at Costco? | Unsure |
| How much at other clinics? | $110 / month before insurance |
| Covered by insurance? | Mine covered enough for up to a 30-day trip. |