Imagine a future when a single document determines whether you work, play or travel.
This scenario – a system of ‘immunity certification’ granting privileges to those vaccinated against the COVID-19 virus is now being considered by a growing number of global companies and governments, who are eager to control the disease and also the to recover economy.
The debate comes at a time when millions of people are slowly but surely being vaccinated and are anxious to return to their pre-pandemic lives. Yet millions more are forced to wait.
People start asking, ‘Why should I be restricted if I do not pose a risk to other people? “” Said David Studdert, a professor of medicine and law at Stanford University. “Somehow ‘immunity certification’ seems to be coming our way.”
Although the World Health Organization and US Centers for Disease Control and Prevention are unlikely to adopt such a strategy, others are already adopting it.
Next month, the National Football League invites 7,500 special guests to the Super Bowl: health workers who can prove they received two doses of COVID-19 vaccine.
Overseas, the European Commission (WHO) wants to facilitate safe travel within its borders by creating vaccination certificates. Although initially used only for medical care – to help travelers who are disadvantaged with vaccines, there are likely to be other applications in the future, according to the Commission’s report on 19 January.
“As more people are vaccinated, the documentation and mutual recognition of vaccination becomes of utmost importance,” the report concluded.
The countries of Cyprus, Romania and Seychelles already allow vaccinated visitors to skip the countries’ quarantine and test requirements. In Chile, citizens who have recovered from COVID-19 – which are given antibodies that give them a natural form of immunity – have been ‘certified’.
The concept is also gaining momentum in the hard-hit aviation and shipping industry. Last week, British cruise operator Saga Cruises announced that all passengers should be fully protected when resuming sailing in May. Australian Qantas Airways says it is considering requiring international travelers to be vaccinated before boarding the company’s plane.
According to a major new survey published last week, Americans are deeply divided over such a strategy.
The research, conducted by Studdert and Mark Hall of Wake Forest University, found that those who support or oppose so-called ‘immunity privileges’ have nearly 50-50 divisions. And opinions did not follow the normal political contours; liberals and conservatives took both sides.
In some ways, a COVID-19 certificate is not entirely different from today’s yellow fever card, proving that the vaccine against that deadly virus is coming in countries where the disease is still raging.
And evidence of vaccination against other pathogens, such as TB and influenza, is already mandatory in certain professions, such as healthcare. In California, children must be vaccinated against childhood diseases to go to school.
But it’s been more than a century since America restricted basic freedoms based on someone’s antibody status. The last time this strategy was used was during the 19th century, when immunity to yellow fever divided New Orleans residents and determined who you could marry or where you could work. That experiment exacerbated cultural inequalities and tore up the city’s social structure.
There are practical problems and ethical objections to immunity certificates, said Natalie Kofler, founder of the global initiative Editing Nature and advisor to the Scientific Citizenship Initiative, Harvard Medical School in Boston.
For one, no one still knows if vaccination transmission occurs, especially among people without symptoms, she said. And there is unfair access; the rich and the powerful are more likely to get a vaccine than the poor and defenseless. The restriction of work, concerts, museums, religious services, restaurants or political polling stations only for those who are vaccinated can be denied by many people.
There are other challenges, experts say. Would a certificate allow all vaccines, including those not FDA-approved but manufactured in China and Russia? What about people who only get one dose? If someone could not be vaccinated because of the risk of rare but real side effects, would they experience discrimination? What about the 5% of people who are vaccinated but not protected?
“Over time, it is likely that a vaccine certification can be scientifically robust, as well as ethically permissible,” Kofler said. “But we are not there yet.”
Before a COVID-19 vaccination certificate can become mandatory for worldwide travel, it must be part of the World Health Organization’s International Health Regulations.
The WTO has for the time being discouraged the issuance of such certificates by saying that their validity cannot be guaranteed and that it can exclude the poorer countries. But it is the design of an international digital vaccination card that will provide a framework for countries, with strict standards.
The U.S. Centers for Disease Control and Prevention is already issuing a card to Americans vaccinated against COVID-19 to verify the date and type of vaccination. But experts say it is unlikely to pursue any strategy that requires the use of the card, but rather to oversee and regulate the fairness or accuracy of this approach.
In preparation, some companies are developing technologies that enable individuals recovering or being vaccinated to verify their status.
The International Air Transport Association is building a digital passport called Travel Pass, a mobile app that contains a traveler’s COVID-19 health status.
Two tech giants – IBM and Salesforce – are designing a blockchain-powered smartphone application called IBM Digital Hall Pass, which can customize businesses and venues needed for access, such as COVID-19 test results, temperature controls and vaccination records.
“Now, as testing widens and vaccine distribution progresses, our organizations will help verify vaccine status and any other relevant health evidence,” said Paul Roma, general manager of IBM Watson Health.
In addition, a large coalition called the Vaccination Credential Initiative is creating an encrypted health card called CommonPass, which can be stored in any digital wallet or paper QR code. Its members include Microsoft, Oracle, the Mayo Clinic and the two largest electronic medical record companies, Cerner and Epic
To coordinate these many efforts, the Linux Foundation is working to help develop a set of universal standards for vaccine applications.
Can such an instrument become a part of everyday life and allow people to find work, classroom, concert hall, stadium or movie theater again?
According to Studdert and Hall, it is still too early because so few people have been vaccinated. But as the numbers climb, it can be inevitable.
“It’s a logical and expected way to act,” Hall said. ‘The question is: Let’s we roll things over? Or help us steer the course? ”