More than 448 million doses of coronavirus vaccines have been administered worldwide, and in some countries, immunization campaigns can resume people’s quasi-normal lives. In Israel, where 50 percent of the population is immunized, residents can show a ‘green pass’ – proof that they have been vaccinated – to enter restaurants, theaters and gyms. Both the European Union and China recently announced their own versions of vaccination cards. Although vaccination certificates enable holders to enter businesses within a country, governments also hope to use them to regulate international travel and borders.
But in a large part of the world, coronavirus vaccines are in short supply and in some cases completely unavailable. As governments, mainly in rich countries, seek to use vaccine passports to ease restrictions, they run the risk of relying on a fragmented system that could adversely affect the pandemic.
In addition to advancing vaccines in Europe and China, the World Economic Forum is working with a group called the Commons Project on a system for documenting coronavirus vaccinations. IBM is developing a Digital Health Pass, and the International Air Transport Association, a trade association for the airline industry, is developing a smartphone app that provides passengers with information on testing and vaccination requirements.
The obligation of vaccine passports for international travel presents several challenges. International law allows countries to prove to visitors that they have been vaccinated against diseases such as yellow fever. But coronavirus vaccines are new and not all of them are allowed around the world.
Countries may decide to accept only evidence of vaccines approved within their borders. China has already said that its vaccine passport may only allow foreigners if they have received a Chinese vaccine. None of the vaccines currently available in the United States are manufactured by a Chinese company. The Oxford-AstraZeneca vaccine is used in 86 countries, but it is not approved for use in the United States. And vaccines administered in some countries may not be effective against new variants found domestically or abroad.
These issues need to be addressed worldwide, and governments should take the opportunity to address these issues at the World Health Organization’s World Health Assembly meeting in May.
Vaccination passport systems must make clear which shots are accepted, and they must be equipped to update the immunization requirements when public health guidelines change. These systems should also prevent countries from arbitrarily refusing to accept certificates. Without international consensus, we risk hedging geopolitical divisions with conflicting requirements that could prolong the pandemic. Vaccination passports that enable citizens of some countries to travel internationally while millions of others await vaccinations will only deepen the world’s inequalities.
The United States has not announced plans for a vaccine passport. Vaccinated Americans receive a card with the date and type of shot they received, but the cards are not used as passes and can be easily forged. And an American plan will raise a number of issues. First, the explosion of vaccines in the United States has been plagued by inequality: black and Latino people are being vaccinated at much lower prices than white people. Second, not everyone can be vaccinated: the shots are not approved for children, and information on the safety of vaccinations during pregnancy is limited. Vaccinations should have a mechanism to ensure that people who do not get the chance are not denied jobs, services or education.
Evidence of vaccination by employers and businesses poses not only ethical and legal obstacles, but also logistical challenges regarding the collection, storage, verification and protection of the data. Businesses that need vaccinations for customers or employees need systems for reviewing vaccine passports, which can cause a significant financial burden for struggling businesses. While schools and healthcare providers have long required and detected certain vaccinations, many companies have never needed them to meet the vaccine requirements.
If vaccine passports are in the form of a smartphone application, some people may not be able to use them. And of course, since a vaccine passport records private health data, failure to protect this information would create a high risk of fraud, forgery, discrimination and invasion of privacy.
People around the world are eager to end the pandemic, and those who are vaccinated are understandably eager to take advantage of the freedom that immunization promises. But every step in establishing vaccine passports must be internationally coordinated and must be accompanied by global and equitable access to vaccines.
Saskia Popescu (@SaskiaPopescu) is an epidemiologist of infectious diseases at George Mason University who advises the World Health Organization on the prevention of infections. Alexandra Phelan (@alexandraphelan) is a global health advocate at Georgetown University advising the WHO on legal issues related to infectious diseases.