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Businesses and governments are developing COVID-19 vaccine certifications that allow people to prove they have been vaccinated so they can enter spaces or travel without worrying too much about getting sick or transmitting the virus to others. Conservative politicians recently took these efforts as evidence of government overbreadth, while others argued that certifications were a more benign public health tool – one that similar at strategies we have been using it to manage disease for decades.
“Usually the reality is somewhere in the middle, and so is it,” says Lisa Lee, director of the scientific integrity and research compliance division at Virginia Tech.
There’s a reason these types of tools are familiar. Using proof of vaccination to enter a country or participate in certain activities is nothing new: many countries in Africa and South America require visitors to be vaccinated against yellow fever before arrival. In the United States, many people need to get the flu shot to work, and some vaccinations are needed to be able to attend schools and colleges.
But there are a few things that differentiate the proposed COVID-19 certifications from these familiar guidelines. They may not be the excessive government boogeyman raised by many conservative politicians, but there are lingering ethical questions around them.
For one thing, the shots are not easily accessible to most people around the world. Many high-income countries have vaccinated tens of millions of people, while low-income countries have obtained far fewer doses. In countries like the United States, which have enough doses of the vaccine for all adults, low-income, non-white people are less likely to have access to these vaccines.
“What we’re going to have for at least the next year or probably two is a very inequitable vaccine distribution,” says Chris Beyrer, professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. Requiring COVID-19 vaccine certification to enter a country could be discriminatory if most people cannot get the vaccine, Beyrer says. “People in rich countries with access to vaccines will once again be able to move around the world, and the world’s poor or people in low- and middle-income countries will be trapped.” The past year has shown that pandemics place a greater burden on some groups than on others, potentially adding to the existing inequity.
Even where vaccines are more abundant, there are still dilemmas around the use of immunization status as a work permit or other activity. In the United States, COVID-19 vaccines are also not fully approved by the Food and Drug Administration (FDA). They are available under Emergency Use Authorization, a slightly lower standard that allows the agency to approve a product when there are no other options available and the benefits outweigh the risks. Companies are still studying these vaccines. While there are no major concerns about the vaccines available in the United States, there is still a lot we don’t know about them. The quasi-experimental nature of these vaccines makes vaccinations ethically mandatory, Beyrer says.
Unlike other vaccine certification programs, these new vaccine passports aren’t just on the table for things like travel or school admissions – which authorities use to prevent a disease from spreading to a new one. location and to ensure that students are protected. Instead, many companies say they will ask people to show their immunization status to do things like attend a sporting event. This is something different from any other vaccination certificate strategy normally used in the United States, says Lee. “It’s not a whole new concept, but the problem that makes it so unusual is that it’s something you have to do to be admitted to a daily event. It’s not something we are used to doing, ”she says.
It’s no surprise that people are worried about these plans, says Lee, although they could help ensure that in-person events don’t become super-broadcasters. She thinks fears that government officials will arrest people on a whim to demand that they show proof of their shots are likely overdone. The Biden administration has stressed that there will be no federally mandated or centralized COVID-19 vaccination certificate. But it’s a new way to use vaccine information, and it’s not out of place for people to express their discomfort, Lee says.
Some of the concerns with COVID-19 vaccine certifications are temporary. Eventually, clichés will become more widely available and equity concerns will not apply in the same way. The FDA will also officially authorize COVID-19 vaccines at some point. After passing through these two checkpoints, a COVID-19 vaccine certificate requirement to enter a country would be be in fact analogous to a yellow fever certificate, Beyrer says. When the FDA clears vaccines, asking people who work in a hospital to show that they have been vaccinated would be more like the flu shot requirements.
By the time that happens, however, the pandemic may no longer be in an emergency phase. As the spread of the virus abates around the world, vaccine certifications may appear less necessary and less justifiable in some cases. If there is very little coronavirus circulating in a community, there is less risk that someone, for example, at a sporting event will catch or carry it. The next few months are likely to offer the most protection. But unfortunately, this is also the time when the photos will be the most difficult to obtain, says Lee. “It’s a bit of a paradox that when we want the most, it’s the least ethical to do.”
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