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Imagine a future where a single document determines whether you work, play or travel.
This scenario – a system of “immunity certification” that grants privileges to those vaccinated against the COVID-19 virus – is now being debated by a growing number of companies and global governments, anxious to control the disease and also restore the economy.
The debate comes at a time when millions of people are slowly but steadily getting vaccinated and eager to resume their lives before the pandemic. Yet millions more are forced to wait.
“People are starting to ask, ‘Why should I be restricted if I don’t really pose a risk to others?’ Said David Studdert, professor of medicine and law at Stanford University. “Somehow it looks like ‘immunity certification’ is looming.”
While the World Health Organization and the United States Centers for Disease Control and Prevention are unlikely to adopt such a strategy, others are already adopting it.
Next month, the National Football League will invite 7,500 special guests to the Super Bowl: healthcare workers who can prove they received two doses of the COVID-19 vaccine.
Abroad, the European Commission (WHO) seeks to facilitate safe travel within its borders by creating vaccination certificates. While they would initially only be used for medical care – helping travelers who suffer from vaccine-related adverse events – there will likely be other applications in the future, according to the Commission report of Jan.19.
“As more and more people are vaccinated, documentation and mutual recognition of vaccination becomes of utmost importance,” the report concludes.
Already, the nations of Cyprus, Romania and Seychelles are allowing vaccinated visitors to violate countries’ quarantine and testing requirements. In Chile, citizens who have recovered from COVID-19 – gaining antibodies that give them a natural form of immunity – have received “virus-free” certificates.
The concept is also gaining traction in the hard-hit airline and cruise industries. British cruise line Saga Cruises announced last week that it would require all passengers to be fully protected when sailing resumes in May. Australia’s Qantas Airways has said it is considering requiring international travelers to be vaccinated before boarding the company’s planes.
Americans are deeply divided over such a strategy, according to a major new survey released last week.
The research, conducted by Studdert and Mark Hall of Wake Forest University, found a nearly 50-50 split among those who support or oppose so-called “immunity privileges.” And opinions did not follow normal political contours; the Liberals and the Conservatives took both sides.
In some ways, a COVID-19 certificate is not that different from today’s yellow fever card, which proves vaccination against this deadly virus to enter countries where the disease still rages.
And proof of vaccination against other pathogens, such as tuberculosis and influenza, is already mandatory in some professions, such as healthcare. In California, young people must be immunized against childhood illnesses to attend school.
But it’s been more than a century since America restricted fundamental freedoms on the basis of someone’s antibody status. The last time this strategy was deployed was in the 19th century, when yellow fever immunity divided the people of New Orleans, dictating who you could get married or where you could work. This experience exacerbated cultural inequalities and tore the social fabric of the city.
There are both practical issues and ethical objections to certificates of immunity, said Natalie Kofler, founder of the global Editing Nature initiative and a consultant for the Scientific Citizenship Initiative at Harvard Medical School in Boston.
On the one hand, no one yet knows whether vaccination prevents transmission, especially among asymptomatic people, she said. And there is unfair access; the rich and powerful are more likely to get vaccinated than the poor and vulnerable. Restricting work, concerts, museums, religious services, restaurants or political polling stations only to people who have been vaccinated could deprive many people.
There are other challenges, experts say. Would a certificate authorize all vaccines, including those not approved by the FDA but made in China and Russia? What about people who only get one dose? If someone cannot be vaccinated, due to the risk of rare but real side effects, will they face discrimination? What about the 5% of people vaccinated, but not protected?
“Over time, it’s likely that a vaccine certification could be both scientifically sound and ethically acceptable,” Kofler said. “But we are not there yet.”
Before a COVID-19 vaccination certificate becomes mandatory for travel around the world, it should be part of the World Health Organization’s International Health Regulations.
For now, the WHO has discouraged the issuance of such certificates, saying their validity cannot be guaranteed and may exclude poorer countries. But he is designing an international digital immunization map that will provide a framework for nations, with rigorous standards.
The United States Centers for Disease Control and Prevention is already issuing a card to Americans vaccinated against COVID-19, verifying the date and type of inoculation. But experts say it seems unlikely to adopt a strategy that enforces the use of the card – opting instead to provide oversight, regulating the fairness or accuracy of that approach.
To prepare, some companies are developing technologies that allow recovered or vaccinated individuals to check their status.
The International Air Transport Association is in the process of creating a digital passport called Travel Pass, a mobile app that will maintain a traveler’s COVID-19 health status.
Two tech giants – IBM and Salesforce – are designing a blockchain-based smartphone app called IBM Digital Hall Pass that allows businesses and sites to customize what is required for entry, like COVID-19 test results , temperature checks and vaccination records.
“Now, as testing becomes more widespread and vaccine distribution is underway, we (will) help organizations verify an individual’s immunization status and any other relevant health certificates,” said Paul Roma, Managing Director of IBM Watson Health.
Additionally, a grand coalition called the Vaccination Credential Initiative is creating an encrypted health card, called CommonPass, which can be stored in any digital wallet or a paper QR code. Its members include Microsoft, Oracle, the Mayo Clinic and the two largest medical electronic record companies, Cerner and Epic.
To coordinate these many efforts, the Linux Foundation strives to contribute to the development of a set of universal standards for vaccine identification applications.
Could such a tool be part of everyday life, allowing people to return to work, the classroom, the concert hall, the stadium or the cinema?
It’s still too early, because so few people have been vaccinated, according to Studdert and Hall. But as the numbers increase, it can be inevitable.
“It’s kind of a logical and expected way to behave,” Hall said. “The question is, are we letting things move forward? Where do we help guide the course? “
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