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Coronavirus Disease 2019

Can Vaccine Passports Stop the Pandemic?

Vaccine passports could help to tackle COVID-19, but have drawbacks.

  • In 2021, proof of a negative COVID-19 test is required to enter countries including Australia, Canada, and the UK.
  • If electronic apps are used, then alternatives must be available for people without access to such technology.
  • Passports will not stop the pandemic, but the documents could contribute to curbing it.

As COVID-19 and lockdowns take an increasingly devastating toll, vaccine rollouts continue around the world. To stay safe and to avoid a resurgence of the virus, different forms of “vaccine passports” or “vaccine certificates” are being mooted.

Ilan Kelman
Could attending shows be safer with vaccine or health passports or certificates?
Source: Ilan Kelman

The document could show vaccination, recovery from infection, or both. It would not be an “immunity passport,” because we do not know how long immunity lasts after vaccination or after surviving COVID-19. Even the tests for current or previous infection are far from perfect.

So questions emerge. Which vaccines would count as “proof of vaccination”? Infection from which strains would count as “proof of recovery”? How often should passports be renewed and would renewal require a booster shot? Could the passports be easily updated with new vaccines and mutations?

These questions are not new, to either COVID-19 or to other diseases. Discussions on health passports for the current coronavirus started with 2020’s lockdowns. Coronavirus-related passes are already being tested with possibilities having been offered for months. Since January 2021, proof of a negative COVID-19 test has been required to enter countries including Australia, Canada, and the UK.

Security and Validation of Passports

Many countries have long required proof of vaccination for yellow fever or polio in order to enter, especially if arriving from a place where these diseases are common. Previously, one factor in successfully eradicating smallpox was proof of vaccination to travel internationally.

Yet no document, certificate, pass, or passport can be a panacea. They can be forged or stolen while applicants can be scammed.

We can learn from what we accept already. Country passports contain numerous security measures, but they cost and can still be counterfeited or stolen while applicants can be scammed.

If vaccine passports are used, then decisions are needed on the document’s security, overall data protection, who pays for the passport, and who is responsible for checking the passport before and after international travel (as happens with country passports).

If the certificate is electronic only, with apps being proposed as the way forward, then alternatives must be available for people without the technology. Phones can be stolen, leading to scams and forgeries for e-passports and e-certificates.

Concerns About Discrimination

Discrimination concerns must be addressed. Over past decades, the USA was one of several countries which, at various times, prohibited entry to people testing positive for HIV. Now, some countries, such as the UK, prohibit entry by people testing positive for COVID-19.

Even before COVID-19 was declared to be a pandemic, related racism was rife. Racists who thought that, to them, someone looked Chinese then attacked innocent people over the spread of the virus. People continue to experience racist abuse over the pandemic.

Sadly, people wearing masks and people not wearing masks have also experienced abuse and discrimination. How could we avoid shaming and physical or verbal attacks for not having a vaccine certificate or a health passport?

Imagine the reactions and backlash if we demanded “vaccinated” and “unvaccinated” areas for airplanes and restaurants! Although separation used to be the case for smoking.

Particular challenges emerge when considering proof of vaccination for local endeavours, such as entering pubs, cinemas, stores, and other public places. Staff have health and safety rights, which was one impetus toward smoking bans in indoor public places in many countries. It will always be a political choice on balancing individual rights, health and safety, and the freedom for businesses to choose.

Trade-Offs Are Inevitable

We must learn from precedents. Proof of vaccinations against numerous diseases are common across Europe and the USA for children to attend school. The evidence is clear that these mandates, and other forms of vaccine certificates, contribute to controlling disease and saving lives.

How this evidence leads to decision-making is often determined by ideology. It is not possible to satisfy everyone when balancing the lives saved, information security and data protection, the costs involved, the benefits of freedom from unvaccinated individuals in public places, and the consequences of a successful forgery, theft, or scam.

The speed and fairness of implementing any passport or certificate also requires balance. Decisions are needed on the documents being compulsory or voluntary as well as whether they would cover vaccination and/or previous infection. Should they be vaccine or health passports for only COVID-19 or linked to other vaccinations, whether obligatory or voluntary?

Who issues and monitors them, who is accountable for problems, who pays for them, and who is prioritised for the documents? It would be counterproductive if vaccination passports were mandatory followed by a long backlog to get either a vaccine or a passport.

Irrespective of these decisions, relying exclusively on passports will not stop the pandemic, no matter how much the documents contribute. The usual measures of physical distancing from unvaccinated people and basic hygiene are paramount, recognizing how many people lack these opportunities.

Consequently, for COVID-19, it is still essential to get an appropriate vaccine as soon as we are offered it, apart from those with medical exemptions. To avoid either a perpetual cycle of lockdowns or mass deaths within collapsing health systems and exhausted health and care workers, the quickest and safest way out of this horrendous disaster is for everyone to get an appropriate vaccine.

References

Kofler, N. and F. Baylis. 2020. Ten reasons why immunity passports are a bad idea. Nature, vol. 581, pp. 379-381.

Dijkstra, R.F., J.C.C. Braspenning, Z. Huijsmans, R.P. Akkermans, E. van Ballegooie, P. ten Have, T. Casparie, and R.P.T.M. Grol. 2005. Introduction of diabetes passports involving both patients and professionals to improve hospital outpatient diabetes care. Diabetes Research and Clinical Practice, vol. 68, no. 2, pp. 126-134.

Strasser, T. 1989. “Health Passports”: Changes and trends. In R. Steffen, H. Lobel, J. Haworth, and D.J. Bradley (eds), Travel medicine, pp. 528-530. Springer, Berlin, Heidelberg.

Voo, T.C., H. Clapham, and C.C. Tam. 2020. Ethical implementation of immunity passports during the COVID-19 pandemic. The Journal of Infectious Diseases, vol. 222, no. 5, pp. 715-718.

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