Imagine a future where one document determines whether you work, play or travel.
That scenario – a system of “immunity certification” that grants privileges to those vaccinated against the COVID-19 virus – is now being contemplated by a growing number of global companies and governments looking to contain the disease and also restore the economy.
The debate comes at a time when millions of people are, slowly but surely, being vaccinated and restless to return to their pre-pandemic lives. Yet many millions of others are forced to wait.
“People are starting to wonder, ‘Why should I be restricted if I’m not really a risk to other people?’” Said David Studdert, a professor of medicine and law at Stanford University. “Somehow it seems like ‘immunity certification’ is headed our way.”
While the World Health Organization and the U.S. Centers for Disease Control and Prevention are unlikely to embrace such a strategy, others are already implementing it.
Next month, the National Football League will invite 7,500 special guests to the Super Bowl – health workers who can prove they received two doses of the COVID-19 vaccine.
Abroad, the European Commission (WHO) tries to facilitate safe travel within its borders by means of vaccine certificates. While they would initially be used only for medical care – to help travelers who suffer from vaccine-related side effects – there are likely to be other uses in the future, the Commission report dated Jan. 19.
“As more people are vaccinated, the documentation and mutual recognition of vaccination becomes paramount,” the report concluded.
The countries of Cyprus, Romania and the Seychelles already allow vaccinated visitors to skip the countries’ quarantine and testing requirements. In Chile, citizens who have recovered from COVID-19 – obtained antibodies that give them a natural form of immunity – have received ‘virus-free’ certificates.
The concept is also gaining traction in the hard-hit aviation and cruise industry. Last week, British cruise line Saga Cruises announced that all passengers must be fully protected when sailing resumes in May. Australia’s Qantas Airways says it is considering vaccinating international travelers before boarding the company’s planes.
Americans are deeply divided on such a strategy, according to a new study published this 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 the so-called “immunity privileges.” And opinions did not follow the normal political contours; liberals and conservatives took both sides.
In some ways, a COVID-19 certificate isn’t all that different from the current yellow fever card, which proves that vaccination against that deadly virus is for entry into countries where the disease is still raging.
And proof of vaccination against other pathogens, such as tuberculosis and influenza, is already mandatory in certain professions, such as healthcare. In California, young people must be vaccinated against childhood diseases to attend 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 in the 19th century, when yellow fever immunity divided New Orleans residents and dictated who to marry or where to work. That experiment exacerbated cultural inequalities and tore the social fabric of the city.
There are both practical issues and ethical concerns about immunity certificates, said Natalie Kofler, founder of the global Editing Nature initiative and advisor to the Scientific Citizenship Initiative, Harvard Medical School in Boston.
First, no one knows yet whether vaccination prevents transmission, especially among asymptomatic people, she said. And there is unfair access; the rich and powerful are more likely to receive a vaccine than the poor and vulnerable. Restricting work, concerts, museums, religious services, restaurants or political polling stations to only vaccinated people could deprive many people of the right to vote.
There are other challenges, experts say. Would a certificate permit all vaccines, including those that are not FDA approved but made in China and Russia? What about people who only get one dose? If a person cannot be vaccinated because of the risk of rare but real side effects, will they be discriminated against? What about the 5% of people who are vaccinated but not protected?
“Over time, it is likely that vaccine certification could be both scientifically robust and ethically permissible,” said Kofler. “But we’re not there yet.”
Before a COVID-19 vaccination certificate can become mandatory for travel around the world, it would have to be part of the World Health Organization’s International Health Regulations.
For now, the WHO has discouraged the issuance of such certificates, as their validity cannot be guaranteed and could potentially exclude poorer countries. But it is designing an international digital vaccination map that will provide countries with a framework with strict standards.
The U.S. Centers for Disease Control and Prevention is already issuing a card to Americans vaccinated with COVID-19 verifying the date and type of vaccination. But experts say it seems unlikely to embrace a strategy that mandates use of the map – opting instead to monitor and regulate the fairness or accuracy of this approach.
In preparation, some companies are developing technologies that allow recovered or vaccinated individuals to verify their status.
The International Air Transport Association is building a digital passport called the Travel Pass, a mobile app that will include a traveler’s COVID-19 health status.
Two tech giants – IBM and Salesforce – are designing a blockchain-powered smartphone app called IBM Digital Hall Pass that allows businesses and locations to customize what is needed for access, such as COVID-19 test results, temperature checks, and vaccination records.
“As testing becomes more widespread and vaccine distribution gains momentum, we will help organizations verify an individual’s vaccine status and other relevant health credentials,” said Paul Roma, IBM Watson Health CEO.
In addition, a grand coalition, the Vaccination Credential Initiative, is creating an encrypted health card called CommonPass that can be stored in any digital wallet or paper QR code. Its members include Microsoft, Oracle, the Mayo Clinic and the two largest electronic health records companies, Cerner and Epic
To coordinate these many efforts, the Linux Foundation is developing a set of universal standards for vaccine reference apps.
Could such a resource become part of everyday life, enabling people to return to work, class, concert hall, stadium or cinema?
It is too early because so few people have been vaccinated, said Studdert and Hall. But as the numbers rise, it may be inevitable.
“This is kind of a logical and expected way to behave,” said Hall. “The question is: let’s keep things going? Or do we help to steer the course? “