After suffering mental agony for nine months by being socially isolated, wearing masks ad nauseam, and not to mention being imperiled by emerging mutated infectious strains of the virus, it seems, shimmering hope is finally on the horizon in the form of the vaccine. Since the onset of this tumultuous pandemic, there wasn’t clear trailblazing progress that showed a clear exit from this despondent situation. Now, vaccines being invented in jaw-dropping time could have a staggering effect on efforts to curb the spread of the Corona Virus, revive the plunging economy, and restore certain beleaguered industries. #Immunitypassport or #vaccinepassport is touted to be the only way out from restrictive quarantine protocols to blithesome normal life. If a vaccine passport gains momentum, it could be a momentous reset for the beleaguered airline and tourism industry, assuming travelers will take to the skies again in large numbers. With passenger volumes plummeting way below 2019 levels and economic growth nose-diving south, vaccine passports — would be most welcome by airlines and industries alike. Vaccine passports may infuse a fresh lease of life for employers, colleges, and schools by creating an easy way to admit only those who are inoculated against #COVID.
This situation of brandishing immunity status is akin to WWII where wearing insignia to describe one’s affiliation was taken to a whole new level. Immunity from disease (or lack thereof) as health status is not a novel concept as the concept of Carte Jaune or Yellow Card for yellow fever/meningitis is trite, hackneyed, and has been there for too long. Immunity passports are similar to international certificates of vaccination such as Yellow Card. Many West African countries, including Ghana, require a Yellow Card attached to the passport as proof of a yellow fever vaccine and won’t permit you to enter the country without it. This Yellow Card was introduced as the international travel document by WHO amid yellow fever epidemics, in the 1960s. In workplaces where human blood is handled e.g. hospitals, labs, etc., staff usually need proof of Hepatitis B vaccination for their own safety and also as a part of occupational health requirements. Immunity passports record facts about your inoculation, including the date you received the vaccine and the type you received.
The availability of vaccines has offered a phenomenal and unprecedented opportunity for startups and tech behemoths to create apps that would capture vaccine and testing information in real-time. IBM, the front runner is starting to accelerate away from the rest through its Digital Health Pass app which allows customers to log and maintain custom indicators of their choice including but not limited to COVID tests, body temperatures, and vaccination records. But the Commons Project’s flagship app – Common Pass is making a huge marketing splash leveraging scannable QR code technology, in this nascent segment. Common Pass app is yet to make a global debut. It is still in the trial phase but is touted to become an overnight leader as it is already being endorsed by the World Economic Forum. The app aims to just sweeten the pot enough for those still sitting on the fence by notifying users about local travel rules, virus test results, vaccination details, etc. enabling them to board international flights. The IATA (International Air Transport Association), the aviation industry’s umbrella organization which represents some 290 airlines and 83% of global air traffic is developing its own app which might see the light of day in early 2021. By its sheer reach, it can easily become the most widely adopted app for vaccine passports. Apart from accommodating vaccination and testing data, the IATA app will also provide travelers with a heap of literature on health requirements and testing/vaccination centers. This burst of early excitement will have to come to grips with some real challenges like early technological hiccups and public apprehension about privacy risks.
Chile is so far the only country to launch an official immunity passport scheme. As more governments and health care organizations strive towards achieving equitable care and administer ubiquitous equitable privileges, immunity passports would be more prone to disparities, privacy risks, willful abuse, intentional discrimination, counterfeiting, fraud, unconscious bias, or stereotypes. Immunity passports might herald the genesis of a bio-surveillance state dichotomized into immunes and non-immunes. Civil liberties experts believe that a cabal of nefarious big pharma folks have hatched a plot to create an invasive system of social control, akin to the heightened surveillance that China adopted during the pandemic. The prospect of utilizing these digital passes inevitably raises the specter of a blight society divided into passports haves and have-nots. What would be more unsettling is the fact that these passports might be deemed as de facto entry passes to get into restaurants, bars, shopping malls, schools, companies, etc. It would be more precarious if private entities begin mandating the vaccine passport apps as entry tickets. Private players like employers, restaurants, colleges, etc. then would determine who can and cannot access their services. This will further entrench the prevalent inequalities in society. What happens to society when the immune starts taking jobs from the non-immune? Restraining people from ordinary activities on the basis of their vaccination status brings up serious ethical and legal considerations. We rightly would consider it unthinkable nowadays to bar someone from a public venue for being disabled or being HIV positive, so why allow the barring of someone for not having a COVID vaccine? If immunity reduces transmission, those with immunity represent no threat to others. It is outrageous that their liberty is being infringed. It is like imprisonment without a just cause. Additionally, if we don’t grant freedoms to the naturally immune, it will be difficult to ethically justify giving freedoms to the vaccinated, unless there are differences in transmissibility.
Immunity passport idea to achieve herd immunity is pointless without research data about the average immunity lifespan. Even if all the necessary layers of vaccine passport apps and vaccines are in place, we still don’t know whether vaccination keeps people around us safe. The data from vaccinated people following vaccination has not been released in the public domain yet. This is an important part of the puzzle because if we don’t understand the key ingredients for protection such as spike protein data, we can’t monitor immunity effectively to understand who is likely to be safe and for how long, following vaccination. Without this, immunity passports or equivalent can only tell us when someone was vaccinated or infected – not whether they are still protected. None of the clinical trials underway have proved that the vaccines fully prevent either infection of vaccinated subjects or their continued exterminating of the coronavirus. So asymptomatic transmission remains a live threat. This sort of uncertain reliability could have public health ramifications – a false result might lead to an individual changing their behavior despite still being susceptible to infection, potentially becoming infected, and unknowingly transmitting the virus to others. For a host of reasons, the use of vaccine passports should be strictly restricted for virtually any purpose other than guiding individual medical care.
Immunity passports if universally exercised need a system of verifiable exceptions. Immune compromised individuals, those with previous anaphylaxis or who are allergic to vaccine components, infants – are all advised to not be vaccinated. There are many legitimate reasons for not having the vaccine, for example, pregnant women have been informed not to have the vaccine. A proviso as it turns out that there might be some certified medical reasons for being unable to take the vaccine should be rolled out.
Future historians will marvel at how human civilization survived the Black Death but came to an end over a cold virus that half the population was immune to and 99.5% of those who caught it survived. When vaccination reaches over 70-80% of the population, the virus will run out of places to hide. This is how we eradicated smallpox in the past, how we reduced polio cases close to eradication, and how we can eliminate SARS-CoV-2 as a threat to humanity. Mass vaccination at this point in time is more important than having vaccine passports. Though the goal for a digital vaccine passport is the same as for a vaccine itself- to keep us safe, it needs careful reconsideration.