Imagine a future when 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 – comes to be deliberated by an increasing number of companies and global governments, concerned with controlling the disease and also restoring the economy.
The debate comes at a time when millions of people, slowly but surely, are being vaccinated and are anxious to return to their pre-pandemic lives. However, many millions of other people are forced to wait.
“People are starting to ask themselves, ‘Why should I be subject to restrictions if I don’t actually pose a risk to other people?’ ”Said David Studdert, professor of medicine and law at Stanford University. “One way or another, it looks like ‘certification of immunity’ is coming.”
While it is unlikely that the World Health Organization and the United States Centers for Disease Control and Prevention will adopt such a strategy, others are already adopting it.
Next month, the National Football League is inviting 7,500 special guests to the Super Bowl: health professionals who can prove they have received two doses of the COVID-19 vaccine.
Abroad, the European Commission (WHO) is seeking to facilitate safe travel within its borders by creating vaccine certificates. Although they are initially used only for medical care – helping travelers who suffer from any vaccine-related adverse events – there are likely to be other applications in the future, according to the Commission’s January 19 report.
“As more people are vaccinated, documentation and mutual recognition of vaccination become extremely important,” the report concluded.
The nations of Cyprus, Romania and Seychelles are already allowing vaccinated visitors to skip nations’ quarantine and testing requirements. In Chile, citizens who have recovered from COVID-19 – obtaining antibodies that give them a natural form of immunity – have received “virus-free” certificates.
The concept is also gaining traction in the airline and cruise sectors, which are hard hit. Last week, British cruise operator Saga Cruises announced that it will require all passengers to be fully protected when the trip resumes in May. Australian Qantas Airways says it is considering the need to vaccinate international travelers before boarding the company’s planes.
Americans are deeply divided on this strategy, according to a major new survey published last week.
The research, conducted by Studdert and Mark Hall of Wake Forest University, found a split of almost 50-50 between those who support or oppose so-called “immunity privileges”. And opinions did not follow normal political contours; liberals and conservatives have taken both sides.
In some respects, a COVID-19 certificate is not unlike today’s yellow fever card, which proves vaccination against this deadly virus for entry into countries where the disease is still spreading.
And proof of vaccination against other pathogens, such as tuberculosis and flu, is already mandatory in some professions, such as health. In California, young people must be vaccinated against childhood illnesses to attend school.
But it has been more than a century since the United States restricted basic freedoms based on someone’s antibody status. The last time this strategy was implemented was in the 19th century, when immunity to yellow fever divided New Orleans residents, dictating who to marry or where to work. This experience exacerbated cultural inequalities and tore the city’s social fabric.
There are practical problems and ethical objections to immunity certificates, said Natalie Kofler, founder of the global Editing Nature initiative and a consultant to the Scientific Citizenship Initiative, 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 receive a vaccine than the poor and vulnerable. Restricting work, concerts, museums, religious services, restaurants or political polling places to only those vaccinated can deprive many people.
There are other challenges, experts say. Would a certificate allow all vaccines, including those not approved by the FDA, but made in China and Russia? What about people who take just one dose? If someone cannot be vaccinated, due to 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 a vaccine certification could be scientifically robust and ethically permissible,” said Kofler. “But we are not there yet.”
Before a COVID-19 vaccination certificate becomes mandatory for travel around the world, it would have to be part of the International Health Regulations of the World Health Organization.
For the time being, WHO has discouraged the issuance of such certificates, saying that their validity cannot be guaranteed and can exclude the poorest nations. But it is designing an international digital vaccination card that will provide a framework for nations, with strict standards.
The United States Centers for Disease Control and Prevention already issue a card to Americans vaccinated with COVID-19, verifying the date and type of inoculation. But experts say it seems unlikely that he will adopt any strategy that compels the use of the card – instead of choosing to provide supervision, 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 building a digital passport called Travel Pass, a mobile application that will maintain the traveler’s COVID-19 health status.
Two tech giants – IBM and Salesforce – are designing a blockchain-powered smartphone app called the IBM Digital Hall Pass, which allows businesses and locations to customize what is needed for entry, such as COVID-19 test results, temperature checks and vaccination records.
“Now, as testing becomes more widespread and distribution of the vaccine is underway, we (will) help organizations verify an individual’s vaccine status and any other relevant health credentials,” said Paul Roma, general manager from IBM Watson Health.
In addition, an important coalition called Vaccination Credential Initiative is creating an encrypted health card, called CommonPass, which can be stored in any digital wallet or QR code on paper. Its members include Microsoft, Oracle, Mayo Clinic and the two largest electronic medical record companies, Cerner and Epic
To coordinate these many efforts, the Linux Foundation is working to help develop a set of universal standards for vaccine credential applications.
Could this tool become part of everyday life, allowing people to return to work, the classroom, the concert hall, the stadium or the cinema?
It is still too early, because few people have been vaccinated, according to Studdert and Hall. But, as the numbers increase, it may be inevitable.
“This is a logical and expected way to behave,” said Hall. “The question is, do we let things go? Or do we help direct the course? “