More than 448 million doses of coronavirus vaccines have been administered worldwide, and in some countries, immunization campaigns are allowing people to resume an almost normal life. In Israel, where 50% of the population has been immunized, residents can show a “green pass” – proof that they have been vaccinated – to enter restaurants, theaters and gyms. Both the European Union and China recently announced their own versions of vaccination passes. While vaccination certificates can allow cardholders to go into business within a country, governments also hope to use them to regulate international travel and borders.
But in much of the world, coronavirus vaccines remain scarce and, in some cases, completely unavailable. As governments, especially in wealthy countries, seek to use vaccine passports to relax restrictions, they are at risk of depending on a fragmented system that can have the adverse effect of extending the pandemic.
In addition to vaccine passes being prepared in Europe and China, the World Economic Forum is working with a group called the Commons Project on a system to document vaccinations against coronavirus. IBM is developing a Digital Health Pass, and the International Air Transport Association, a trade association in the civil aviation industry, is developing a smartphone app that will provide passengers with information about testing and vaccination requirements.
The requirement for vaccine passports for international travel presents several challenges. International law allows countries to require visitors to prove that they have been vaccinated against diseases such as yellow fever. But coronavirus vaccines are new and not all have been authorized for use worldwide.
Countries can decide to accept evidence only from vaccines approved for use within their borders. China has already said that its vaccine passport will only allow foreigners to enter if they have received a Chinese vaccine. None of the vaccines currently available in the United States are produced by a Chinese company. The Oxford-AstraZeneca vaccine is being used in 86 countries, but has not been approved for use in the United States. And vaccines administered in some countries may not be effective against new variants that appear both domestically and abroad.
These issues need to be addressed on a global scale, and governments should take the opportunity to address these issues at the World Health Assembly meeting of the World Health Organization in May.
Vaccine passport systems must clarify which vaccines will be accepted and must be equipped to update immunization requirements when public health guidelines are changed. These systems should also prevent countries from arbitrarily refusing to accept certificates. Without international consensus, we run the risk of consolidating geopolitical divisions with inconsistent requirements that can prolong the pandemic. Vaccine passports that allow citizens of some nations to travel abroad while millions of others wait for vaccination will only serve to deepen global inequalities.
The United States has not announced plans for a vaccine passport. Vaccinated Americans receive a card indicating the date and type of vaccine they received, but these cards are not being used as passes and can be easily forged. And an American plan would present several problems. First, the vaccine’s launch in the United States has been plagued by injustices: blacks and Latinos are being vaccinated at much lower rates than whites. Second, not everyone can be vaccinated: vaccines have not been approved for children and data on vaccination safety during pregnancy are limited. Vaccination passes will need a mechanism to ensure that people who cannot get vaccines are not denied jobs, services or education.
The requirement of proof of vaccination by employers and companies would not only lead to ethical and legal obstacles, but also logistical challenges around how data is collected, stored, verified and protected. Companies that require vaccines for customers or employees will need systems to review vaccine passports, which can create a significant financial burden for companies in distress. Although schools and health care providers have demanded and screened certain immunizations for a long time, many companies have never had to deal with vaccine requirements.
If vaccine passports come in the form of a smartphone app, some people will not be able to use them. And, of course, since a vaccine passport records private health data, failure to protect that information would create a great risk of fraud, forgery, discrimination and privacy violations.
People around the world are eager to end the pandemic, and those who are vaccinated are understandably eager to take advantage of the freedom that immunization promises. But any move to institute vaccine passports must be coordinated internationally and must be combined with global and equitable access to vaccines.
Saskia Popescu (@SaskiaPopescu) is an infectious disease epidemiologist at George Mason University, who advised the World Health Organization on infection prevention. Alexandra Phelan (@alexandraphelan) is a global health advocate at Georgetown University who has advised WHO on legal issues related to infectious diseases.