The next big flashpoint on the coronavirus response has already sparked cries of tyranny and discrimination in Britain, protests in Denmark, digital misinformation in the United States and geopolitical skirmishes within the European Union.
The subject of the debate: vaccine passports – cards issued by the government or smartphone badges stating that the carrier has been vaccinated against the coronavirus.
The idea is to allow families to come together, economies to restart and hundreds of millions of people who received the injection to return to normal, all without spreading the virus. Some versions of the documentation may allow their holders to travel internationally. Others would allow entry into only vaccinated spaces, such as gyms, concert halls and restaurants.
Although these passports are still hypothetical in most places, Israel became the first to launch its own last week, capitalizing on its high vaccination rate. Several European countries are considering to follow. President Biden asked federal agencies to explore the options. And some airlines and tourism-dependent sectors and destinations hope to demand them.
Dividing the world between vaccinated and unvaccinated raises daunting political and ethical questions. Vaccines go largely to rich countries and privileged racial groups within them. The granting of special rights to vaccinees, while increasing restrictions on unvaccinated ones, risks increasing the already dangerous social gaps.
Skepticism about the vaccine, already high in many communities, shows signs of increasing if vaccines are seen as imposed by the government. The plans also run the risk of exacerbating Covid nationalism: a dispute between nations to promote their citizens’ self-interest in the global good.
“Immunity passports promise a way to return to a more normal social and economic life,” wrote Nicole Hassoun and Anders Herlitz, who study public health ethics. But with vaccines unevenly distributed by race, class and nationality, “it is not obvious that they are ethical”.
Still, there are clear advantages: grandparents meeting with grandchildren from outside the city; sports, concerts and other events returning in part, but safely; resumption of international travel and some tourism; companies reopened without putting workers at undue risk.
All of this is the reason, Drs. Hassoun and Herlitz wrote, vaccine documents “may be unavoidable”.
Widening Society’s Divides
Some countries require proof of vaccination – for example, against yellow fever – to enter. The same is true of schools and daycare centers in many states.
But there are few precedents for society-wide restrictions. And, by limiting services to people with the right paperwork, governments would effectively require vaccination to use them.
Special privileges for vaccinees favor, by definition, demographic data that are inoculated at higher rates. In Western countries, these communities tend to be white and affluent.
This evokes an unpleasant image: professional-class whites disproportionately allowed in stores, baseball games and restaurants, with people of color and working class members disproportionately kept out. If workplaces require proof of vaccination, it can hurt employment as well.
“If vaccines become a passport to do different things, we will see communities that have already been hardest hit by Covid being left behind,” said Nicole A. Errett, a public health expert at the University of Washington.
Then there is the application.
“You could easily see a situation that is creating discrimination, prejudice and stigma,” said Halima Begum, who runs a British racial equality organization called Runnymede Trust.
“We have already seen, with the coronavirus regulations blocked, disproportionate amounts of stops and searches for young minority men,” she said, referring to police searches and fines. “This way, you can see who is potentially more likely to be grabbed for not having a passport and therefore being denied access.”
This increases public distrust, she said, at a time when governments need perhaps three-quarters of their populations to vaccinate voluntarily.
Still, passport-style policies would, in theory, help to control the pandemic as a whole, reducing general infections and economic disruptions that excessively affect underprivileged groups.
The only way to unravel this dilemma, said Errett, is to “address inequality itself”, eliminating racial and class disparities that worsened during the pandemic.
Vaccine Geopolitics
Then, there is inequality between nations, mainly relevant for international travel.
Approved vaccines against coronavirus have, with some exceptions, generally been distributed among nations wealthy enough to buy or produce them. The world’s poorest may be two or three years from now, although their residents are also less likely to travel across borders.
However, there are billions in the middle: with the means to travel and, sometimes, the need, but not access to shots.
“If we are opening the world only to people from high-income countries, we are creating a lot of inequality,” said Dr. Errett. “We are cutting people off the resources and connections that keep economies and communities thriving.”
Still, some poorer countries that depend on tourism are embracing the idea. Thailand officials said they hope to establish a policy this summer to accept vaccine passports.
Some experts are asking governments to wait for international standards on passports before releasing travel, so that uneven standards do not lead to unsafe practices or geopolitical games.
“A challenge from the start has been to get countries to do what is best for the world, rather than what is best for people within their borders,” said Errett.
Witness the maneuvers within the European Union, whose 27 countries share long borders, but have totally different economic needs and vaccination rates.
Southern European states, such as Spain and Greece, which depend on tourism, are pushing for the bloc to adopt the documents. German and French officials have expressed reservations, at least for the time being. Their countries have lower vaccination rates, which means that travel restrictions would put their residents at a relative disadvantage.
A struggle for mandates
When Britain’s foreign minister recently speculated that proof of vaccination might be required for bars and shops, a lawmaker from his own party, Mark Harper, replied: “I don’t think you want to demand that people have to go through by a specific medical procedure before they can take care of their daily life. “
The California vaccine struggle over whether stricter school requirements after measles and whooping cough have highlighted the state’s low immunization rates offers a worrying prediction.
Marginal activists have long opposed school vaccinations, some motivated by conspiracies, others by what they described as totally natural lifestyles.
When California lawmakers decided to close the state’s generous options for non-participation, anti-vaccine groups “directed their message to one of the rights of parents,” said Renée DiResta, a disinformation expert at the Stanford Internet Observatory.
“It attracted many more people and made the project partisan,” she said, with state Republican lawmakers almost uniformly opposing it as a tyrannical government intrusion.
It was approved, as well as similar measures in other states. Vaccination has increased and rates of preventable disease have fallen. But the dispute polarized some voters against vaccine mandates and even vaccines themselves. A subsequent bill in 2019 was even more fiercely contested.
Although DiResta supported the projects, she warned that “the spectrum of a mandate” could “erode the ability to appeal to people” to obtain Covid vaccines based on informed consent.
The reaction, she said, is already taking shape on social networks, which have been incubators of the “antivaxxer” feeling.
“The European conversation about passports has really reached the anti-xxx communities here,” fueling conspiracies of forced global vaccination, she said.
The California example suggests that opponents of the vaccine may exploit discomfort with government orders to polarize people about the possibility of being vaccinated. Masks and detachment are already politicized in the United States, reducing compliance.
“I think the real risk, honestly, is politicized disinformation,” said DiResta, which can scare people into believing that “the government is forcing an intervention on you.”
Small minorities are openly opposed to vaccines. A much larger share – up to a third of Americans, in a poll, predominantly Republicans – is only hesitant. The effort to obtain collective immunity will depend on that third party.
A confusing mission
One problem: there is no agreement on the main purpose of a vaccine passport program.
Governments usually talk about them as a way to open economies. Individuals, as a way to return to normal life. Public health specialists as a way to reduce transmissions.
These objectives are aligned, but imperfectly. At some point, the authorities need to prioritize.
Dr. Errett pointed out implementation issues, largely unknown, that could force an answer. Would you need two doses to obtain the document or just one? Do vaccines made in Russia or China qualify? What are the rules for religious or medical opt-outs? Some activities are restricted to cardholders until collective immunity, only until infections fall below a certain line – or forever?
“We need to be aware of the costs and benefits,” she said, and not just adjust as we go, but by “the precedent we are setting.”
“We people with a pandemic,” she said, “have said this since the beginning: we don’t expect this to be the last pandemic we see.”
Matina Stevis-Gridneff contributed reports from Brussels.