May I See Your Vaccine Passport, Please?

Here we are! March 2021, and unprecedented efforts have been made to accelerate the development of multiple vaccines with encouraging immunity results. States and organizations are optimistic about a safe return to open public places. The big question is, how to get people to return to work, school, travel, and continue their normal activities while minimizing transmission risk? 

The basic idea is to link a person's identity to a document or certificate stating that they have recovered from COVID-19 or have been wholly inoculated.

A new old idea

In the medieval years, the Italian authorities issued a fede di sanitá (certificate of health). This paper included travelers' details to show that they and any goods they were carrying did not carry the plague (Birkwood, 2020). Much later, with the Spanish flu, modern states realized their vulnerability and stress related to health issues. National borders gradually became, among other things, membranes to ensure immunity of populations, and the concept of the Passport mutated to regulate people's movement due to national security issues (Kavalski and Ross, 2020). 

By the mid-20s, governments demanded compulsory medical examinations. Soon, these exams were dropped due to technological limitations and a growing concern about privacy infringement. Fast forward, the concept of "vaccination passport" was conceived and agreed upon at the International Sanitary Convention for Aerial Navigation in 1933 (USLI, 2021). Until 2007, the document was formally called the International Certificate of Vaccination or Prophylaxis (ICVP). Commonly known as the "Yellow Card," the IVCP is a required document used by travelers to demonstrate specific vaccination history before crossing a country's border.

Vaccine Passport

Like the yellow card, a vaccine passport establishes proof of vaccination linked to the holder's identity. A vaccine passport aims to help the world return to pre-COVID-19 activities and travel without compromising personal or public health regarding the ongoing context. Studies suggest that a vaccine passport should be internationally standardized with verifiable credentials based on a platform of interoperable technologies, such as a WHO Smart vaccination certificate. According to the Royal Society of the UK, a vaccine passport should be secure for personal data, portable, and affordable for individuals and governments while meeting the user's legal and ethical considerations.

To the travel industry in general and the airlines in particular, electronic proof of vaccination is the key to re-opening the world. Nevertheless, the World Health Organization (WHO) repeatedly cautions that there is not enough evidence about antibody-mediated immunity's effectiveness to guarantee the accuracy of an "immunity passport." According to diverse scientists, somewhere between 70%-85% of people need to be immune from COVID-19 to achieve herd immunity.

Not just about travel

During the ongoing COVID-19 pandemic, experts suggest that having access to digital vaccine certificates can help manage and document whether individuals carry antibodies, either from illness or vaccination. Lately, Microsoft, Salesforce, Oracle, and other health companies have launched the Vaccine Credential Initiative (VCI, 2021). This initiative aims to develop technology to provide all Americans with an encrypted copy of immunization records stored on a digital wallet (VCI, 2021). 

According to IBM, through its platform, each person could determine what information they want to share, with whom, when, and for what purpose – without sharing the underlying personal data used to generate the credential. The startups' efforts to develop digital health credentials are also remarkable considering that the pandemic's magnitude will unlikely have a single solution universally implemented.

Travel or not, vaccines are crucial.

It is not new that governments have often required certain vaccinations for specific diseases when traveling to certain countries. What is new is that everyone might need to show proof of vaccination when traveling. As a result, the world could be severely divided into vaccinated and unvaccinated people, raising many political and ethical questions. Consequently, diverse experts have said companies' main focus should be on helping the public get vaccinated rather than developing digital vaccine passports. 

Unlike other countries, the US , through the CDC, is currently discouraging nonessential travel. Following the CDC's available information, there is no guidance on managing vaccinated people during a trip. Also, there are no established international standards for vaccines or vaccination documentation. Nevertheless, there is a possible welcome consideration of the White House about President Biden's executive order to assess the feasibility of linking COVID-19 vaccination to International Certificates of Vaccination or Prophylaxis (ICVP) and producing electronic versions of ICVPs (WH, 2021).  

Recently, there are many international efforts to accept a vaccine passport widely while opening their economies faster. Moreover, diverse European Union states like Spain, Greece, Italy, and Portugal that are heavily reliant on tourism are pushing to get a vaccine passport. Simultaneously, other countries such as Belgium, France, Netherlands, and Germany stay doubtful considering possible ethical implications and premature decisions. In Asia, the Chinese government has officially launched a health certificate using WeChat. It promises to be the model that will "walk the world" (MFA, 2021). Nevertheless, studies suggest that given China's lack of transparency about its vaccine's reliability, it raises concerns about its efficacy. 

Similarly, many other countries have mixed results. A reason to worry is that some people might not be willing to get a vaccine due to existing health conditions, others will need to wait in the line, and others might choose not to be vaccinated due to personal reasons. 

What do you think? Do you believe that vaccine passports are a good idea that will create a social divide? Or does it depends on the manner that a country manages its implementation?

As always, I look forward to reading your comments.

Sources:

Birkwood, K. 2020. 'A very unjust affront'? William Harvey's experience of quarantine. Royal College of Physicians. URL: https://history.rcplondon.ac.uk/blog/very-unjust-affront-william-harveys-experience-quarantine

CDC (Center for Disease and Control Prevention). 2021. When You've Been Fully Vaccinated. URL: https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated.html

Gartner. 2021. Digital COVID-19 Vaccine Certificate: The Road to a New Normal. URL: https://www.gartner.com/en/documents/3995810/digital-covid-19-vaccine-certificates-the-road-to-a-new-

Harris, R. 2021. A Rocky Road On The Way To Herd Immunity For COVID-19. NPR. URL: https://www.npr.org/sections/health-shots/2021/02/03/963373971/a-rocky-road-on-the-way-to-herd-immunity-for-covid-19

IBM. 2021. New York and IBM Begin COVID-19 Digital Health Pass Pilot. URL: https://www.ibm.com/watson/health/resources/digital-health-pass-blockchain-explained/

Kavalski, E., and Ross, N. 2020. A 'fast lane' for the vaccinated? Europe inches closer to COVID-19 vaccine Passports. Fortune. URL: https://fortune.com/2021/02/26/europe-covid-19-vaccine-passport-israel-greece-eu/

MFA (Ministry of Foreign Affairs). 2021. Good news! The Chinese version of the "International Travel Health Certificate" is officially launched. URL: https://mp.weixin.qq.com/s/baV5_lA9U18YS1cAq4mmpQ

Royal Society. 2021. Twelve criteria for the development and use of COVID-19 vaccine passports.

USLI (United States Legislative Information). 2021. Sanitary Aerial Navigation. URL: https://www.loc.gov/law/help/us-treaties/bevans/m-ust000003-0089.pdf

VCI (Vaccine Credential Initiative). 2021. About the vaccine credential initiative. URL: https://vaccinationcredential.org/

WHO (World Health Organization). 2020. "Immunity Passport" in the context of COVID-19. URL: https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19

WH (The White House). 2021. Executive Order on Promoting COVID-19 Safety in Domestic and International Travel. URL: https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/21/executive-order-promoting-covid-19-safety-in-domestic-and-international-travel/

Wilson, K., Atkinson, K., and Bell, C. 2016. Travel Vaccines Enter the Digital Age: Creating a Virtual Immunization Record. The American Journal of Tropical Medicine and Hygiene.