Vaccine passports: Problem or solution?

Globally, there have been debates about the vaccine passport as governments are exploring avenues to reopen their economies with the coronavirus pandemic approaching its second anniversary and vaccine rollout well advanced in many countries. The issue of vaccine passports has been controversial and contentious. Who will gain, and who will lose? 33% of the world population has received at least one dose of a COVID-19 vaccine, 5.08 billion doses have been administered globally, 33.85 million are now administered each day and only 1.4% of people in low-income countries have received at least one dose[1]. The key argument for the vaccine passport by governments is to allow people to travel, access public locations, attend large gatherings and return to work without compromising the health and safety of other people.

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How do they work around the world?

The implementation of vaccine passports globally varies widely. In several countries, vaccine passports are being trialled only to allow international travel, in other jurisdictions for the condition of entry to public buildings or to access services. The Australian prime minister Scott Morrison has thrown his support behind the use of vaccine passports, saying the concept is sensible and businesses have the right to refuse entry. However, there has been internal resistance within his political coalition against the vaccine passports. However, the European Union (EU) has introduced its version of the vaccine passport, the EU digital COVID Certificate for all EU citizens and residents, and specific categories of third-country travellers since 1 July 2021.

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Similarly, the United Kingdom National Health Service (NHS) has introduced an NHS COVID Pass, which can be used as evidence of COVID-19 status when travelling abroad and has also been trialled at a series of significant events in England. Israel uses a “green pass” smartphone application permitting vaccinated individuals’ access to public venues (e.g., gyms, hotels, entertainment[2]). Equally, Denmark, China, Singapore, Malaysia, and India have also developed some versions of vaccine passports. The International Air Transport Association has tied up with some 20 airlines to pilot a smartphone application to implement “digital health passport” that could securely store COVID-19 diagnosis and vaccination data of passengers across boundaries[3].

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Healthy equity debate

Around the world, the argument against vaccine passports is growing. The debates for and against vaccine passports are controversial, and the source of concern includes the right to privacy, lasting immunity and transmission, its connection with digital travelling passports and data protection. A deep-rooted and intractable concern is that any scheme for vaccine passports risks being discriminatory, biased, and inequitable, especially for low-income countries with less than 1.4% one dose vaccination. Consider the inequities we see already in the distribution of COVID-19 vaccines: supplies and distribution have predictably favoured richer countries[4]. The World Health Organization (WHO) is opposed to vaccine requirements for travel because it is a health equity issue that will affect low-income countries. However, the WHO endorses certificates confirming vaccination against yellow fever for entry into certain countries[5].

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There are many social, geographic, political, economic, and environmental factors that create challenges to vaccination access and acceptance, often affecting low-income countries, racial and ethnic minority groups. There have been calls for a uniform global approach to testing, not vaccine passport, that will allow travel to restart because the vaccines are not widely available in all parts of the world. It has been augured that the vaccine passport might encourage an elitist system that will see residents from richer and developed countries going on vacation, and those without vaccine access cannot enjoy the same benefits because they live in an underprivileged side of the world.

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A short survey was conducted for this paper and 57% of respondents from 25 August 2021 to 31 August 2021 were opposed to the idea of a vaccine passport. However, 21% of the respondents supported the idea of a vaccine passport, and 21% were unsure if it was a problem or a solution. Health equality and disparities concerns remain about the societal divide that these vaccine passports could trigger. The Nuffield Council on Bioethics states that such passports could enable coercive and stigmatising workplaces, thereby compounding current structural disadvantages[6]. Vaccine passports must be available and accessible to all to prevent exacerbating existing societal inequalities and worsening the health divide. Vaccines are scarce, and access remains unequal, both globally and within countries[7].

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What is fair and equitable?

Digital health passes could become an important vehicle for a rapid return to commerce, recreation, and travel[8]. Although the advantages of vaccine passports globally may be indisputable, implementation will require ethical and equitable justifications and practical solutions that do not victimize against the poor, the less educated literate, and people from low- and middle-income countries. Without effective mitigation strategies and alternative solutions, the hardships experienced by marginalised and vulnerable groups will be intensified through the perpetuation of prejudice and unfairness. If governments and companies are to roll out vaccine passports, the gains of vaccine passports should not be dispersed unequally, and countries globally must strive to ensure that vaccines are available to all people.

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In conclusion, flexibility and adaptability are crucial to moving forward. Within the last 18 months, the world has learnt those pandemic policies that are sensible one month may need to be altered a month later. Likewise, rational, and ethical vaccine certification policy is likely to shift regularly as vaccine availability increases, herd immunity nears, and scientific evidence of effectiveness or limitations grows[9]. Determining vaccines for children under twelve, understanding how long vaccines work and how well they protect against new variants will be critical to returning to pre-COVID-19 times. However, knowing that change is inevitable is not grounds for holding back guidance until circumstances become clearer. Current circumstances demand immediate policies that offer reasonable latitude for freedom, balancing the protection of public health with a return to pre-pandemic life.

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[1] Hannah Ritchie, Edouard Mathieu, Lucas Rodés-Guirao, Cameron Appel, Charlie Giattino, Esteban Ortiz-Ospina, Joe Hasell, Bobbie Macdonald, Diana Beltekian and Max Roser (2020) - "Coronavirus Pandemic (COVID-19)". Published online at OurWorldInData.org. Retrieved from: 'https://ourworldindata.org/coronavirus' [Online Resource]

[2] Wilf-Miron?R, Myers?V, Saban?M.?Incentivizing vaccination uptake: the “green pass” proposal in Israel. ?JAMA. Published online March 15, 2021. doi:10.1001/jama.2021.4300

[3] Morrison M. Flight Global: IATA health passport app to roll out with 20 airlines, https://www.flightglobal.com/airlines/iata-health-passport-app-to-roll-out-with-20-airlines/142369.article; 29 August 2021

[4] Tanner R, Flood CM. Vaccine Passports Done Equitably. JAMA Health Forum. 2021;2(4):e210972. doi:10.1001/jamahealthforum.2021.0972

[5] World Health Organization. Amendment to International Health Regulations (2005), annex 7 (yellow fever). 2013. www.who.int/ith/annex7-ihr.pdf.

[6] Nuffield Council on Bioethics. Rapid policy briefing: covid-19 antibody testing and “immunity certification.” 2020. www.nuffieldbioethics.org/publications/covid-19-antibody-testing-and-immunity-certification.

[7] Osama T, Razai M S, Majeed A. Covid-19 vaccine passports: access, equity, and ethics BMJ 2021; 373: n861 doi:10.1136/bmj.n861

[8] Gostin LO, Cohen IG, Shaw J. Digital Health Passes in the Age of COVID-19: Are “Vaccine Passports” Lawful and Ethical? JAMA. 2021;325(19):1933–1934. doi:10.1001/jama.2021.5283

[9] Mark A. Hall, and David M. Studdert. “Vaccine Passport” Certification — Policy and Ethical Considerations, March 31, 2021. DOI: 10.1056/NEJMp2104289