Immunity passport

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An immunity passport or vaccine passport, also known as an immunity certificate,[1] recovery certificate[2] or release certificate[3] is a document, in both paper and digital format, attesting that its bearer is immune to a contagious disease.[4] Similar to quarantine, public certification is an action that governments can take to mitigate an epidemic.[5]

An immunity passport is not the same as a vaccination record or vaccination certificate proving someone has received certain vaccines verified by the medical records of the clinic where the vaccines were given.[6] The Carte Jaune ("yellow card") is an official vaccination record issued by the World Health Organization (WHO). It has been argued that the primary difference is that vaccination certificates such as the Carte Jaune incentivise individuals to obtain vaccination against a disease, while immunity passports incentivise individuals to get infected with and recover from a disease.[7]

The concept of immunity passports has drawn much attention during the COVID-19 pandemic as a potential way to contain the pandemic and permit faster economic recovery.[8] This could include a "health passport" for people who have either been vaccinated or otherwise developed immunity by surviving COVID-19.

Concept[edit]

Immunity certificates are a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease. These antibodies can either be produced naturally by recovering from the disease, or triggered through vaccination. Such certificates are of practical use only if all of the following conditions can be satisfied:[9][10][11][12]

  • Recovered or vaccinated patients have protective immunity that prevents them from being reinfected
  • The protective immunity is long-lasting
  • The pathogen mutates sufficiently slowly for immunity to work against most strains
  • Immunity tests have low false-positive rates

If reliable immunity certificates were available, they could be used to exempt holders from quarantine and social distancing restrictions, permitting them to travel and work in most areas, including high-risk occupations such as medical care.

COVID-19[edit]

As of May 2020, it remained unclear if any of these conditions have been met for COVID-19.[9] On 24 April 2020, the World Health Organization (WHO) stated that "At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an 'immunity passport'".[4] For example, research published in April 2021 shows that the Pfizer vaccine effect lasts for at least six months.[13]

Due to the imbalance in the distribution of vaccines in the developing world, there are concerns about the inequity of immunity passports for travellers. In a 15 April 2021 meeting published 4 days later, the World Health Organisation’s emergency committee opposed immunity passports, saying "States Parties are strongly encouraged to acknowledge the potential for requirements of proof of vaccination to deepen inequities and promote differential freedom of movement".[14]

However, many countries may increasingly consider the vaccination status of travellers when deciding to allow them entry or whether to require them to quarantine. “Some sort of vaccine certificate will be important” to reboot travel and tourism, according to Dr David Nabarro, special envoy on COVID-19 for the World Health Organization (WHO), in February 2021.[15] Countries experimenting with or seriously considering COVID-19 immunity passports include Aruba,[16] Britain,[17] Israel[18] and Canada.[19]

In some cases, an immunity passport will be combined with a vaccination certificate, so that both people who survived COVID-19 and people who have been vaccinated will use the same type of documentation. In January 2021, Israel announced that all Israelis who have received their second vaccination as well as all who have recovered from infection will be eligible for a "green passport" that will exempt them from isolation requirements[20] and mandatory COVID-19 tests, including those on arrival from overseas.[21] The passport will be valid for 6 months.[21]

In March 2021, the WHO's director of digital health and innovation Bernardo Mariano said that "We don't approve the fact that a vaccinations passport should be a condition for travel."[22] Lawmakers in several US states are also prematurely considering legislation to prohibit COVID-19 immunity passports.[23]

As of 4 April 2021, it is not yet clear whether vaccinated people that remain asymptomatic are still contagious and are thus silent spreaders of the virus putting unvaccinated people at risk. "A lot of people are thinking that once they get vaccinated, they’re not going to have to wear masks any more," said Michal Tal, an immunologist at Stanford University. "It’s really going to be critical for them to know if they have to keep wearing masks, because they could still be contagious."[24]

Map showing (1) that New York state has a COVID-19 passport scheme; (2) that Florida, Montana, Tennessee, Texas, and Utah have banned COVID-19 passports; and (3) that no other U.S. states have done either.
A map showing which US states have implemented (cyan) or banned (green) COVID-19 vaccine passports. Gray indicates that the state has done neither. [1][2][3][4][5]

Marjorie Taylor Greene, a newly elected Republican US Representative for Georgia, told her supporters on Facebook in early April 2021 that "something called a vaccine passport" was a form of "corporate communism" and part of a Democratic effort to control people's lives.[25] However, a representative survey of the U.S. population showed that, prior to the issue becoming politicized, public views on immunity passports were evenly split and the divide crossed, rather than followed, political and ideological lines.[26]

On 15 March 2021, the US federal government opined that it should not be the one verifying COVID-19 vaccination[27] and that any processes developed should be free, private and secure when Andy Slavitt, White House senior adviser for COVID-19 response, stated: "It should be private. The data should be secure. Access to it should be free. It should be available both digitally and in paper and in multiple languages. And it should be open source." He also said "It's not the role of the government to hold that data and to do that". Later, on 6 April 2021, an announcement was made that the US federal government would not introduce mandatory vaccine passports, citing privacy and human rights concerns.[28]

Digital health passports[edit]

Chinese government[edit]

In March 2021,[29] the government of China rolled out the world's first[30] COVID-19 vaccine passport system through a partnership[31] with AliPay and WeChat. The system provides a health certificate that includes an individual's vaccine status and the results of COVID-19 testing.[31][30][29] Initially, the system would only indicate that an individual had been vaccinated if they received a Chinese-made coronavirus vaccine, leading to criticism, though by April 2021 the system began to accept records of receiving the Pfizer-BioNTech, Moderna, and Johnson & Johnson vaccines.[32] As of March 2021, the app was optional and its use was restricted to Chinese citizens.[31] The digital health passport is intended to better facilitate travel.[33][31] Privacy advocates and Chinese netizens have expressed concerns regarding the potential invasive data collection and the use of data for non-health monitoring purposes.[31][34]

EU Digital COVID Certificate[edit]

Greece's prime minister, Kyriakos Mitsotakis proposed the creation of an EU COVID Certificate that would revive freedom of movement and facilitate free travel for the vaccinated European Union's citizens in the Schengen Area. The EU Covid certificate's purpose is to authenticate the vaccination status of its holder. The 27 EU member states adopted guidelines on the proof of vaccination for medical purposes. The EU Digital COVID Certificate (EUDCC), will come into force on 1 July and will allow for travel restrictions to lift across all 27 member states. The certificate will be available for both EU and specific non-EU countries as well.[35][36][37][38]

IATA Travel Pass[edit]

The International Air Transport Association (IATA) has proposed a digital app to authenticate the COVID test and/or vaccination status of travellers. In early 2021, it was being trialled by many leading airlines including Air New Zealand, Qantas and Singapore Airlines.[39] In an editorial of Radio New Zealand, the propagandist said it is likely that such a document will become a pre-requisite for air travel to countries where Covid-19 is not prevalent such as Fiji, Taiwan, Australia and New Zealand.[40]

Negative-test certificates[edit]

In contrast to immunity certificates, so-called Covid-free certificates assert a person's Covid test result for a short period of time (typically in the range of a few days). In this context, Covid-free certificates link a person's identity to the Covid test result. [41]

Arguments and controversy[edit]

Proponents of the idea such as Sam Rainsy, co-founder of the opposition Cambodia National Rescue Party (CNRP) have argued that immunity, whether acquired naturally or through vaccination, is a resource which needs to be used to limit the impact of the pandemic on the global economy. Note that the many people in Cambodia depend entirely for their living on a tourism industry which has been wiped out. Poor countries can also benefit from recording immunological status as this will reduce wastage of scarce vaccines. Ethical concerns about immunity certificates have been raised by organizations including Human Rights Watch (HRW).[42] According to HRW, requiring immunity certificates for work or travel could force people into taking tests or risk losing their jobs,[42] create a perverse incentive for people to intentionally infect themselves to acquire immunity certificates,[42] and risk creating a black market of forged or otherwise falsified immunity certificates.[42] By restricting social, civic, and economic activities, immunity passports may "compound existing gender, race, ethnicity, and nationality inequities."[43] Immunity certificates also face privacy and human rights concerns.[28]

On the other side, it is argued that it would be disproportionate to deprive immune persons – who can neither infect themselves nor others – of their basic freedoms.[11] This general prevention would only be justified as a last resort.[44] Accordingly, Govind Persad and Ezekiel J. Emanuel stress that an immunity passport would follow the “principle of the ‘least restrictive alternative’“ and could even benefit society:[45]

"Just as the work of licensed truckers benefits those unable to drive, the increased safety and economic activity enabled by immunity licenses would benefit the unlicensed. For instance, preferentially hiring immune individuals in nursing homes or as home health workers could reduce the spread of the virus in those facilities and better protect the people most vulnerable to COVID-19. Friends, relatives, and clergy who are immune could visit patients in hospitals and nursing homes."

An opponent of immunity passports in Britain has suggested that, to understand the dangers of Covid passports, one should simply imagine an obesity equivalent. In a Daily Telegraph opinion piece, Sir Charles Walker MP wrote:

"The Government should not let its drive for health certification stall at Covid-19 passports. If it is serious about saving lives and promoting personal responsibility then it must target the avoidable and identifiable disease of obesity....It is an inescapable fact that a great many hospital beds, doctors and NHS resources have been absorbed over the past year by the clinically obese... It is clear that by sucking resource away from deserving illnesses and social causes, the obese kill those of a healthy weight. But at last change might be possible. In the same way that people will soon have to prove their Covid status, we could also be at the stage where technology could be deployed to monitor people's obesity status. Such a breakthrough would finally allow the state to restrict the overweight's access to certain dining facilities and high-calorie foods. Upon entering a restaurant, the business could scan a mobile phone app that showed your BMI. Those within the healthy range could order what they wished off the menu, while the overweight could be restricted to ordering size-limited portions. As for the obese, they could be asked to settle for a salad or simply invited to leave. For takeaway orders, companies such as Just Eat or Deliveroo could use the same data, taken over the telephone, to weed out the obese from placing a fast-food order. In supermarkets, your BMI status could be scanned at checkout, with fatter customers having certain foods removed from their baskets or replaced with healthier options."[46]

Several US states, including South Dakota, Montana, Idaho, Utah, Florida, Texas and Arizona,[47] have banned the use of COVID-19 immunity passports.[48][49]

In April 2021, the World Health Organization advised against the use of mandatory COVID-19 vaccine passports for travel, citing ethics and efficacy concerns.[50][51][52]

History[edit]

An Italian health pass (fede di sanità) for travel during times of plague, 1722
Sample of a certificate, which should inter alia demonstrate immunity to yellow fever caused by illness. It was used for immigration to the United States in the late 19th century.[53]

Quarantine has been used since ancient times as a method of limiting the spread of infectious disease. Consequently, there has also been a need for documents attesting that a person has completed quarantine or is otherwise known not to be infectious. Since the 1700s, various Italian states issued fedi di sanità to exempt their bearers from quarantine.[54]

The International Certificate of Vaccination (Carte Jaune) is a certificate of vaccination and prophylaxis, not immunity. The document has remained largely unchanged since it was adopted by the International Sanitary Convention of 1944.[55] The certificate is most commonly associated with Yellow Fever, but it is also used to track vaccination against other illnesses.

An early advocate of immunity passports during the COVID-19 pandemic was Sam Rainsy, the Cambodian opposition leader. In exile and under confinement in Paris, he proposed immunity passports as a way to help restart the economy in a series of articles which he began in March 2020 and published in The Geopolitics and The Brussels Times.[56][57][58] The proposals were also published in French.[59] The idea became increasingly relevant as evidence of lasting acquired immunity became clear.[60]

In May 2020, Chile started issuing "release certificates" to patients who had recovered from COVID-19, but "the documents will not yet certify immunity".[61] Many governments including Finland,[62] Germany,[63] the United Kingdom,[64] and the United States[65] have expressed interest in the concept. Israel has implemented a "green pass" system, which allows those who are fully vaccinated (or otherwise have recovered fully from COVID-19) to eat at restaurants, attend concerts, and travel to other nations, like Egypt, Cyprus, and Greece.[66]

New York state requires professional sports venues that host fans to use "Excelsior Pass" or similar methods to confirm if attendees have received one of the following:[67]

  • a full course of COVID-19 vaccine
  • a negative PCR test within 72 hours
  • a negative antigen test within 6 hours

Small and medium performing arts venues that use Excelsior Pass or other proof of health status are permitted to reopen at higher capacity, in some cases with up to 250% more attendees.[68]

See also[edit]

References[edit]

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