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. A reliable serological testing for antibodies against SARS-CoV-2 virus is done to certify people as immune to COVID-19 and issue an immunity documentation. [9] Despite the benefits of vaccination and to solve economic and social problems due to the pandemic, issuing COVID-19 immunity certificates point out issues in science, ethics, and laws. [10]

Scientific concept

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:[11][12][13][14]

  • 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 natural immunity

People acquire a degree of natural immunity from SARS-CoV-2 virus when they are exposed to a live virus and develop a primary immune response which produce antibodies that can recognize specific COVID-19 variants. [10]As of May 2021, the World Health Organization (WHO) reported that more than 90% of individuals establish recognizable antibodies in a period of four weeks of SARS-CoV-2 virus infection. For most people, these detectable antibodies roughly stay for at least 6-8 months which provide protective measures against reinfection.[15] Individuals who develop antibodies against the virus do not guarantee a lasting immunity due to recurrent mutations of SARS-CoV-2 virus that may not be recognized by the previously developed antibodies.[10] Current knowledge about the developing immune response from natural infection with SARS-CoV-2 virus do not specify strong and lasting duration of protection and immunity. [15] The uncertainty of the science behind COVID-19 immunity and the dependency on unknown conditions raises issues on adopting COVID-19 immunity certificates. [10]

COVID-19 vaccination certificates

As of May 2020, it remained unclear if any of these conditions have been met for COVID-19.[11] 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.[16]

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".[17]

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.[18] Countries experimenting with or seriously considering COVID-19 immunity passports include Aruba,[19] Britain,[20] Israel[21] and Canada.[22]

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[23] and mandatory COVID-19 tests, including those on arrival from overseas.[24] The passport will be valid for 6 months.[24]

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."[25] Lawmakers in several US states are also prematurely considering legislation to prohibit COVID-19 immunity passports.[26]

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."[27]

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 (green), banned (red), or partially banned (yellow) COVID-19 vaccine passports. Gray indicates that the state has neither implemented or banned COVID-19 vaccine passports. [28][29][30][31][32][33]

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.[34] 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.[35]

On 15 March 2021, the US federal government opined that it should not be the one verifying COVID-19 vaccination[36] 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.[37]

Digital health passports

Chinese government

In March 2021,[38] the government of China rolled out the world's first[39] COVID-19 vaccine passport system through a partnership[40] with AliPay and WeChat. The system provides a health certificate that includes an individual's vaccine status and the results of COVID-19 testing.[40][39][38] 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 Janssen vaccines.[41] As of March 2021, the app was optional and its use was restricted to Chinese citizens.[40] The digital health passport is intended to better facilitate travel.[42][40] Privacy advocates and Chinese netizens have expressed concerns regarding the potential invasive data collection and the use of data for non-health monitoring purposes.[40][43]

EU Digital COVID Certificate

EU Digital COVID Certificate (issuing country: Czech Republic)

The EU Digital COVID Certificate (EUDCC), also called the Green Pass,[44] came into force on 1 July 2021 and allows for travel across all 27 member states, and additionally Switzerland, Iceland, Norway, and Liechtenstein.[45]

Greece's prime minister, Kyriakos Mitsotakis, had proposed the creation of such a certificate to revive freedom of movement and facilitate free travel for the vaccinated European Union's citizens in the EU and Schengen Area (San Marino and Vatican City pending).[46][47][48][49]

A certificate can be issued to a person who has been vaccinated with an EMA-approved COVID-19 vaccine, has recently recovered from COVID-19, or has recently had a negative PCR test.[45] According to the EU, children under the age of 6 "should also be exempted from travel-related testing."[50] The certificate contains a digitally signed QR code and is available on paper or as PDF. Reference software and app source code has been published by the EU.[51]

The QR code is encrypted, but anyone can know the name, birth date, and validity status by scanning it with the German checker app, for example.[52] It contains a unique identifier, name, birth date, issue date, and vaccination/test/recovery information. The data is not centrally stored.

The keys are stored by the issuers, the public keys are also stored in the EU Gateway.

The certificate is only accepted on presentation of matching valid identity documentation.

On 8 July 2021, the EU commission decided to accept Swiss COVID vaccine certificates, making them applicable in the entire Schengen area.[53] The EU certificate is valid in Switzerland too, as it is part of the Schengen Area.

Some EU countries, such as Hungary, started to recognize digital vaccine passports from outside of the EU, including from Kazakhstan. However, those certificates are not applicable in the Schengen area.[54]

On 21 July 2021, French Prime Minister Jean Castex confirmed that the COVID pass would be required for leisure activities involving more than 50 people, and must be presented at theme parks and concerts as well as cinemas, swimming pools, and museums.[55] The following day, the Italian government announced similar restrictions would take effect August 6, and would apply to an even wider array of activities like spas, casinos, and indoor restaurant dining. "The Green Pass is essential if we want to keep businesses open," Prime Minister Mario Draghi told reporters.[56]

Switzerland COVID Certificate

The Swiss COVID certificate is not provided automatically, it must be explicitly requested to comply with data protection laws.

People under the age of 16 do not need a COVID certificate in Switzerland.

It is interoperable with that from the EU. It contains a digitally signed QR code. The certificates are delivered on paper or as PDF. An optional app only available for some Android, iOS, and Huawei devices is also provided by the government to store and manage them (after scan, as the data are not kept in a central system). The source code of the COVID Certificate System will be published for anyone to use.[57]

The QR code is encrypted, but anyone can read the information by scanning it with the COVID Certificate app.[58] It contains the data that is readable on the paper certificate (unique identifier, name, birth date, issue date, and vaccination/test/recovery information).

The app license specifies that penalties may be applied for abusive use or negligence. The keys are stored in the national Backend run by the Confederation, the public keys are also stored in the EU Gateway. The certificate is only accepted on presentation of matching valid identity documentation. A light certificate that contains no health data can be generated with the app after loading the full certificate. It is only valid in Switzerland. The app will automatically delete revoked certificates. One should anyway be notified by the authorities by other means, which could be only postal, with the lack of the app preventing perhaps an opportunity of getting tested before a check. A new certificate can be requested. It might not be possible to receive a new one by check time or even get tested. Certificates can be revoked or rejected because of name misspellings for example, so they should be checked on reception. As the app is optional, one expects that checking the text is enough. One might lose all copies of a certificate or it might get revoked while one is abroad. It might not be possible to receive a new one there and one would have to get tested to return. Even if one checked the data, there's always the possibility that lots of certificates have to be reissued for security reasons. One should also pay attention to the vaccination plan. It is possible that a new dose would be required which is not available abroad and one would have to get tested before returning. If you don't use the app you won't be able to verify that your certificate has not been replaced with an invalid one without your knowing. If you use the checker app it could be someone else's with the same name and birth date.

US COVID Certificate

As of July 2021, the US has not issued a digital COVID vaccine certificate for international travelers. US persons who have been vaccinated are issued a COVID-19 Vaccination Record Card by the CDC. However, those cards are easily counterfeit and do not bear a copy-proof QR code nor a digital signature. Acceptance of CDC cards by other countries is not a given. In June 2021, a spokesperson for the EU pointed out that fully vaccinated Americans entering a Schengen nation could present proof of vaccination or illness to the health authority of the host nation, which in turn would issue a digital EU COVID vaccine certificate. A number of US airlines have also encouraged to upload health information before boarding a plane to a foreign destination. Digitally issued vaccine certificates have been internationally criticised due to privacy concerns, inequitable access and inconsistent acceptance of different vaccine types.[59]

IATA Travel Pass

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.[60] 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.[61]

The IATA Travel Pass app requires a biometric passport and an Android 6.0 (API Level 23) or newer NFC device or an iOS NFC device.[62]

The passport data will be stored in the iPhone Secure Enclave or similar Android hardware.

A test might need to be taken at a partner laboratory. A printed copy of the test might have to be carried. The cost of the test might not be included. The app shows what is required for the trip.

IATA states that the data is not centrally stored.

International Standard

The Royal Society published a report on 19 February 2021 where the need for the international standard, many standard development organizations have tried to create a standard acceptable both for the host country to receive an immunity passport holder and for the vaccine administered country with other eleven challenges.

On 12 March 2021, Ecma-International announced its intention to create international standard which prevents counterfeits and protects private data as much as possible in Call for Participation on Vaccine Passports International Standardization. [63]

Negative-test certificates

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. [64]

Arguments and controversy

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).[65] According to HRW, requiring immunity certificates for work or travel could force people into taking tests or risk losing their jobs,[65] create a perverse incentive for people to intentionally infect themselves to acquire immunity certificates,[65] and risk creating a black market of forged or otherwise falsified immunity certificates.[65] By restricting social, civic, and economic activities, immunity passports may "compound existing gender, race, ethnicity, and nationality inequities."[66] Immunity certificates also face privacy and human rights concerns.[37]

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.[13] This general prevention would only be justified as a last resort.[67] 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:[68]

"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."[69]

Several US states, including South Dakota, Montana, Idaho, Utah, Florida, Texas and Arizona,[70] have banned the use of COVID-19 immunity passports.[71][72]

In April 2021, the World Health Organization (WHO) advised against the use of mandatory COVID-19 vaccine passports for travel, citing ethics and efficacy concerns.[73][74][75] In February 2021, the position of World Health Organization (WHO) on requiring proofs of COVID-19 vaccination for international travel purposes remains against on using this as a condition for departure or entry. [76]

Reliability and Quality of Tests

The extent of protection of the vaccine for the emerging new variants of COVID-19 is not yet well understood. [77] For a reasonable policy approach for quality the scientific reliability of tests, the World Health Organization (WHO) recommended that there should be an established minimum duration of immunity, reliable indicators of concentration/quantity antibody, and accurate availability of tests to ensure that the results are within satisfactory levels. The setting of the threshold of tolerable error is a responsibility of the government, not the private companies to avoid conflict of interest. [9]

Ethical and Social Issues

The ethical issues that arises in the acceptability of immunity certificates revolves in the policy objectives and the intended use. [9] The public health restriction on implementing immunity certificates limits the freedom of an individual to perform social activities. [77]For people who are concerned about the economy and business, issuing immunity certificates would be beneficial because it prevents severe consequences of recession. For many people who recovered from COVID-19 or vaccinated, having a COVID-19 immunity certificate will help them get back to their normal lives. For the people who cannot get the the vaccine or not immune, issuing immunity certificates create unfairness and discrimination. [10] Implementing COVID-19 immunity certificates will not justify people who are neither at risk of getting infected of COVID-19 nor contagious. [78]

Existing social disparities in the society is likely to be affected by imposing COVID-19 vaccination certificates. People who are privilege to receive the vaccination will have gained access to going back to normal life while low-income populations will remain disproportionately low on vaccinations which hinders their social privilege to go out.[77] The religious people and/or people who refuse to get vaccinated have also restricted on their liberties. [77]

History

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.[79]

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.[80]

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.[81] 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.[82][83][84] The proposals were also published in French.[85] The idea became increasingly relevant as evidence of lasting acquired immunity became clear.[86]

In May 2020, Chile started issuing "release certificates" to patients who had recovered from COVID-19, but "the documents will not yet certify immunity".[87] Many governments including Finland,[88] Germany,[89] the United Kingdom,[90] and the United States[91] 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.[92]

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:[93]

  • 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.[94]

See also

References

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