What’s the Deal with Vaccine Passports?

Living through the global pandemic has felt like undergoing social experiments at a global scale one after another. Lockdowns, mask-mandates, never ending supplies of hand sanitiser have changed life in radical ways. It seems that moving out of our Covid-19 reality will be no less charged. The latest debate in the cross section of technology, health, and society centres on Vaccine Passports.

In January, Iceland became the first European nation to issue and recognise vaccine passports [1]. UK PM Boris Johnson has ordered a review on Vaccine Passports [2]. While on 17 March 2021 Ursula von der Leyen, president of the European Commission, announced plans to implement a Digital Green Certificate for travel within the EU [3]. Two days later the World Health Organisation issued its Interim guidance on putting together a Smart Vaccine Certificate opening the door for the development.
This post will unpack some of the issues involved.

What are Vaccine Passports?

In the simplest form, Vaccine Passports are a record of vaccination. In recent months however the term has come to mean a digital record accessed through a smartphone.
As Rebecca Heilweil of Vox explains, “When people talk about vaccine passports, they’re generally referring to a two-part system: a digital record that a person got vaccinated, and an app that can access that record to confirm the person has met the requirements to visit a particular place or attend an event.” [4]
Digital records come with the distinct advantage of being far harder to falsify. Already a market is starting to emerge for falsified vaccine certificates in the US [5]. But creating a trustworthy record isn’t simple.
The challenge emerges as app designers need a way to draw information from a wide variety of health providers, verify their authenticity and form partnerships with those willing to trust their apps.
For this reason, a government run option seems easiest. However, this triggers fears of the 1984 variety.
In fact, the Biden administration has made it clear that no federal vaccine passport system will be put in place in the US. The reason behind this call coming from fears of a vaccine passport actually decreasing public trust in the vaccination programme and thus fewer people signing up for vaccinations.

Where are Vaccine Passports Likely to be Required?

This seems to lie at the heart of the debate. The idea of vaccination requirements for travel is not new. The World Health Organization endorses certificates confirming vaccination against yellow fever for entry into certain countries [6].
The European Commission’s proposal for a Green Pass is a mechanism meant to allow for travel between states, not to restrict travel within them.
The difference here is the move from a border check between countries/regions to one within society itself. We are used to passport checks at most borders, we are far less ok with them when trying to get into a pub, hairdresser, or our own office.

What is out there right now?

Israel has had one of the fastest vaccines drives with 60% of the population having received at least one dosage of the vaccine as of 14 April 2021 [7].
To facilitate a return to ‘normal life’, the Israeli government has rolled out an application for cell-phones called Green Pass allowing access to a variety of spaces for those who have had both doses of the vaccine more than a week prior, or recovered from the disease with presumed immunity.
Many questions remain ovr the balance achieved in Israel’s government run covid response programme.
A notable example has been the use of its secret service “The Shin Bet” to conduct contact tracing. Despite concerns over surveillance, and lack of controls, this mandate was extended in November 2020. Us – onlookers – might be uncertain of whether to be horrified or buoyed by the fact that the Shin Bet’s programme has only had a 13% success rate in tracking covid [8].
This is before we get into the ethical questions of the neglect of the occupied West Bank and Gaza strip, which fall into Israel’s responsibility to supply with vaccines under the Fourth Geneva Convention.
In the US private solutions have started to emerge for vaccine proof. Two of these apps – CommonPass, and Clear — are already available for download. The question then becomes whether private companies and organisations should be trusted with this data, when governments are not.

Are Vaccine Passports Going to Be Useful for Long?

When it comes to international travel, we can easily envision a situation whereby proof of vaccination stays with us for a long time. Eradicating Covid is likely to take time with outbreaks moving between regions before enough immunity is reached.
Within a country, you would hope that they aren’t useful for too long. The situation imagined is one in which enough people have been vaccinated to allow for the reopening of facilities, yet not enough to have reached herd immunity. This should be a very temporary situation, but if vaccine supplies continue to stall in the EU, it could be dragged out for far longer than imagined.

What are the Pros?

Let’s not forget that we are living in a period of unprecedented government control of everyday life. We are dealing with restrictions on movement at a scale which could not have been imagined earlier in our lifetimes. Ending these vast restrictions on freedoms should be prioritised. In fact, the public health principle of least infringement requires that governments enact solutions to health crises which least limit individual rights [9].
Having a system for vaccine certification which cannot be falsified or lost makes this more viable.

The Concerns

Privacy


The challenge is unique when it comes to privacy as is pointed out by Brian Behlendorf, executive director of Linux Foundation Public Health, an open-source, technology-focused organization.
“[t]he concept of privacy here is complicated because you are ultimately trying to prove to somebody that you received something…You aren’t keeping a secret, so the challenge is to present and prove something without creating a chain of traceability forever that might be used.” [10]
Who has access to this data is important. Do we trust governments? Do we prefer private tech companies to hold onto this health data? Neither option seems all that desirable.
The next question is when should this data be erased? How long can we justify hanging onto it in a world, where multiple outbreaks might be expected to persist?
We might be left waiting for a global declaration announcing the end of the pandemic with legal obligations tied to this event.

Social Impact


As with so much else in our Covid realm, the ramifications of vaccine passports are going to be societal and not just individual.
Throughout the past 13 months it has been the poor and more vulnerable who have borne the worst impacts of Covid-19. This goes for the health outcomes, where minority communities have had higher death rates. It also extends to the economic effects, where a “K” shape recovery has been documented, whereby the middle-class and the rich
Vaccine passports could easily become the next step in allowing two-tier life to develop. This is before digital divides are considered. Groups who are less comfortable with technology or simply priced out of affording it could easily be excluded.
The plan announced by European Commission president Ursula von der Leyen, in March, extends beyond proof of vaccines and would also include negative covid-19 tests and proof of immunity. A plan offering these options would go far in alleviating the inequality, if cheap and rapid testing is available. At the same time, having physical, non-tech options will be necessary too.

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(Why not read a comprehensive research on Covid App and Contact Tracing: our reports were provided as input into application development processes and – in order to promote further discussion on this topic – some of them are available here with open access.)

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1 https://www.cbc.ca/news/canada/north/iceland-covid-passports-canada-1.5904828

2 https://www.bbc.com/news/uk-56169616

3 ‘Coronavirus: Commission Proposes a Digital Green Certificate’, Text, European Commission – European Commission, accessed 15 April 2021, https://ec.europa.eu/commission/presscorner/detail/en/ip_21_1181.
4 Rebecca Heilweil, ‘Everything You Need to Know about Vaccine Passports’, Vox, 31 March 2021, https://www.vox.com/recode/22349266/vaccine-passports-vaccination-record-commpass-walmart-walgreens.
5 Sheera Frenkel, ‘Online Scammers Have a New Offer for You: Vaccine Cards’, The New York Times, 8 April 2021, sec. Technology, https://www.nytimes.com/2021/04/08/technology/vaccine-card-scam.html.
6 https://www.who.int/ith/ith-country-list.pdf

7 This of course ignores the Occupied Palestinian Territories under Israel’s control, where less than 1% of the population have been given access to the vaccine.
8
 https://www.haaretz.com/israel-news/tech-news/.premium-israel-extended-coronavirus-contact-tracing-despite-contradicting-data-1.9230978
9 Tasnime Osama, Mohammad S. Razai, and Azeem Majeed, ‘Covid-19 Vaccine Passports: Access, Equity, and Ethics’, BMJ 373 (1 April 2021): n861, https://doi.org/10.1136/bmj.n861.
10
 https://www.cbc.ca/radio/thecurrent/the-current-for-feb-17-2021-1.5916652/covid-19-vaccine-passports-must-address-privacy-equity-concerns-say-experts-1.5916936