Françoise Baylis highlights some of the limitations of COVID-19 vaccine certificates.
In early Spring 2020, with the first wave of the pandemic, there was considerable enthusiasm for so-called “immunity passports” for people who had survived COVID-19 and were presumed immune to the coronavirus. The plan was for individuals with immunity passports to be able to return to work outside of the home and, more generally, to move about society without public health restrictions such as masking and physical distancing. Scientific, practical and ethical objections to this idea were fast and furious.
In late Fall, with the second wave of the pandemic and the initial vaccine roll-out, enthusiasm shifted from immunity passports to vaccine certificates. Many suggested that individuals could be required to provide proof of vaccination against COVID-19 in order to access long-term care facilities or certain work environments, to attend mass gatherings such as music or sporting events, and to travel abroad.
Vaccine certificates are preferable to immunity passports for at least two reasons. First, there is likely to be increased certainty about the fact and duration of immunity with vaccine-acquired immunity as compared with infection-acquired immunity. Second, vaccine certificates incentivize vaccination which is a public health good whereas immunity passports would create perverse incentives for people to seek out infection which threatens public health.
There are nevertheless scientific, practical and ethical limitations with vaccine certificates. For a start, clinical trial data for the first vaccines approved for emergency use in the general population provide only limited data about the duration of immunity and provide no data about whether the vaccines stop transmission. People who have been vaccinated against COVID-19 could be asymptomatic and transmitting the virus. In addition, there are now concerns about whether the new coronavirus mutation referred to as B.1.1.7 could make the current vaccines less effective.
Notwithstanding these challenges, Qantas airlines has announced that vaccine certificates will be required for all its international flights once vaccination is reasonably available. And, the World Health Organization is working to develop global standards for digital vaccination certificates to facilitate international travel.
Vaccine certification for international travel is not a new idea. This kind of certification has been used in the past – for example, with Yellow Fever – and it is not unreasonable for it to be used in the future for other contagious diseases including COVID-19. As others have argued, however, the use of vaccine certificates “must have a health rationale, be non-discriminatory, consider the human rights of travellers, and not be more restrictive of international traffic than reasonably available alternatives.”
This will require careful attention to technical specifications and digital design features. It will also require the introduction of purpose-driven legislation to protect human rights and to prohibit the illegitimate use of vaccine certificates. As well, it will be important to have in place social policies to address the needs of marginalized and disadvantaged individuals, communities and countries.
Meanwhile, there are those who advocate for the use vaccine certificates as a passe-partout for a wide range of public and private spaces including the workplace, theaters, cinemas, sporting venues, and places of worship. This is a highly contentious proposal. Of particular concern is the risk of exacerbating existing inequities among rich and poor individuals, as a direct consequence of unfair vaccine distribution. For example, the Pfizer-BioNTech and Moderna vaccines require ultra-cold freezers. In many countries these are not available in hospitals and pharmacies in poor neighbourhoods. There is a similar risk of inequity among rich and poor nations. A few days ago, Moderna announced that it would not be supplying vaccine to South Africa.
In addition to differences in terms of access to vaccination, there are also differences in terms of access to technology. Not everyone owns a smart phone and not all governments have the ability to manage digital “security, authentication, privacy and data exchange.”
Vaccination and vaccine certificates are not quick fixes for the COVID-19 pandemic. This is especially so when one considers how access to safe and effective vaccines is limited by manufacturing capacity, storage requirements, distribution challenges, regulatory procedures, sales contracts, geography, priority lists, consent and more.
To effectively control this and future pandemics, governments must address health inequities, locally, nationally and globally. The surest way to build a safe and better future for us all is to ensure that we all have equal access to adequate health care and to decent jobs – jobs for which people are paid a fair wage, have proper sick leave, and are provided with safe working conditions. And for those who do not work, we need to ensure that there are adequate social supports and services. Against this backdrop, public health measures which include equitable vaccine distribution are more likely to be effective.
Françoise Baylis is a University Research Professor at Dalhousie University. @FrancoiseBaylis