Michael Crawford argues that implementation of immunity passports and vaccination certificates should be delayed until young adults and youths can be vaccinated: justice demands equitable access, but delay will also help reduce the risk of re-emergence, new variants, and additional long-term economic harms.
Pity our young adults. In Canada, they are at the bottom of the list for vaccination, and successive lock downs and restrictions have translated to missed coming-of-age experiences. Gone are proms, graduation, and many learning and social activities – the very substrates of life-learning and life-forming experiences. How difficult their decisions must be as they pursue and compete for diminished entry-age job and internship opportunities. In the absence of vaccination, is low-wage employment as a service clerk, or labourer worth the risk? In this regard, epidemiologists are re-evaluating how access to vaccines should be prioritized: should access be shifted from age and health co-factors to exposure risk? Here, political implementation has been damaging. Against medical advice, for example, the Province of Ontario delayed addressing hotspots over cohorts.
Admittedly, the risk of serious complications or death for young adults from COVID-19 is lower than for older cohorts, but a significant medical risk nonetheless remains. Neither is the economic dimension comforting: Canada’s Employment Minister has admitted that reduced access to the first years of employment could permanently disadvantage candidates in the race for future earnings and success. Considering these two contexts, medical and economic, any implementation of COVID-19 immunity passports or vaccination certificates needs to be carefully evaluated because young adults would be the last to gain access to such documents, and, being unvaccinated, would remain the most exposed if others travel and return to circulate emerging COVID-19 variants..
Vaccination certificates or COVID-19 immunity passports have been proposed as a way to open travel in way that is safe and that helps to get international economies back on the path to normalcy. Such documents are also regarded as a tool to facilitate the opening of local economies and businesses. In New York State, for example, the digital Excelsior Pass (vaccination or COVID-19-free certification) is being deployed to permit re-opening of large sports and music venues, and restaurants. Several practical and ethical challenges are associated with such a plan.
For example, scientifically, prior recovery from COVID-19 may not ensure complete immunity to infection beyond a few months nor does a recent test prevent one from becoming a carrier in the future. Moreover, though the evidence is improving, we are still not sure whether fully vaccinated individuals can transmit the virus, even if they never develop symptoms. The variants of concern pose additional threats. We may be entering an era of endemic infection requiring modified annual booster shots. Moderna is already testing a revised vaccine directed against more recent viral variants. Finally, it is not yet clear how durably vaccines can confer immunity.
Ethically, immunity passports or vaccination certificates unfairly privilege those with easy and early access to vaccines. Would such individuals enjoy primacy of access to transportation, to jobs in certain work places, or enjoyment of public spaces? Inevitably, the economic divide would be exacerbated. And what of people disadvantaged by geography, mobility (stay-at-home seniors for example), or age? Parents with children under 12 years old will be disadvantaged since their children cannot yet be vaccinated – how will they negotiate job security and access while protecting their young?
A recent epidemiological survey indicates that infection rates are changing: 37% of recent cases are occurring in people under the age of 29. Universities and colleges, with close quarter housing, older cohorts, and students with a sense of immunological invulnerability, are developing into hotspots for introduction and dissemination into communities. Frustrations and impatience are beginning to surface as a small minority find the temptations and opportunities to socialize irresistible.
Vaccination programs rely upon buy-in and a sense of community responsibility to be effective: they can be regarded as a kind of social responsibility contract. In this light, vaccination certificates would incentivize vaccination more than COVID-19 immunity passports (which include people who have recently tested negative, or who have survived prior exposure). Such programs, though, must be designed to avoid fostering mistrust. There are few campaigns designed to appeal to this cohort, and many younger members of society are reluctant to get vaccinated. In Ontario, for example, young grocery and store clerks have only just been granted access to vaccination, but the lines and waiting lists are long. How do we persuade young adults to buy-in when they are pushed to the back of the line? They were required to restrain social, educational, and economic activities to protect the aged at the beginning of the pandemic. The relationship should now be reciprocal. How do we foster trust when they must suffer higher exposure and mortality risk as entry-level frontline employees? How are they served if their elders can travel using a vaccination or immunity certificate or passport, and risk returning, unrestricted, with new variants against which the young have no immunization or resistance?
Passports or certificates should not be implemented until we are ALL equitably endowed with immunity. Otherwise we risk fostering a climate of mistrust, and breeding the variants and outbreaks we all need to avoid. We need to show the same solidarity with our young that they have shown to us when we, as elders, were the most vulnerable. Failure in this regard will mark a breach of faith, but also risk sacrificing herd immunity and encouraging a fourth wave in the name of economic expediency.
Michael Crawford is a Professor of Biomedical Sciences at the University of Windsor