Vaccination is underway and it is great news…
However, according to the WHO, “94% of countries that have started vaccinating their populations are in the high- or high-middle income category.” Despite the efforts of WHO with COVAX (the vaccines pillar of the Access to COVID-19 Tools (ACT) Accelerator), around 2.5 billion people living in 130 low- and middle-income countries are yet to receive a single dose and a large number will probably not receive anything before 2023.
In this pandemic it looks like we are always running behind, not only because SARS-CoV-2 has some characteristics (e.g. asymptomatic patients already transmitting the disease) which makes the fight particularly difficult but also because the world was not prepared, in spite of numerous warnings. This, unfortunately, keeps the virus in the driving seat.
Since April 2020 and with renewed interest and support these days, the idea of a COVID-19 vaccination passport or an immunity passport (digital or physical) is floating in the air. The objective of such documents would be to certify that an individual has antibodies against the coronavirus SARS-CoV-2 because he or she got COVID-19, the disease caused by this coronavirus in a recent past or has been vaccinated against SARS-CoV-2 and is “therefore” immune.
At first glance, who can disagree with a suggestion supported by some governments mainly in the West, airlines and IATA, airports, touristic places, policy think-tanks, and the digital industry, to make our lives easier and to allow us to travel and cross borders? As a Greek policymaker highlighted: “the vaccinated persons should be free to travel”.
This may not be as simple as it appears, however, and we should think twice before jumping into this kind of approach at this very moment. I will mention only a few of the problems that such passports, if introduced, would create:
There is currently a lack of sufficient scientific data on the role of infection and vaccines on immunity: we still ignore the degree to which vaccines confer future immunity and how long this immunity lasts. We have no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection. We are uncertain about whether a vaccine can prevent transmission; it is most probably not completely protective. We witness the emergence of new variants, which may affect the efficacy of existing and future vaccines. Vaccines are not a magic bullet. It is therefore difficult and premature to guarantee the accuracy of an immunity or vaccination passport; these passports will create a false feeling of security and will encourage neglect of public health gestures such as wearing masks and increase the risks of continued transmission.
The ethical issue of discrimination and exclusion, “the haves and the have-nots”, in relation to these passports, cannot be underestimated. A few people mainly from rich countries will be able to travel for business and leisure, like in the good old days, when most people in the world will not be vaccinated. As long as vaccines have not been offered to the whole world population, these passports will increase inequalities and fuel divisions within and between countries, leading to unrest. People from countries without the “passport system” in place may be forbidden from travelling to countries that request these documents. In certain countries, the poor and some minorities may not have access to vaccines in case of shortages and to jobs if the passport is used internally. “The full potential of vaccines cannot be realized if narrow national interests and economic power determine who gets access, instead of basic principles of fairness and ensuring that allocation will optimize their public health impact.” (Quote from the second report on progress from the Independent Panel for Pandemic Preparedness and Response prepared for the WHO Executive Board, January 2021).
Some administrative issues are worth mentioning; in fact, they are also ethical and legal. Who will qualify for the passport? Who will assess antibody testing and vaccination? What about the young people, often the last ones to be vaccinated as most of them are less at risk? Who will ensure that the vaccination passport is from a trusted source and the information it contains is valid? How will countries mutually recognize the document? How to make sure people do not obtain these documents through corruption and bribery? Are we willing to end up with a list of “good” countries and “bad” countries? I suppose many will answer that all these can be solved through digital documents containing a bunch of health data, but do we agree on diminishing individual privacy and expanding the sharing of personal data?
To conclude, at this very moment of the pandemic when so many nations and so many people are still in pain and fighting hard to overcome the disaster created by COVID-19, we should continue to take seriously the existential risks of this disease; immunity or vaccination passports are not the solution, they are part of the problem and can jeopardize efforts in controlling the epidemic. What is needed is increasing our efforts from the local community to the highest international levels and continuing to address the situation with what science tells us about the SARS-CoV-2. This means implementing known public health and social protection measures with speed; ensuring access for all people to diagnostics, vaccines and therapeutics, and essential supplies; increasing research in genomic surveillance, new vaccines and therapeutics, etc. It is only through global cooperation, science, competent and empathic leadership, democratic processes, and solidarity that we will go back to a “normal” life, and eventually this will happen. In the meantime, the WHO continues to work on these issues and hopefully advances in science and knowledge will open ways for safe travelling. But now testing for those who need to travel and following national and international travel advice is the least bad way to go.