Substituted Trust
Actually, probably not. The same fraudsters who provided you with dubious documentation to get past the bouncers at your local college pub have already turned their talents to vaccine documentation. Add to this the problems with verifying documentation at every port of entry.9 Just picture the line for immigration and passport control the last time you flew into the U.S. Now imagine a second line, just as long, for a second set of agents to review your Yellow Card. Already, this is starting to sound less like the happy ending to 2021 that we all want.
There is hope. The model is Global Entry, which was created by the U.S. Customs and Border Protection Agency to expedite clearance traveling to the U.S. For a modest fee, the Department of Homeland Security pre-vets low-risk travelers so they don’t have to be interviewed by an immigration agent. A quick interaction with a computer is all it takes to confirm your identify and your history, before you are whisked away to baggage claim.
An electronic Yellow Card would solve many problems. Just imagine a world in which you carried a phone app or an RFID card that you could flash at your flight attendant or restaurant host or concert ticket taker—or anyone else who wanted proof of your vaccinated status—before they step aside and allow you to reclaim a small part of your previous life.
The problem is coming up with a universally agreed-upon format to both store and transmit the relevant data, while offering a modicum of security and privacy for the individual.
The people who brought you the Linux operating system are on the case. The Linux Foundation Public Health (LFPH) is hosting the COVID-19 Credentials Initiative (CCI) to create a standardized, open-source approach to vaccine credentials, with an emphasis on interoperability and cybersecurity.10
Jenny Wanger, director of programs at LFPH puts it eloquently: “Ultimately, these credentials are a way of substituting trust. One of the things the pandemic has done that’s, I think, been psychologically damaging for so many people is all of a sudden you can’t trust anybody, even your family.”11 An electronic Yellow Card would, once again, allow us to trust strangers with our health.
Several candidates are already vying for dominance in this space:
- IATA Travel Pass. If you are flight-savvy, you recognize the International Air Transport Association from the database it maintains to help travel agents book flights. This professional organization, however, supervises many aspects of commercial flying, and therefore has a particular interest in making this technology work.12
- CommonPass: This is envisioned as a phone app, created by the World Economic Forum and the Commons Project Foundation in Switzerland, that would allow travelers to provide vaccination records without revealing other protected health information.13
- Augmented Borders: This technology, being developed by IDEMIA, would allow you to clone the chip in your passport onto your phone. It is not being specifically developed to serve as an immunity passport but adding such a feature would be a snap.14
The Vaccinated Caste
From a purely medical standpoint, any of these products could represent an important step toward making people comfortable again with travel. The ethics of the vaccine passport, however, are murky.
First, not all are comfortable with creating a universe in which the unvaccinated are disadvantaged. Requiring vaccinations in some circumstances is generally accepted—to attend public school, for example. But even for routine vaccinations, the courts continue to be flooded with requests for exceptions based on personal beliefs.15
Add to this the newness of the coronavirus vaccine technology and the public’s varying opinions on the threat posed by SARS-CoV-2, and it’s not surprising that the resistance is higher. My institution, for example, has elected not to require vaccination because no vaccine is, technically, FDA approved. Such gossamer arguments will allow many institutions to delay making coronavirus vaccination mandatory, but we will eventually have to address this problem head-on.
More concerning is that vaccine passports will simply reinforce the social inequities that influence access to coronavirus vaccines in the first place. It surprised absolutely no one to learn that the wealthy managed to jump the line and buy early access to vaccine. Many others managed to be first in line simply because they had enough free time to work the system.
The CDC has recorded race and ethnicity for only half the patients who have received a coronavirus vaccination in the U.S. From the available data, however, it seems 65% of patients who have received the coronavirus vaccine, as of March 1, are white. Only 9% were Hispanic and 7% were Black. In other words, white patients are being vaccinated much faster than Hispanic or Black patients. On the other hand, non-Hispanic Black patients account for only 12% of the total U.S. population, but 34% of COVID-19 deaths.16 Creation of vaccine passports, potentially, may create one more way in which minorities may suffer at the hands of COVID-19.
The issue is even more fraught when one looks beyond our borders. One hundred thirty nations have not yet administered a single dose of a coronavirus vaccine, representing 2.5 billion people who are being left behind.17 Worldwide, wealthy nations are flexing soft power, offering vaccines in exchange for some consideration at a later date, like a mobster making an offer that can’t be refused. Forcing these nations to sit out international travel and commerce while waiting for these vaccines simply reinforces their disadvantage.
There are no easy answers. Some countries and airlines are already requiring evidence of vaccination prior to travel. Israel has already introduced a Green Pass, which allows the COVID-immune to access a range of services, including restaurants, gyms and theaters. Later this year, Europe will begin to welcome back tourists who can prove they received an EMEA-approved coronavirus vaccine. Meanwhile, it’s important we find new ways of getting coronavirus vaccines to those who need them most.
Souls to the polls efforts, in which people would vote after religious services, transformed electoral politics in the U.S.; similar efforts may help us reach those who may not actively seek vaccination.18 Mobile vaccine clinics may further extend our reach.19
At the end of the day, vaccine passports may make some of our lives easier, but the ultimate goal is to make sure we can all enjoy those Independence Day cookouts, together.
