On Feb. 21, 2021, Israel introduced “green passes” – evidence of COVID-19 vaccination or presumed immunity after recovery from the disease. This form of certificate is called by several other names, most notably immunity passports. According to the global vaccine alliance GAVI, “an immunity passport is an official document that certifies an individual has been infected and is purportedly immune from SARS CoV-2.”
Israel’s launch of green passes may have received greater publicity than other similar systems. For instance, Saudi Arabia introduced such a plan in January 2021. Other regions and countries, including the EU, Estonia, Sweden, Iceland, Denmark, Hungary, Lithuania, U.K. Canada and more, are either in the process of pilot-testing or considering introducing a digital COVID-19 vaccine certificate.
Vaccine certificates are not a novel idea. On the contrary, the WHO approved the international certificates of vaccination or prophylaxis (ICVP) also called carte jaune/yellow card for a range of vaccines against specific viruses of epidemic proportions, including yellow fever, which are limited in geographical spread.
But COVID-19 is a global pandemic. All policies associated with its containment have therefore taken on a global dimension, escalating ethical concerns and vulnerabilities on a correspondingly global scale, and requiring global standardized accommodation for all contingencies and to mitigate inherent ethical risks.
One of the risks being considered is whether vaccine passports or certificates risk distracting attention from real priorities, such as tackling persisting vaccine nationalism, which now constitutes an obstacle to aggressive vaccination to achieve global herd immunity. Further, herd immunity at the global level would render moot the need for a vaccine certificate.
Another important competing priority is the intensification of research on second-generation vaccines, or even a universal SARS CoV-2 vaccine to account for emergent variants, which are now threatening to torpedo progress on vaccine development. In addition, the focus should be on tackling the extremely disruptive effects of COVID-19.
The case for vaccine certificates
The idea of a COVID-19 vaccine certificate is a response to global lockdown fatigue and the desperation of citizens, corporations and governments to get back to some sense of normalcy, as well as to open up the economy. Understandably, it is being pushed primarily by stakeholders in international travel, including airline associations, hotels and several other tourism entities.
There is a strong argument for some form of certification of vaccination, especially for international travel and border control as a strategy to stem the spread of SARS CoV-2 and its variants. In this regard, the WHO is currently partnering with Estonia on a pilot COVID-19 vaccine certificate project with potential for global standardization and adoption. The project is based on each individual country’s input, including a certified list of health-care providers or authorized entities to issue the certificates in participating countries to build global credibility and trust in the authenticity of the source of the certificates. The use of blockchain technology may enhance the security and privacy of the information given by people who get the certificates.
Ethical and governance concerns
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As many Canadian provinces signal their interest in digital vaccine certificates, it is important to note that the project raises more ethical and governance concerns at national and sub-national levels. The Israeli example provides some insights. Candidates can download an app on their mobile device and put in some personal information to generate a QR code, which they can swipe to access public spaces such as pubs, gyms, hotels, theatres, etc. Those who do not use mobile devices have the option to generate and print their own barcodes on paper or to receive the certificate via mail – electronic or conventional. Evidently, there is a lot of technology involved, requiring interoperability and collaboration with private operators of public spaces. In addition, citizens are required to negotiate their civil liberties with risks to privacy rights and potential for stigmatization.
Experience has shown that governments do not have good track record of electronic or digital services delivery. Issues may arise in regard to undocumented residents, and citizens or migrants with limited digital literacy. Also, while much fuss is made about those who voluntarily reject vaccination, not as much is heard about those who cannot take the vaccines for other reasons such as pregnant women, children and others who worry that there is insufficient data to prove the safety of vaccination, not to mention autistic citizens, people with breathing difficulties and those on immunosuppressants.
Perhaps the most agitating aspect of digital vaccine certificates is their potential to serve as a real or potential coercive strategy to deal with vaccine holdouts or vaccine hesitancy. As a coercive strategy, digital vaccine certificate could be counterproductive on many fronts. First, vaccine skeptics may be inclined to procure the certificates fraudulently – as Israeli’s short experience indicates. Second, these people may be inclined to become deliberately infected to acquire antibodies, with all the risk that entails. Third, certificates may create a sense of false confidence. None of these scenarios is ethical.
Fourth, as a coercive tool, vaccine certificates could amplify mistrust, stoking suspicion and escalating social divisions. As evident with the politicization of mask wearing in the United States, digital vaccine certificates – if not handled with ethical due diligence – may play into the hands of conspiracy theorists who have linked the pandemic to Armageddon and a foretold satanic global world order.
Are vaccine certificates a good use of funds?
At national and international scales, digital vaccine certificates could be a costly venture on many fronts. Financially, it may result in a waste or diversion of resources. First, given that all vaccine approvals so far have been issued on an emergency basis, it is not clear what is the duration of immunity associated with the current vaccines. With the increasing discovery of highly infections variants, it is not known the extent to which the emergent strains could be unaffected or only partially affected by current vaccines.
Should vaccination campaigns result in early attainment of herd immunity, the funds spent on digital vaccines certificates may not be worth the trouble. On a related matter, there is no guarantee that those vaccinated or those with antibody-associated immunity cannot still transmit the virus, albeit on a less lethal scale. Because of these unknowns, Israel’s green pass has a “shelf life” of six months. It is assumed that after that period, passholders will enter into another bureaucratic, yet unknown, cycle of re-validation.
While there are both economic and pragmatic imperatives for digital vaccine certificates, those do not resonate on an equal basis in international and domestic or sub-national contexts. To move forward with the project, it must not be at the expense of ongoing priorities in the fight against COVID-19. Digital vaccine certificates must be implemented under a global standardized framework that accommodates legitimate exemptions. It must not serve as a tool to escalate social and ideological tensions, nor cause discrimination against or stigmatization of the most vulnerable. Those include categories of peoples who – for reasons other than vaccine hesitancy – cannot be vaccinated. They also include travelers from the most-impoverished parts of the world whose inability to be vaccinated is a result of current vaccine nationalism, through which developed countries have ratcheted up a superfluous stockpile of vaccines.