Immunity passport

An immunity passport, also known as an immunity certificate,[1] recovery certificate[2] or release certificate[3] is a document attesting that its bearer is immune to a contagious disease.[4] Similar to quarantine, the certification of travellers is an action states can take to mitigate an epidemic.[5]

An Italian health pass (fede di sanità) for travel during times of plague, 1722

An immunity passport is not the same as a vaccination record (also called a vaccination certificate), which is a record proving someone has received certain vaccines. It can be found in the medical records of the clinic where the vaccines were given.[6] The Carte Jaune ("yellow card") is an official vaccination record issued by the World Health Organization (WHO). It has been argued that the primary difference is that vaccination certificates such as the Carte Jaune incentivise individuals to obtain vaccination against a disease, while immunity passports incentivise individuals to get infected with and recover from a disease.[7]

The concept of immunity passports has drawn much attention during the COVID-19 pandemic as a potential way to contain the pandemic and permit faster economic recovery.[8] This could include a "health passport" for people who have either been vaccinated or otherwise developed immunity by surviving COVID-19.

Concept

Immunity certificates are a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease. These antibodies can either be produced naturally by recovering from the disease, or triggered through vaccination. Such certificates are practical only if all of the following conditions can be satisfied:[9][10][11][12]

  • Recovered patients have protective immunity that prevents them from being reinfected
  • The protective immunity is long-lasting
  • The pathogen mutates sufficiently slowly for immunity to work against most strains
  • Immunity tests have low false-positive rates

If reliable immunity certificates were available, they could be used to exempt holders from quarantine and social distancing restrictions, permitting them to work (including high-risk occupations such as medical care) and travel.

COVID-19

As of May 2020, it remains unclear if any of these conditions have been met for COVID-19.[9] On April 24, 2020, the World Health Organization (WHO) stated that "At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an 'immunity passport'".[4]

“Some sort of vaccine certificate will be important” to reboot travel and tourism, according to Dr David Nabarro, special envoy on COVID-19 for the World Health Organization (WHO).[13]

In some cases, an immunity passport will be combined with a vaccination certificate, so that both people who survived COVID-19 and people who have been vaccinated will use the same type of documentation. In January 2021, Israel announced that all Israelis who have received their second vaccination as well as all who have recovered from infection will be eligible for a "green passport" that will exempt them from isolation requirements[14] and mandatory COVID-19 tests, including those on arrival from overseas.[15] The passport will be valid for 6 months.[15]

In March 2021, the WHO's director of digital health and innovation Bernardo Mariano said that "We don't approve the fact that a vaccinations passport should be a condition for travel."[16] Lawmakers in several US states are also prematurely considering legislation to prohibit COVID-19 immunity passports.[17]

As of 4 April 2021, it is not yet clear whether vaccinated people that remain asymptomatic are still contagious and are thus silent spreaders of the virus putting unvaccinated people at risk. "A lot of people are thinking that once they get vaccinated, they’re not going to have to wear masks any more," said Michal Tal, an immunologist at Stanford University. "It’s really going to be critical for them to know if they have to keep wearing masks, because they could still be contagious."[18]

Marjorie Taylor Greene, a newly elected Republican US Representative for Georgia, told her supporters on Facebook in early April 2021 that "something called a vaccine passport" was a form of "corporate communism" and part of a Democratic effort to control people's lives.[19] However, a representative survey of the U.S. population showed that, prior to the issue becoming politicized, public views on immunity passports were evenly split and the divide crossed, rather than followed, political and ideological lines.[20]

On 15 March 2021, the US federal government opined that it should not be the one verifying COVID-19 vaccination[21] and that any processes developed should be free, private and secure when Andy Slavitt, White House senior adviser for COVID-19 response, stated: "It should be private. The data should be secure. Access to it should be free. It should be available both digitally and in paper and in multiple languages. And it should be open source." He also said "It's not the role of the government to hold that data and to do that". Later, on 6 April 2021, an announcement was made that the US federal government would not introduce mandatory vaccine passports, citing privacy and human rights concerns.[22]

History
Sample of a certificate, which should inter alia demonstrate immunity to yellow fever caused by illness. It was used for immigration to the United States in the late 19th century.[23]

Quarantine has been used since ancient times as a method of limiting the spread of infectious disease. Consequently, there has also been a need for documents attesting that a person has completed quarantine or is otherwise known not to be infectious. Since the 1700s, various Italian states issued fedi di sanità to exempt their bearers from quarantine.[24]

In 1959, the WHO created the International Certificate of Vaccination (Carte Jaune) as a certificate of vaccination, particularly for yellow fever.[25] However, these are certificates of vaccination, not immunity.

An early advocate of immunity passports during the COVID-19 pandemic was Sam Rainsy, the Cambodian opposition leader. In exile and under confinement in Paris, he proposed immunity passports as a way to help restart the economy in a series of articles which he began in March 2020 and published in The Geopolitics and The Brussels Times.[26][27][28] The proposals were also published in French.[29] The idea became increasingly relevant as evidence of lasting acquired immunity became clear.[30]

In May 2020, Chile started issuing "release certificates" to patients who had recovered from COVID-19, but "the documents will not yet certify immunity".[31] Many governments including Finland,[32] Germany,[33] the United Kingdom,[34] and the United States[35] have expressed interest in the concept. Israel has implemented a "green pass," which allows those who are fully vaccinated, or have recovered fully from COVID-19 to eat at restaurants, attend concerts, and travel to other nations, like Egypt, Cyprus, and Greece.[36] And New York state has implemented its "Excelsior Pass" to facilitate entry to sports arenas and other large venues for those who have been vaccinated.[12]

Arguments and controversy

Ethical concerns about immunity certificates have been raised by organizations including Human Rights Watch (HRW).[37] According to HRW, requiring immunity certificates for work or travel could force people into taking tests or risk losing their jobs,[37] create a perverse incentive for people to intentionally infect themselves to acquire immunity certificates,[37] and risk creating a black market of forged or otherwise falsified immunity certificates.[37] By restricting social, civic, and economic activities, immunity passports may "compound existing gender, race, ethnicity, and nationality inequities."[38]

On the other side, it is argued that it would be disproportionate to deprive immune persons – who can neither infect themselves nor others – of their basic freedoms.[11] This general prevention would only be justified as ultima ratio.[39] Accordingly, Govind Persad and Ezekiel J. Emanuel stress that an immunity passport would follow the “principle of the ‘least restrictive alternative’“ and could even benefit society:[40]

“Just as the work of licensed truckers benefits those unable to drive, the increased safety and economic activity enabled by immunity licenses would benefit the unlicensed. For instance, preferentially hiring immune individuals in nursing homes or as home health workers could reduce the spread of the virus in those facilities and better protect the people most vulnerable to COVID-19. Friends, relatives, and clergy who are immune could visit patients in hospitals and nursing homes.”

Immunity certificates also face privacy and human rights concerns.[22]

COVID-19 negative-test certificates

In contrast to immunity certificates, so-called Covid-free certificates assert a person's Covid test result for a short period of time (typically in the range of a few days). In this context, Covid-free certificates link a person's identity to the Covid test result.

IATA Travel Pass

The International Air Transport Association (IATA) has proposed a digital app to authenticate the status of travellers that is being trialled by many leading airlines including Air New Zealand, Qantas and Singapore Airlines.[41] It is likely that such a document will become a pre-requisite for air travel[42] to countries where Covid-19 is not prevalent such as Fiji, Taiwan and New Zealand.

Many countries will increasingly consider the vaccination status of travellers when deciding to allow them entry or not or require them to quarantine since recently published research shows that the Pfizer vaccine effect lasts for six months or so.[43]

See also

References
  1. Smith-Spark, Laura. "Is this how to get out of lockdown?". CNN.
  2. "COVID-19: What are immunity passports and how would they work?". World Economic Forum.
  3. "Explained: Are immunity passports, release certificates the way to go?". indianexpress.com. May 10, 2020.
  4. ""Immunity passports" in the context of COVID-19". World Health Organization. April 24, 2020. Retrieved May 1, 2020.
  5. Mary Manjikian (24 February 2016). Threat Talk: The Comparative Politics of Internet Addiction. Routledge. p. 131. ISBN 978-1-317-01027-2.
  6. "Locating and Tracking Adult Vaccine Records". www.cdc.gov. March 17, 2020.
  7. Phelan, Alexandra L (4 May 2020). "COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges". The Lancet. 395 (10237): 1595–1598. doi:10.1016/S0140-6736(20)31034-5. PMC 7198144. PMID 32380041. Retrieved 29 November 2020.
  8. A. Chotani, Rashid; Ashraf, Syed S.; Mize, Charlie; Clark, Terry (April 30, 2020). "'Immunity passport' key to containing spread of coronavirus". UPI. Retrieved May 1, 2020.
  9. Altmann, Daniel M; Douek, Daniel C; Boyton, Rosemary J (April 2020). "What policy makers need to know about COVID-19 protective immunity". The Lancet. 395 (10236): 1527–1529. doi:10.1016/S0140-6736(20)30985-5. PMC 7185915. PMID 32353328.
  10. Cyranoski, David (4 May 2020). "Profile of a killer: the complex biology powering the coronavirus pandemic". Nature. 581 (7806): 22–26. doi:10.1038/d41586-020-01315-7. PMID 32367025.
  11. Hall, Mark A.; Studdert, David M. (2020-06-09). "Privileges and Immunity Certification During the COVID-19 Pandemic". JAMA. 323 (22): 2243–2244. doi:10.1001/jama.2020.7712. ISSN 0098-7484. PMID 32374358. S2CID 218520529.
  12. Hall, Mark A.; Studdert, David M. (2021-03-31). ""Vaccine Passport" Certification — Policy and Ethical Considerations". New England Journal of Medicine. 0. doi:10.1056/NEJMp2104289. ISSN 0028-4793. PMID 33789006.
  13. "COVID vaccine passports deemed key in the near future, says WHO officer".
  14. Turak, Natasha (January 15, 2021). "Israel is launching Covid immunity passports. Here's what they allow you to do". CNBC.
  15. "Israel's green passport provides vaccination incentive" – via Globes.
  16. Josephs, Jonathan (2021-03-20). "Qantas boss: Governments 'to insist' on vaccines for flying". BBC. Retrieved 2021-03-21.
  17. "Vaccine passports are latest flash point in Covid politics". New Zealand Herald. NZME Publishing Limited. 4 April 2021. Retrieved 4 April 2021. Vaccine passports being developed to verify Covid-19 immunisation status and allow inoculated people to more freely travel, shop and dine have become the latest flash point in America's perpetual political wars, with Republicans portraying them as a heavy-handed intrusion into personal freedom and private health choices. They currently exist in only one state — a limited government partnership in New York with a private company — but that hasn't stopped GOP lawmakers in a handful of states from rushing out legislative proposals to ban their use.
  18. Mandavilli, Apoorva (8 December 2020). "Here's Why Vaccinated People Still Need to Wear a Mask". New York Times. Retrieved 4 April 2021. In most respiratory infections, including the new coronavirus, the nose is the main port of entry. The virus rapidly multiplies there, jolting the immune system to produce a type of antibodies that are specific to mucosa, the moist tissue lining the nose, mouth, lungs and stomach. If the same person is exposed to the virus a second time, those antibodies, as well as immune cells that remember the virus, rapidly shut down the virus in the nose before it gets a chance to take hold elsewhere in the body. The coronavirus vaccines, in contrast, are injected deep into the muscles and stimulate the immune system to produce antibodies. This appears to be enough protection to keep the vaccinated person from getting ill. Some of those antibodies will circulate in the blood to the nasal mucosa and stand guard there, but it’s not clear how much of the antibody pool can be mobilized, or how quickly. If the answer is not much, then viruses could bloom in the nose — and be sneezed or breathed out to infect others. “It’s a race: It depends whether the virus can replicate faster, or the immune system can control it faster,” said Marion Pepper, an immunologist at the University of Washington in Seattle. “It’s a really important question.” This is why mucosal vaccines, like the nasal spray FluMist or the oral polio vaccine, are better than intramuscular injections at fending off respiratory viruses, experts said.
  19. "Vaccine passports are latest flash point in Covid politics". New Zealand Herald. NZME Publishing Limited. 4 April 2021. Retrieved 4 April 2021.
  20. Hall, Mark A.; Studdert, David M. (2021-03-31). "Public Views about COVID-19 "Immunity Passports"". MedRxiv: 2021.01.26.21250184. doi:10.1101/2021.01.26.21250184. S2CID 231719316.
  21. Weise, Elizabeth (15 March 2021). "Vaccine passports should be free, private and secure, White House says. But who will be issuing them?". USA Today. Retrieved 8 April 2021. The federal government shouldn't be involved in verifying that people have been vaccinated against COVID-19, the White House says, but whatever process is developed should be free, private and secure. "It's not the role of the government to hold that data and to do that," Andy Slavitt, White House senior adviser for COVID-19 response, said in a briefing Monday. While Americans need a way to reliably demonstrate that they’ve been vaccinated, the government shouldn’t be the one issuing such a certification, Slavitt said. “It should be private. The data should be secure. Access to it should be free. It should be available both digitally and in paper and in multiple languages. And it should be open source,” he said. As more people are vaccinated, both here and around the world, it will likely become more important to provide proof of vaccination – to get on a plane or a cruise ship, hold certain jobs or even enjoy a night out. Israel already has a "green card" to prove people have been vaccinated; other countries are contemplating requiring proof of vaccination for entry; and the World Health Organization is reviewing the idea of certification.
  22. "Covid: US rules out federal vaccine passports". BBC News. 6 April 2021. Retrieved 7 April 2021. "The government is not now, nor will be, supporting a system that requires Americans to carry a credential," she said. "Our interest is very simple from the federal government, which is Americans' privacy and rights should be protected, and so that these systems are not used against people unfairly." Countries around the world are looking at the introduction of so-called vaccine passports, which would be used to show that a person has been inoculated against Covid-19, as a way of safely reopening mass gatherings and travel. In England, a "Covid status certification" scheme is being developed to enable concerts and sports matches to take place. It would record whether people had been vaccinated, recently tested negative, or had already had and recovered from Covid-19. The European Union is also working on plans to introduce certificates, while in Israel a "Green Pass" is already available to anyone who has been fully vaccinated or has recovered from Covid-19, which they have to show to access facilities such as hotels, gyms or theatres. line feed character in |quote= at position 303 (help)
  23. Olivarius, Kathryn (2 April 2019). "Immunity, Capital, and Power in Antebellum New Orleans". The American Historical Review. American Historical Association. 124 (2): 440, footnote 88. doi:10.1093/ahr/rhz176. Retrieved 25 June 2020.
  24. "Fedi' di Sanita Archivi".
  25. "International certificate of vaccination or prophylaxis". World Health Organization. Retrieved May 1, 2020.
  26. Rainsy, Sam (March 27, 2020). "How to Prevent COVID-19 From Paralysing the World's Economy". The Geopolitics. Retrieved February 26, 2021.
  27. "Immunity Passports: A proposal to revive tourism, international trade and transport". The Brussels Times. April 12, 2020. Retrieved February 26, 2021.
  28. "International Immunity Passports Can Help Restore Freedom of Movement". The Geopolitics. April 8, 2020.
  29. "CAMBODGE - CORONAVIRUS: L'appel de Sam Rainsy pour des passeports «immunitaires afin de combattre l'épidémie mondiale de Covid 19". www.gavroche-thailande.com (in French).
  30. Mandavilli, Apoorva (November 17, 2020). "Immunity to the Coronavirus May Last Years, New Data Hint". The New York Times. Retrieved February 26, 2021.
  31. "In reversal, Chile says coronavirus release certificates will not prove immunity". Reuters. April 29, 2020. Retrieved May 1, 2020.
  32. Mutanen, Annikka. "Suomalaiset tutkijat kehittivät vasta-ainetestin, joka paljastaa, kuka on jo sairastanut koronaviruksen". Helsingin Sanomat (in Finnish). Retrieved May 1, 2020.
  33. Day, Joel (April 1, 2020). "Coronavirus breakthrough: Germany roll outs promising antibody test to end lockdown". Daily Express. Retrieved May 1, 2020.
  34. "Britain looking at COVID-19 immunity certificates but more research needed". Channel News Asia. April 3, 2020. Retrieved May 1, 2020.
  35. Kristine, Lofgren (April 10, 2020). "Anthony Fauci Says Government Is Discussing Immunity Cards For Coronavirus Survivors". Inquistr. Retrieved May 1, 2020.
  36. "Israel's dilemma: Can the unvaccinated return to workplaces?". AP NEWS. 2021-04-02. Retrieved 2021-04-04.
  37. Roth, Kenneth; Sparrow, Annie (April 28, 2020). "Should People Without Coronavirus Antibodies Be Second-Class Citizens?". The New York Times. Retrieved May 1, 2020.
  38. Phelan, Alexandra L (May 2020). "COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges". The Lancet. 395 (10237): 1595–1598. doi:10.1016/S0140-6736(20)31034-5. PMC 7198144. PMID 32380041.
  39. Anika Klafki, "Der Immunitätsausweis und der Weg zurück in ein freiheitliches Leben", Verfassungsblog (in German), retrieved 2020-07-10
  40. Persad, Emanuel: The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”). 2020, p. 2241.
  41. "IATA Travel Pass Initiative". IATA. Retrieved 2 April 2021. A global and standardized solution to validate and authenticate all country regulations regarding COVID-19 passenger travel requirements. IATA Travel Pass will incorporate four open sourced and interoperable modules which can be combined for an end-to-end solution
  42. "Digital Covid-19 vaccine passport likely to be essential for future international travel". RNZ. 26 March 2021. Retrieved 2 April 2021. With a trans-Tasman bubble expected to be in place by the end of April, Air New Zealand has already confirmed it will trial the IATA Travel Pass on its Auckland to Sydney route next month.
  43. Ian, Sample (1 April 2021). "Pfizer vaccine has 91% efficacy for up to six months, trial shows". The Guardian. Retrieved 3 April 2021. He said scientists had become “terribly worried” about the variant’s ability to evade immunity from previous infection or vaccination. “Studies like this confirm our sense that the vaccine gives such massive protective headroom that even with some loss of immunity, you’re still safe,” he said.
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