You’ve likely heard that companies are now developing vaccine passports—also called immunity passports or vaccine certificates—to verify a person’s COVID-19 vaccination status, latest test result, or antibody test result. So you may soon be asked to scan a QR code on your smartphone to attend sporting events or concerts, cross borders, fly commercial airlines, and even enter a restaurant or your office building.
The idea is that this digital code will serve as proof of a vaccinated person’s limited risk to others and therefore be the key to returning to some form of prepandemic life. But some experts and organizations have concerns about privacy—as well as the passports’ potential to further inequities in the U.S. and globally.
“The vaccine is a fundamental way to end the pandemic,” Stefan Baral, M.D., associate professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health, tells SELF. So vaccine passports have been accelerated to incentivize getting vaccinated and ultimately increase vaccine coverage in the population. They can also be a way to protect essential workers by minimizing the risk they’re exposed to from the public, he says.
And while this may seem like a buzzy new concept, requiring proof of vaccination isn’t a new approach to public health, Brendan Parent, J.D., assistant professor in the division of medical ethics at NYU Langone Health, tells SELF.
For instance, the World Health Organization created the International Certificate of Vaccination or Prophylaxis, commonly referred to as a “yellow card.” This certificate has been in use since the 1950s as an official record of required vaccines, like those for yellow fever or cholera, for international travelers. In the U.S., the vaccine passports are similar to state mandates for the measles, mumps, and rubella (MMR) vaccine in children going to public schools, or workplaces that require an annual influenza vaccine.
What will vaccine passports actually be like?
On a global scale, the WHO has a Smart Vaccination Certificate Working Group that’s tasked with establishing global standards for those certificates. In the U.S., the Biden administration says that it won’t be authorizing a national passport app, according to CBS News, thereby leaving the task to the private sector, nonprofit organizations, and individual states.
Because there are currently no global or national standards for vaccine passport regulations, they may look and function slightly differently depending on where you are, at least for now. But in the future they will likely be more standardized once those regulations exist.
For instance, New York has already launched the Excelsior Pass, a pilot program using an app developed by IBM. The app provides a digital credential, similar to boarding passes on airline apps, that is now required for entrance at venues such as Madison Square Garden.
Walmart is partnering with the Vaccine Credential Initiative, which is a group of tech companies and nonprofits (including Microsoft and the Mayo Clinic) working together to build and standardize vaccine credentials. As a result of this partnership, those who get their vaccines at Walmart or Sam’s Club pharmacies will be able to easily report their health data to several passport apps, including one from airport security company Clear.
On the other hand, officials in Texas and Florida have banned local businesses and organizations that receive government funds from mandating the use of vaccine passports.
Why are some experts worried about the inevitable rise of vaccine passports?
Although vaccine passports are not a new idea, these are unique in that they’re being built into the architecture of our smartphones. NYU Langone’s Parent is opposed to the digital passport and is in favor of a physical credential—more like a driver’s license—because the digital option “introduces a lot more issues, including data privacy issues,” he says.
When vaccine passports or credentials do become available to you, the first question you want to ask is whether those credentials live on your phone or in a centralized database, Jenny Wanger, director of programs at the Linux Foundation Public Health (LFPH), tells SELF. (Linux specializes in open-source software and developing the ecosystem around software to make it successful.)
If the credential is stored in a centralized database, that database gets pinged every time someone scans the passport to see if it’s valid, Wanger says. That’s like the DMV getting an alert whenever you present your driver’s license in a bar. And if the passport system is centralized, then whoever holds the database can ultimately decide how your information is shared.
But “plenty of apps store data locally on the phone and never send it to a central server,” Wanger says, which means your privacy is better protected in those cases. If the credential is stored just on your own device, you’re in control of how and when your data is shared, just the way you’re in control of how the photos on your phone are shared. Plus, even if someone steals your phone, it would be much harder to gain access to password-protected information.
In addition to the privacy concerns, there are potential access and equity issues around vaccine passports. On a global scale, wealthier countries like the U.S. have bought up the majority of vaccine doses. While North America and Europe have already vaccinated around 31% and 18% of their respective populations, only 0.9% of the population of the continent of Africa has been vaccinated, according to the New York Times world vaccination tracker.
The inequitable access to vaccines means that vaccine passports could prevent millions of those in low- and middle-income countries from traveling. Unlike other vaccines needed for travel that are broadly available and can be administered upon arrival to the destination country, COVID-19 vaccine passports may be limited to those who can be vaccinated before travel. That means those in low- and middle-income countries will be disproportionately affected by the requirement.
Domestically, there’s concern around passport inequity due to the digital divide and limited access to smartphones for the elderly and historically marginalized groups, including those who are unhoused. Baral expects most people in marginalized groups will eventually be vaccinated, but “they are just going to have a difficult time showing proof of that.” This could become especially problematic if passports are required to access daily activities, such as entering a store or medical facility.
There are others who may not want to or be able to get the vaccines for medical reasons, such as pregnancy or certain health conditions or allergies, or for religious reasons. Colleges and businesses (such as Rutgers University and software company Salesforce) are already starting to require vaccines for people to return to in-person classes and work. In some situations, people can request a religious or medical exemption, but will those people be barred from aspects of normal life without a passport? That remains to be seen.
There are ways to address some of these concerns, but not all.
When you’re deciding whether or not to use a vaccine passport app, take note of how the app works, the information it requires, and where that information is stored. One thing Wanger and the group at LFPH are advocating for is that vaccine passports show “only the barest minimum of information. Just your vaccination status. Not your name or address or phone number,” she says. If you’re using the Excelsior Pass and were vaccinated at a state-run site in New York, for instance, you will be able to verify your identity before downloading your pass, so someone else shouldn’t need to check it.
In anticipation of the technology access issues, LFPH hosted a paper-based summit in March to make sure paper vaccine credentials—which don’t require a smartphone app—were part of the strategy, Wanger said. And for the Excelsior Pass in New York, vaccinated persons also have the option to print their QR code (though this still requires access to some technology). There will inevitably be disadvantages to the paper vaccine passport over a digital one, but it’s critical that there’s a carefully considered physical option that offers as much functionality as possible, Wanger says.
With regards to medical or religious exemptions from the vaccines, Wanger says the folks at LFPH are arguing that there should be multiple avenues to demonstrate a person’s limited risk and acquire a passport. For instance, a negative COVID-19 test can temporarily show a person is of limited risk, or an antibody test could show they’ve built up some immunity. “We want to create different paths for people to participate in the reopening of society no matter what,” she says.
On a global scale, Baral says that combining predeparture COVID-19 testing with vaccination on arrival could be one way to minimize risks without inadvertently limiting the movement of millions who don’t have access to the vaccine.
But ultimately this is an ongoing, developing issue in the U.S. and the rest of the world. Vaccine passports offer a crucial opportunity for some to return to some semblance of “normal,” but they come with complex risks for many others.
Correction: This article originally misspelled Jenny Wanger’s name and has been updated to correct that.
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