COVID-19 vaccines are a bright, if inconsistent, ray of hope in the dark fight against the pandemic. With more than one billion vaccine doses delivered worldwide and more than half of all U.S. adults having already received at least one dose, the possibility of reaching widespread immunity is moving closer to reality. However, the continued roll-out of the vaccines brings with it a set of vexing questions.
Should vaccinated people be able to move more freely than those who are unvaccinated? Should businesses or governments mandate or regulate proof of vaccination for certain services or entertainment in the name of public health? Can proof-of-vaccination systems be implemented equitably for communities of color that have borne the brunt of the pandemic without compromising individual rights?
Decision-makers must consider a series of principles in rolling out any proof-of-vaccination system, starting with equity.
As representatives of an organization committed to human rights – including the universal right to health – and the promotion of science-driven public health strategies, we believe the answers to these complex questions depend on the underlying circumstances in which vaccine “certificates” or “passports” are conceived and implemented. Decision-makers must consider a series of principles in rolling out any proof-of-vaccination system, starting with equity.
Whether you call them passports, certificates, or something else, one thing is certain about proof-of-vaccination systems: if the vaccine is not reaching communities equitably, requiring proof of vaccination cannot be done fairly. As of April, 83 percent of vaccines globally had been administered in high- and upper-middle-income countries, compared to just 0.1 percent in low-income countries. As long as global vaccine distribution is so dramatically skewed toward rich countries, vaccine certificate requirements for international travel and commerce will be inequitable. Broader global vaccine availability, as advocated by the People’s Vaccine Alliance, is an ethical and public health imperative. Equitable access to vaccines would also lay the groundwork for more equitable vaccine certification systems.
Disparities sadly abound within countries as well. Take the United States as an example, where Black and Latinx people continue to have lower vaccination rates relative to their population size, an affront made worse by the disproportionate COVID-19 burden these communities have borne. As is the case in the global context, achieving greater in-country and local equity in vaccine distribution would help build a stronger foundation on which to develop fair, rights-respecting vaccine passport mechanisms.
As long as global vaccine distribution is so dramatically skewed toward rich countries, vaccine certificate requirements for international travel and commerce will be inequitable.
The specific platforms used for vaccine passports can introduce additional considerations. Digital systems are convenient for those who have access to smartphones, but paper forms must be accepted to accommodate people who do not have the necessary technology or do not trust digital systems that, if unchecked, can create privacy concerns. Millions of Americans do not use the internet. The perception of passports as surveillance systems must be addressed by setting up strong guardrails that prohibit the use of people’s vaccine status for anything other than allowing them to access a specific space or service, backed by explicit written policies that prohibit the use of vaccination status systems by immigration or law enforcement officials.
While these equity and privacy concerns are major civil and human rights issues, as public health practitioners we also see the value of demonstrating immunity as a tool to enhance social and economic activity while limiting the spread of COVID-19. But based on current research, a vaccinated person may still be able to transmit the virus, though to a much lesser degree and with extremely low infection rates. If scientific evidence eventually confirms that transmission by vaccinated people is minimal, and that vaccine-based immunity holds up over time and against an increasing number of virus variants, the case for employing vaccine passports will be stronger. In the meantime, as some early-adopting countries and U.S. states roll out vaccine passes, these systems must not substitute for existing and proven COVID-19 mitigation strategies, such as mandated mask-wearing and social distancing.
These pitfalls are significant, but they should not cause us to throw up our hands and dismiss vaccine certification systems, nor give up on the important task of simultaneously protecting public health and rights during this unprecedented pandemic. Public health best practice and individual rights can and do coexist, and can be merged to create useful, rights-based systems. If we follow evolving public health guidance, invest time and resources to address inequities in vaccine distribution and availability, and incorporate strong privacy protections, we will move closer to creating fair and trustworthy proof-of-vaccination systems. If these efforts fall short, vaccine passports will be another in the long list of ways in which COVID-19 has magnified inequities that conspire against the right to health.