‘Vaccine Passports’ – balancing the benefits against the risks

Traveller carrying COVID vaccine passport
Dr Adrian Hyzler Chief Medical Officer at Healix International

Dr Adrian Hyzler
Chief Medical Officer

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Dr Adrian Hyzler, Chief Medical Officer at Healix International, provides his perspective on the current debate about Vaccine Passports ahead of the EU Commission’s proposals for a ‘Digital Green Pass’, set to be published on 17th March.

There’s no question that any initiative that can enable international travel without increasing the risk of infections from COVID-19 will be welcomed by the much beleaguered travel industry and all its associated services. But the lack of discrimination from COVID-19 – it affects every age group, every gender, every race, every socio-economic group – could actually be the potential for a very high risk of discrimination if ‘Vaccine Passports’ are adopted as the only way to allow international travel.

This form of immune-privilege will disadvantage a number of people

I want to be clear. I see no harm in a ‘Digital Immunity Certificate’, per se, for ease of verification of vaccination status, especially as this will be easier to verify by authorities and less susceptible to a range of forgeries or indecipherable documentation. However, I do worry about the further implications of a ‘passport’ or ‘green pass’ that enables those that are vaccinated to do things that others cannot. This form of immune-privilege will disadvantage a number of people, many of whom are already victims of inequity and discrimination, not just as a result of COVID, but dating back well before the pandemic.

In the last week European Commission President Ursula von der Leyen announced plans for the creation of a ‘Digital Green Pass’ for EU citizens to travel safely. The proposal is due on March 17 and is being developed in response to pressure from tourism-dependent countries to help them salvage the summer season. However, across the EU there isn’t currently a clear consensus on this approach.

A complicated global picture

Concerns about the impact on those not yet eligible or unable to have the vaccine have been raised highlighting the very complicated picture. And that concern must be recognised as a global issue.

For example, South Africa has declined to use its supplies of the AstraZeneca vaccine claiming that data shows that it is ineffective against the variant in wide circulation. So will they allow travellers who are vaccinated with this vaccine to enter the country? Ukraine, Lithuania and Poland have made a political decision not to allow the Russian Sputnik V vaccine to be used for their citizens – will they allow travellers entry who have received this vaccine? Slovakia, Hungary and the Czech Republic have authorised the Sputnik V vaccine from the Gamaleya Institute in Russia for their citizens, in response to the perceived slow rollout of EMA approved vaccines from the European Commission – will this be an accepted vaccine for the rest of the European Union member states? Similarly, Hungary and the Czech Republic have licensed the Chinese vaccines, Sinovac and Sinopharm, respectively…

It is in the interests of governments of countries that depend on tourism to promote means available to encourage travel

Of course, it is in the interests of governments of countries that depend on tourism for their economies and have been hardest hit by the devastating drop-off in leisure travel to promote whatever means are available to encourage inbound travel. Greece has led the drive in Europe and is lobbying the European Union to introduce legislation around ‘Vaccine Passports’ (VPs). Italy, Cyprus, Spain and Malta are supporting the Greeks – all are highly dependent on tourism revenue. Denmark is to introduce VPs this month and Sweden is soon to follow. However, the UK government has put on hold any decision on VPs, pending further discussion. The US has adopted a similar policy of further debate on the matter.

‘Vaccine Passports’ – what’s the answer?

There is undoubtedly a demand for a ‘Digital Immunity Document’ and this will simplify the process of: verification of inoculation; confirmation of positive COVID test within a time period of between 3 and 6 months; and COVID test notification. From an international travel point of view you could look at this as the equivalent of an airline’s app that enables you to store your boarding pass, airline membership card and flight details electronically. Some people use the electronic version but others continue with paper documentation and the process still functions.

Any such scheme will require close cooperation of governments in allowing access to an individual’s vaccination records

But let’s not forget that 3.4 billion people worldwide do not have internet access and over 1 billion people do not have a mobile phone of any kind. Therefore, any such scheme will require close cooperation of governments in allowing access to an individual’s vaccination records. And that, of course, brings up another issue – data privacy.

There are two further discussion points. The first is the concept of an electronic means of verifying ‘immunity/infection status’ as opposed to a paper document. The other more complex discussion, that is often confused by the concerns around the ‘passport’ or ‘pass’, is what will governments, organisations and businesses choose to do with that information. Will there be a requirement for vaccination for entry to a country/a restaurant/a gym/a music festival etc. or will it form one of a layer of requirements that will determine what restrictions will be required on entry? This implies that there will be a need for ‘immunity security’ to prevent entry for the unvaccinated – is this really what the hospitality industry wants?

My thought is that vaccination status should be one of the determinants of entry quarantine requirements, in combination with natural immunity and testing. The whole approach to prevention of COVID-19 transmission is dependent on layers of protection – it is not just about masking or physical distancing or even vaccination. No preventive measure is fully protective but each tool of prevention is layered on top of the next and together they form a stronger barrier.

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