The Time Relevance of Vaccine Passports

Imagine a world where you will be required to verify your immunity to a virus wherever you go – work, restaurants, movies, buses, trains, flights, that is, all public places. Depending on where you live, a developed economy like the United States or the United Kingdom, or a low and middle-income country like Sub-Saharan Africa, this process could appear seamless or tedious. 

Vaccine passports will be your pass to any public and private space in the post-pandemic world. These can be as simple as QR codes on your mobile phones to traditional paper records of your COVID-19 vaccination status. Such an identification system could be a foundation for Digital IDs, a tool much needed in low-and-middle-income countries. Lack of identification mechanisms deprives the vulnerable to exercise social, legal, and political rights. Not only will they provide access to identity and services to the poor, but these also will ensure better research and accountability. 

The debate around identification systems has taken the shape of vaccine passports in this pandemic era. But vaccine passports are not new to us. The World Health Organization (WHO) recommends certificates for vaccination against yellow fever, and they have been in place well before the COVID-19 pandemic. If you decide to travel to South American or African countries, such a certification is mandatory. Visitors of Hajj have to show vaccination certification for Meningococcal Meningitis before entering Saudi Arabia. 

For one, vaccine passports could incentivize people to take their jabs on time. It will ensure individual and public immunity, reaping positive externalities. Vaccine certification is a better alternative than immunity certification, which in turn incentivizes infection than protection.  

If the pandemic were to continue for the next two to three years, which might be the case in developing countries like India, vaccine passports could substitute lockdowns down the line. Even medical researchers are debating how the subsequent phases of this pandemic will look. The notion of “herd immunity” – depending on how contagious the virus is, 50% to 90% of the population immunized before the infection rates decline – is yet to withstand the test of time. For COVID-19, at least 70% population needs to be immune to reach this so-called herd immunity. 

As of May 12, 2021, 8.66% of the world’s population have received at least one dose of vaccination, and only 4.27% have received all the prescribed doses. Though the developed countries have a higher vaccination rate than the developing countries, covering a significant proportion and reaching marginalized populations will take at least 2 to 3 years. And while we are at it, vaccines are becoming less responsive to new variants, and most of them will require additional dosages in the coming months and years. 

Vaccine passports have and will come in various shapes and forms. The European Union is working towards a Digital Green Certificate, while Denmark plans to introduce Coronapas linked to NemID. Israel, which has one of the highest vaccination rates, already has a Green Pass for those fully vaccinated. Estonia, one of the most advanced digital economies, will be using QR codes as verification mechanisms. These countries have the advantage of secure digital IDs in place, well before the pandemic. 

On the other end of the spectrum lies countries like India, one of the worst affected countries by the pandemic, where the vaccination drive is yet to gain momentum. Though India has Aadhaar Cards, its version of Digital ID systems, it has faced discrepancies in issuing vaccination certificates. Errors in vaccination details, such as date of dosage and language of issuance, cropped up. Some received vaccination certificates without being vaccinated, while others, even though vaccinated, failed to receive any certification. It is a marker of vaccine hesitancy on the part of the citizens and inefficient administration on the part of the government, leading to such inconsistencies.

Inequitable access to vaccine passports can also come from inequitable access to vaccines. The rich nations have ordered vaccines much more than required. As of January 25, 2021, Canada had hoarded 9.6 vaccines per person, the UK had 5.5 vaccines per person, and the USA had 3.7 vaccines per person. Amid this, the Covax scheme, co-led by the World Health Organisation (WHO), the Global Vaccine Alliance (Gavi), and the Coalition for Epidemic Preparedness Innovations (CEPI), enabled redistribution of vaccines by delivering more than 49 million doses to developing countries. 

Inequities can also arise in cases of existing medical conditions and pregnancy that exempt people from taking vaccines. Pregnant women can still be eligible for vaccinations once they have delivered and are lactating. In the light of this, vaccine passports will have to factor in exemptions and the validity of such exceptions. It will require much more sophisticated identification systems to be put in place, keeping track of exclusionary cases. There will also be a requirement of tracking booster shots in the coming years, which the developers can introduce in the form of updates to applications and QR code scanners. 

While vaccine passports pose a threat to free mobility and equitable access to identification systems, they are bound to create disparities among communities. Vulnerable sections of the most developed and developing societies – elderly, migrants, and low-educated populations – will be the ones bearing the loss.  

There are also issues concerning data privacy. With the increasing interests of private companies such as Oracle, Microsoft, Google, and Salesforce in creating vaccine certification systems, data privacy will be an issue. The enthusiasm of these companies also suggests that vaccine passports will become another prerequisite to going back to offices and applying for new jobs. Federal Digital IDs are safer but not the safest alternative. India’s Aadhaar Identification has faced several data breaches in the past. 

The time relevance of vaccine passports will face serious consequences, ranging from unequal access to vaccinations globally and within countries to vaccine hesitancy to administrative challenges in developing Digital IDs to data privacy issues. Even reaching “herd immunity” in the not-so-near-future will make vaccine passports redundant, at least for domestic use in developed economies. 

Though it can be an opportunity for low-income and developing countries to build a foundational identification system to ensure universal healthcare in the years to come, it is essential to combat the existing bottlenecks in vaccine distribution in these regions. With time and experience of upcoming phases and evolving mutations of COVID-19, we could design and renew vaccine passports for local and global use successfully.