Immunity passport, or immunity certificate, a digital corona passport, has been announced by some countries to ease travel restrictions amid the COVID-19 pandemic. The passports, also called risk-free certificates, would identify and share the immune status of an individual vis-à-vis SARS-CoV-2. The idea is to enable individuals to travel or move freely supposing that they are not likely to get re-infected or to transmit the disease. Identification and documentation of immunity is seen as important for the return of normalcy enabling people to meet and conduct business.
Many countries including UK, Israel, Greece, Poland, Spain, and Sweden are on track to produce immunity passports. In the absence of an agreed international standard, going forward with the implementation would be difficult. The move has sparked off a controversy on ethical and scientific grounds. The World Health Organization (WHO) has issued a warning against such certificates.
How It will Work
These digital passes will either be maintained through a smartphone application or through a digital wallet. These risk-free certificates would tell the authorities whether the person is eligible for travel. It would attest one of the following things about the holder of the document—whether the person has:
(i) been tested negative for Covid-19 virus;
(ii) recovered from the virus;
(iii) been vaccinated for the virus.
In Israel, this document will also exempt individuals from quarantine during travel.
Similar Initiatives
This idea of a vaccine-related ‘passport’ is not new. The International Certificate of Vaccine or Prophylaxis (ICVP), also called the ‘yellow card’, is produced by passengers when travelling to certain countries, as proof of vaccination against yellow fever, rubella, cholera, or malaria. While this system of documentation exists, immunity passports will be the first initiative to make the information digital.
IBM (International Business Machines Corporation), an American multinational technology company is working to create digital passes including information on temperature checks, virus exposure status, virus test results and status of vaccination. These passes will enable people to access public places.
The Commons Project foundation (a Swiss-based group) has been working towards developing a digital health pass, called, the ‘CommonPass’. These passes would enable travellers to access and produce test and vaccine status-related information to authorities through a QR code.
Denmark is expected to launch the first version of immunity passport by May 2021. Estonia announced in 2020 that it was testing a digital immunity passport to facilitate a safe return to workplaces after the lockdown. In April 2020, Chile announced a plan to issue immunity passports to those who had recovered from the viral disease. UK has entered the initial live testing stage for the Covid-19 immunity and vaccination passport. It has been developed by Mvine and iProov jointly and backed by Innovate UK. Efforts have been made to document immunity data while ensuring that there is no breach of privacy. After the completion of two trials, the passport which does not require the user to possess smart technology is to be rolled out along with an increased vaccination drive. The passport was initially announced in April 2020. The International Air Transport Association (IATA), a global aviation body, is set to launch its digital travel pass, according to a report in February 2021. The travel pass would store information relating to travellers’ details vis-à-vis health, COVID-19 diagnosis and vaccination, travel, etc. It can be saved on the phone as a mobile app. Other international airlines like Emirates and Etihad are also adopting similar digital passes.
Advantages
Immunity passports, or risk-free certificates, are aimed at easing restrictions on people. Such passports can be used to identify individuals who are at reduced or low risk of transmitting infection. By reducing the risk of infection, these passports will enable free movement. Restrictions on movement of people are imposed to reduce the risk of contagion. The risk of transmission of the virus through immune individuals is very less so any restriction imposed on them would prove unethical or unjustified. However minimal, the economic benefits of allowing certain individuals to travel and return to work will prove beneficial to the society. Also, immune health-care workers can provide service without fear and small businesses can be reopened with immune members. There are challenges in measuring and inferring immunity to SARS-CoV-2 but these could be overcome in the coming months.
Challenges
Concerns of immunity passports relating to use are as follows:
- Issues Regarding Immunity
In infection-related immunity, the degree of immunity induced is not known. While most of the people who have recovered from the virus have antibodies, it is not certain whether this prevents symptomatic disease or just reduces its severity. Uncertainty persists regarding the immune responses to the virus. It is not clear whether such people can carry the pathogen and transmit it. Another issue is the duration of immunity that can be attained after recovering and having antibodies.
In fact, much remains to be understood regarding the spread of the virus and immunity to it. Without adequate knowledge on the spread of the virus and immunity to it, categorisation of people as immune or non-immune becomes difficult. It can lead to dangerous consequences.
According to World Health Organization (WHO), using immunity passports could lead to a risk of continued transmission. There is no evidence at present that people who have recovered from COVID-19 and have antibodies to the disease are protected from a second infection. Studies have not evaluated whether the presence of antibodies to SARS-CoV-2 gives immunity to subsequent infections. The certificates could also create a false sense of security, making people complacent and ignoring health and safety protocol. Laboratory tests, such as, rapid immunodiagnostic tests and detecting antibodies need to be validated further to determine how accurate and reliable they are. Otherwise, they may falsely categorise those who have been infected as negative, and those who have not been infected as positive. So, any immunity passport, issued at this stage, cannot guarantee accuracy.
- Using Vaccines as the Base for Such Passports
Vaccines can make immunity possible for the whole population. The pattern and duration of immunity is more predictable in vaccine-induced immunity but timely access to vaccination remains an issue. Inadequate data regarding the efficacy of the vaccines also pose difficulty in using vaccines as a base for immunity passports.
- Privacy Concerns
Concerns of privacy relate to the possibility that such records can lead to monitoring of people’s movement and health statuses. The UK has insisted that its system will not capture or store any identity data; it will use ‘an abstract mathematical model’ of the user’s face using artificial intelligence (AI), to work out a set of numbers to represent them—unique to a person. The number will be linked to the test or vaccine reference number of the person. Protection of privacy has to be ensured and fraudulent passports should be checked.
- Other Concerns
Issuing of immunity passports would add another layer of bureaucratic paperwork which will further complicate the situation. Issuing these passports might intensify the existing inequalities in society. Categorising people as immune and non-immune may also cause resentment among the people of the community and provide for stigmatisation. Permitting immune persons to exercise more freedom than those who are not immune would compound the existing structural disadvantages and social stigmatisation. Importantly, prevalence of immunity varies from place to place. There are also doubts raised regarding the economic benefits of having such passports.
When research finds reliable data on immune response to Covid-19
and the ability of identifying immune individuals develops, immunity passports can be introduced. Moreover, these passports must be subject to amendments and cancellations, and integrated with measures like physical distancing and contact tracing in order to keep people safe.
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