Approach vaccination passports with caution

With the rollout of several efficacious vaccines in more and more countries and the concerted efforts of people to overcome the COVID-19 pandemic and return to normalcy, the issue of vaccination passport is being discussed across the world.

A vaccination passport is a documentation certifying that the bearer has been vaccinated against COVID-19 and is safe to travel within as well as outside a country. This will ease restrictions on travelers and help reopen economies without compromising public health.

In some countries such as Israel and Denmark, vaccination passports are being used as an entry ticket to restaurants, theaters, and sports and entertainment venues. And the European Union is mulling issuing "Green Digital Certificates" to people who have been vaccinated so they can travel freely within the EU.

But despite the vaccination passport being touted as a key to reopening the global economy, the issuing of "green passes" to vaccinated people at a time when the rest of the population still faces restrictions has been quite controversial. Thus vaccination passports should be approached with caution.

How efficacious are COVID-19 vaccines?

Foolproof evidence that vaccines prevent or at least substantially reduce transmissions is required to legitimize the use of vaccine passports. Scientists are not certain about the duration and extent of protection vaccines provide against infections, particularly against new variants of the virus. What is more or less clear, however, is that the severity of the disease reduces dramatically in a person who has been inoculated.

Although vaccinated people will be less at risk of contracting the virus, they could still carry the virus and infect others. According to Rebecca C.H. Brown, Dominic Kelly, Dominic Wilkinson and Julian Savulescu, of the University of Oxford, "Evidence from previous work with seasonal coronaviruses and studies of SARS-CoV-2 vaccines in macaques suggests that previous infection or vaccination might protect from severe disease, but an individual might nevertheless carry the virus at similar levels, and for a similar duration, to those previously uninfected, with an unchanged potential for transmission."

To make the vaccine passport an effective and safe tool for reopening the global economy, there is a need to first determine that individuals allowed to travel from one country to another will not spread the virus. As we are still uncertain about whether or not vaccinated individuals can contract COVID-19 and yet be asymptomatic, and in turn can transmit the virus to others, mandating vaccine passports as a "green pass" for overseas travel would be tantamount to compromising public health.

The move, in fact, could backfire as it could lead to a false sense of security that the vaccinated individuals are no longer at risk of transmitting the virus, which, according to infectious disease expert Abdu Sharkawy, of the University of Alberta, Toronto, can create serious outbreaks, affecting mainly the non-vaccinated population.

Move could exacerbate inequity and unfairness

Vaccination passports could also lead to disparity in individual rights, obligations and privileges, thus creating a series of problems related to privacy, legality and ethics. In particular, it could create ethical problems, as it could exacerbate inequity, unfairness and discrimination.

To begin with, due to inadequate vaccine supply, vaccine distribution is inequitable at both the global and domestic levels. At the global level, wealthy countries, which account for just 16 percent of the global population, have acquired about 60 percent of the COVID-19 vaccines, while most of the developing countries have not been able to vaccinate even their priority groups.

At the domestic level, even in some developed countries, only a few key groups have been vaccinated in the first phase due to vaccine shortage, leaving most people below the age of 50, especially those below 18, vulnerable. Many people cannot be vaccinated for health reasons, such as allergies, pregnancy, or immune system problems. Such people, no matter how old they are or which country they belong to, cannot be vaccinated.
Additionally, many people across the world are not trustful of vaccines and refuse to take the jabs for religious and/or cultural reasons.

Undue privilege for people from developed countries

As such, vaccination passports will offer undue privileges to those who have easy access to vaccines, which in a way will be a discrimination against people who have not been vaccinated due to any of the above reasons. To put it simply, vaccination passports could widen the societal rift, and exacerbate inequity and unfairness.

More important, vaccination passports would be especially inequitable and unfair for the least-developed countries in that their citizens would be denied permission to travel to other countries. It could also, according to Shannon McMahon, of The Washington Post, "create an unethical global incentive for inoculating travelers before prioritizing doses for at-risk populations in poorer countries with less access to vaccinations". In fact, most of the least-developed countries are not likely to roll out extensive vaccination programs this year for want of vaccines.

Mike Ryan, the World Health Organization's Health Emergencies Programme executive director, also said: "If access to vaccine is unequal, then inequity and unfairness can be further branded into the system." That's why the WHO is not supportive of the vaccination passport system.

Restricted use of 'privilege travel'

On the one hand, given the fact that vaccines are mostly efficacious in protecting people against coronavirus infection, the bearers of vaccination passports who have tested negative for the virus should be allowed to skip quarantine on entering a country but still wear a face mask and maintain social distance. This is vital to restoring normalcy in countries that have managed to more or less contain the spread of the virus.

On the other hand, the vaccination passport system should be a complementary rather than an exclusive tool for easing travel restrictions and reopening economies. For people without an access to vaccines, a system of showing negative COVID-19 test results should serve the same purpose. And for the sake of equity and fairness, people should be allowed to use multiple tools to furnish information about their health status.

Yoav Schlesinger, principal of AI Practice at Salesforce, Columbia University, explaining the broader idea of digital health credentials, said: "From our perspective, one of the most critical elements of this safe return back to 'normal' is that digital health credentials incorporate much more than just vaccine status. Digital health credentials need, from an equity standpoint, to allow people to demonstrate their health status through a negative COVID test, through proof of recovery and antibody tests, etc."

In other words, there is a need to adopt an inclusive approach to health credentials without being caught in an ethical dilemma. Only in this way can we strengthen our pandemic response, accelerate economic recovery, and boost public confidence in the global fight against the virus.

The author is a professor at and director of the Center for Global Governance and Law, Xiamen University of Technology. The views don't necessarily reflect those of China Daily.