In the race between COVID-19 vaccinations and the spread of new mutations, a new dividing line has emerged over digital vaccine passports.
Supporters say digital vaccine passports will offer proof of vaccination to businesses, universities and medical professionals. Detractors say digital vaccine passports will replace mask mandates as the latest ideological bugaboo that could heighten vaccine hesitancy. Others worry digital vaccine passports might reinforce existing social inequality, including access by minorities to vaccinations.
After receiving a COVID-19 vaccine, people now get a piece of paper, often a card, indicating when they were vaccinated, the type of vaccine administered and who gave the shot. The paper document bears the logo of the Centers for Disease Control. It is the only evidence anyone has of their vaccination status.
The Vaccination Credential Initiative, a public-private collaboration that includes IBM and Microsoft, wants to create digital proof of vaccination to replace paper records, which can be misplaced or forged. New York is the first state to adopt digital vaccination proof in the form of a smartphone app, which can be used to gain admission to venues or to satisfy employers. People with negative COVID-19 tests also can use the app. Hawaii’s governor has authorized a digital vaccine passport to go online by this summer to help visitors avoid minimum quarantines.
The World Health Organization has established a work group to create common standards for digital vaccination certification that would take into account privacy, security, authentication and data exchanges for COVID-19 and other immunizations.
However, deeper concerns surface over a database of digital vaccination documentation. “We’d be moronic not to set up a system that doesn’t permit re-accessing who might need a booster shot,” says Arthur Caplan, a founding director of New York University’s Division of Medical Ethics.
The specter of a national database is what has spooked political opposition, especially by conservatives. The Republican governors of Texas and Florida have already issued executive orders banning any requirement for digital records, claiming that would infringe on individual freedom and privacy.
Civil rights groups also have sounded an alarm over the potential for misuse of digital vaccination records to deny access or discriminate in hiring or housing.
Referring to ‘digital vaccination passports’ has been especially problematic. “That’s what makes people nervous, and it’s a term that we should stop using domestically,” said Caplan, who uses ‘vaccine authentication’ and ‘certification’ to describe digital proof of vaccination. Caplan and others say it is vital for the public health of the nation to avoid polarizing another element in the battle against COVID-19.
President Biden seems to adhere to that logic by declining to endorse digital certification and declaring there are no plans for a centralized federal vaccination database. Biden’s press secretary Jen Psaki said, “We believe it will be driven by the private sector.”
Businesses such as restaurants, hotels, cruise ships and airlines are pushing for some type of reliable evidence of vaccination, which they view as a key to reopening or expanding their capacity. Many universities plan to require proof of vaccination before allowing students to return to campus this fall. Recent polling shows 63 percent of Americans favor some form of digital vaccination verification.
At the center of the issue is the national effort to achieve herd immunity, which may require 85 percent of Americans to be vaccinated. As a record 5 million vaccinations were administered in the United States in a single day over the weekend, public health officials say the priority is to get as many people vaccinated as soon as possible. So far, more than 72 million Americans have been fully vaccinated, representing nearly 22 percent of the population. Resistance to digital verification of the vaccine may serve as a further excuse to refuse vaccination.
“Unfortunately, it’s just another instance in which public health around COVID-19 has been extraordinarily politicized,” says Eric Feldman, a professor of medical ethics and health policy at the University of Pennsylvania Carey Law School. “We’ve seen what happens with mask mandates, where reluctance turns into outright refusal, revolution and fury among people who feel like their civil liberties and their fundamental rights to make decisions about their own health and well-being are being challenged.”
There can be ethical questions about what amounts to a two-tier system of Americans who have been vaccinated and those who haven’t. Feldman said he expects cases to be litigated over limiting or forbidding access for failing to have proof of vaccination.
Concern over digital records and vaccination mandates tend to overlook current practice and history. CDC oversees a digital database to record immunizations for children to help healthcare providers and families stay up to date on necessary immunizations. The US Supreme Court in 1905 upheld the constitutionality of mandatory smallpox vaccination programs. In 1922, the high court dismissed a case from Texas where a parent sued because her student was excluded from public school for failure to present proof of vaccination. Schools still require proof of immunization for mumps and measles.
Anyone with a driver’s license or car registration is on a database that law enforcement officials can access to track down a name, an address and a picture. There is a computerized National Driver Register maintained by the National Highway Traffic Safety Administration of drivers who have had their driver’s license suspended or revoked or who have been convicted of a serious traffic-related offense.
One workaround being tossed out is an opt-in system, much like the TSA PreCheck that lets passengers through airport security lines quickly or a QR code used by cruise ships to check passengers in and off a vessel. The information is stored online, encrypted and only accessed to show verification.
“This isn’t to penalize those who don’t vaccinate,” Caplan says. “It’s to reward those who do and for the government to be able to keep track so we can respond if there’s a new outbreak or we need boosters.”
Efthimios Parasidis, a professor of health services management and policy at the Ohio State University College of Public Health, says, “There must be a fair balance between public health, individual choice and other aspects of society and health privacy.”
“There must be a fair balance between public health, individual choice and other aspects of society and health privacy.”
Some public health experts warn a debate over a national vaccine registry isn’t worth the risk of stirring up a political fight. They say a better approach is to offer incentives to be vaccinated. That appears to be the general approach the Oregon Health Authority wants will pursue to convince older adults in rural parts of the state to get the shot. OHA officials say they want to make getting a shot as easy as buying a lottery ticket.