As vaccination programmes in Europe and America accelerate, there is increasing clamour for their benefits to be fast-tracked through the use of vaccination or immunity passports.
Much of the discussion has revolved around the regulation of international travel, with such passports seen as a potential alternative to testing or quarantine of travellers.
But alongside proposals for an internationally recognised scheme have been suggestions by several states on using vaccination status as a means of opening up their internal economies.
In keeping with their track record throughout the pandemic, the UK government has been sending mixed messages, with ministers contradicting each other over whether the introduction of such a passport system is being considered.
In early February, vaccines minister Nadhim Zahawi had ruled out their use, describing them as “un-British”, only for fellow cabinet minister Dominic Raab to claim not only were such documents being considered but that they might be applied internally to regulate access to places like supermarkets.
Cue Tony Blair writing in the Mail on Sunday, that Britain should lead the way in introducing just such a system for international travel.
Those with long memories will recall that the former premier has form in this field. In 2004, during the War on Terror, Blair led a bid to introduce compulsory ID cards which was eventually dropped after a revolt in the House of Commons.
In truth, the noise from the United Kingdom has been far from the most fervent around Europe, with many EU member states making tentative moves towards introducing different forms of vaccination documents.
In France, a proposed bill to allow restrictions to an individual’s freedom of movement based on immunity or vaccination status is being debated.
The issue has allowed Le Rassemblement National President Marine Le Pen to position herself as a defender of France’s traditional values, stating “There cannot be second-class citizenship for non-vaccinated people.”
Meanwhile, Cyprus – with an eye towards maximising summer tourism – has announced it will relax all entry requirements – including quarantine and testing – to those who have been vaccinated.
Hungary adopted this policy several weeks ago for its own citizens, with several other member states planning to follow suit.
Israel, which has progressed furthest with its vaccination campaign, will this week begin using so-called “Green Passes” to regulate access to gyms, hotels and music venues.
The passes combine personal details about the bearer (including their passport number and date of birth) with the all-important COVID-19 vaccination status.
But the rollout has already hit snags after a roaring trade in fakes was revealed being run off messaging app Telegram.
In response, Israel’s Ministry of Health has threatened to impose fines on those caught with a fake pass and insisted the security of the system will be intensified.
Requiring vaccination for unfettered international travel has some precedents, as in the case of yellow fever.
Since the publication of the International Health Regulations in 2005, annex 7, has made provision for countries where the disease is prevalent to require a record of vaccination for entry.
It has been mooted that the WHO could amend the annex to include COVID-19. However, it should be noted that the situation with coronavirus is not entirely analogous to yellow fever, for which under the IHR a single vaccine shot is considered to be valid for life.
All that is currently known suggests that COVID-19 will require an ongoing campaign of vaccination to cover new variants and seasonal spikes in infection; suggesting that any international vaccine pass could be a permanent feature.
The IHR provisions are aimed at preventing a local disease outbreak from going international, not as a means to manage an already global pandemic for the benefit of the tourism industry.
Requiring a vaccination record to participate in civil society is even more controversial.
In Poland, plans are to use a digital system, similar to Israel’s Green Pass, which is accessed via a QR code.
Poland’s Deputy Minister of Health Anna Golawska stated, “The document will be the so-called passport of the vaccinated person, which will confirm that the person has been vaccinated and can use the rights to which vaccinated people are entitled.”
This may be a clumsy translation. Nevertheless, fears are growing that allocation of rights may become contingent on carrying some form of ID which confirms a person’s vaccination status.
Some EU member states, however, have been more circumspect on the issue.
Earlier this month, the Deutscher Ethikrat (German Ethics Council) advised against granting any special privileges to those who have received a COVID-19 vaccine.
Highlighting the continued risk of transmission, the Council recommended that restrictions should only be lifted on a universal basis.
Considering the slow pace of vaccination campaigns across the European Union, not to mention that over 100 countries worldwide have yet to receive any vaccines, these announcements seem at best premature.
Much of the current reporting on vaccination-based immunity passports assumes that vaccination equates to no risk of transmitting the virus. This is far from being effectively demonstrated.
Although data out of Israel shows a promising drop in the rate of transmission as a result of mass vaccination, it is still not known whether any of the available vaccines confer sterilizing immunity to the person receiving the jab.
If they don’t, then while the threat of serious illness and death is significantly reduced, the risk of transmission will remain to some degree.
A vaccination certificate is not equivalent to a PCR test which can demonstrate the presence or absence of the virus.
Similarly, a serological test that could detect the presence of anti-SARS-CoV-2 antibodies lacks definitive value since it is again uncertain how long such antibodies are retained, and thus how long an immunity passport should be valid for.
Consequently, the rationale for restricting international travel to those who have received a COVID-19 jab is hard to justify in purely scientific terms.
While New Zealand, Vietnam, and Thailand have pursued so-called “zero-COVID” strategies since the onset of the pandemic – and as a result has maintained relatively low levels of community transmission – they are the exceptions.
Europe, North and much of South America continue to see high levels of infection.
Then there is the problem of the virus variants and the degree to which each vaccine is effective against them.
It’s known that the so-called South African variant shows some resistance, so much so that in the case of the Oxford/AstraZeneca vaccine, its roll-out was paused earlier in the month in South Africa itself.
Other countries have expressed scepticism about the British developed jab with several, including Germany, Belgium and France advising against its use for the over 65s over questions of efficacy.
The picture isn’t yet clear regarding which vaccines are most effective against the ever-broadening range of variants, which are spread across the globe from Brazil to South Africa and the UK.
How an internationally recognised and reliable system of vaccine passports would account for all this is unclear.
Nevertheless, the clamour for such a system is growing with international consensus nowhere to be found. Indeed, even the World Health Organisation seems split on the issue.
In January, the WHO Emergency Organising Committee stated its opposition to the prospect, only for its special envoy for the global response, Dr David Nabarro, to suggest in an interview with Sky News that “some sort of vaccine certificate no doubt will be important.”
The WHO’s public statement is also at odds with its own collaboration with the Estonian government on just such an internationally recognised system.
Passport to Profit?
As with the rise of vaccine nationalism, which briefly threatened to put a hard border on the island of Ireland, and is now threatening to exclude much of the developing world from the global immunisation programme, vaccine passports reveal the conflict over pandemic response.
The seemingly ambiguous position of the World Health Organisation reflects longstanding criticism that its focus on “global health security” ultimately amounts to protecting wealthy nations from the effects of emerging diseases originating in poorer ones.
We should remember that the political and ethical form of a project like health security depends greatly on the regime in which its goals are formed.
Like many transnational projects, global health is a highly contested space where the idea of a moral obligation to people in deprived parts of the world comes up against imperatives towards self-protection and self-interest.
As the vaccination programme gains pace, this conflict is also playing out at a national level between representatives of capital and those with a narrowly focussed concern on controlling the virus.
In November 2020, the International Air Transport Association (IATA) recommended a travel pass that would connect airlines with government authorised identity checks and accredited laboratories. in order to confirm a person meets the regulations for travel.
In an article for The Evening Standard, Editor-in-Chief and former UK Chancellor George Osborne waxed lyrical on the common sense necessity for vaccine status to be the gateway to “living a normal life”.
Despite recognising that the element of compulsion plays into the hands of conspiracy theories about forced vaccinations and social credit scores, Osborne was sanguine about the prospect of society becoming impossible without proof of vaccination.
The longtime critic of big government pointed out that many companies have made tentative moves to require vaccination to access services or even apply for jobs.
This latter prospect raises the spectre of “Immuno-capital”, as those with access to testing and vaccination leverage this privilege over disadvantaged communities.
Nowhere in Osborne’s article, or in any UK government statement on the issue, has the obvious conflict with current data protection laws, or a whole raft of anti-discrimination and human rights law, been raised.
It is unclear how governments with international commitments to prevent discrimination can adopt a vaccine incentive scheme that is openly discriminatory when healthcare regulators have already recommended that some groups (e.g. those with a history of severe allergic reactions) not receive certain versions of the vaccine.
Writing in The Lancet last year, Alexandra Phelan noted that immunity passports would impose an artificial restriction on who can and cannot participate in social, civic, and economic activities.
According to Phelan, such restrictions might create a perverse incentive for individuals to seek out infection, especially people who are unable to afford a period of workforce exclusion.
This would compound existing gender, race, ethnicity, and nationality inequities that the pandemic has already exacerbated.
Since vaccine confidence is lower amongst BAME communities raises the possibility that minorities – which have suffered greater hardship during the pandemic – will be excluded from the recovery and stigmatised as recalcitrant bearers of contagion.
The clamour of big business for vaccine passports is a desperate attempt to engineer a return to profit, but with seemingly little concern for the effect on inequality and privacy of the means for doing so.
Finally, most countries have adopted an age-based rationale for prioritising people for vaccination. The upside of this is that by summer, the most vulnerable across the EU should have been protected.
However, if the model of vaccine passports being pioneered by Israel and Poland catches on, we may be faced with the real prospect of young people having to watch from the sidelines as those already vaccinated start to take up their lives again.
Young people bear the least burden of the virus itself but have had to face the greatest burden and loss of prospects as a result of the pandemic response.
It would be a deep injustice if after sacrificing so much they were then shut out of society, even temporarily.
A criticism of the way the lockdown was relaxed last year is that it prioritised the economy over people’s lives. This time around, with the risk to life thankfully reduced, it may be decades of equality and human rights legislation that is under threat.
This should be a concern for everyone, as once the idea of assigning rights based on a person’s health status is normalised, what lies ahead may be a dark and slippery slope.
Photograph courtesy of Joel Schalit. Published under a Creative Commons license.