Immunity passports and vaccination records have been occasionally discussed over the last year, but they are quickly becoming the new buzz word in the media.
With vaccine distribution increasing across the U.S. and around the world, we are already witnessing the U.S. Centers for Disease Control and Prevention relaxing its social distancing and masking recommendations for vaccinated people.
In light of these expanded freedoms, some are calling for proof of vaccinations with an increase in travel likely in the months ahead. For example, cruise lines are scheduling special cruises for the vaccinated only.
With that in mind, we must ask, “What are immunity passports? And what are the ethical implications associated with them.”
Like so many ethical questions, we have to start with definitions and facts.
The most common terms used in the media are immunity passport, immunity certificate, vaccine record, vaccine passport and vaccine certificate.
These are not interchangeable terms. Immunity and vaccination are not the same thing.
Immunity refers to the body’s natural response to create antibodies against a prior pathogenic infection. Immunity certificates have historically had mixed results.
With a history going back beyond the European plagues, these certificates are legal documents, completed by a government official or physician, certifying that an individual is immune to the disease in question and exempt from restrictions or quarantine.
While a good idea in theory, they have limitations.
They only work if public health workers know enough about the disease in order to certify that an individual is actually immune.
Plus, even if someone develops immunity, it is not always for a lifetime. This makes it difficult to track who has lost immunity.
Think in terms of the common cold. What good is it to say you are immune to the common cold if you get 2-3 colds a year?
The problem intensifies with more severe diseases like COVID-19. Antibody testing cannot determine how long someone will maintain immunity from COVID-19. The science is not in yet.
The other problem is falsification of documents.
Countless times throughout history, people of influence have bribed or pressured public health workers and physicians to certify immunity in order to avoid quarantine or travel restrictions.
Vaccination, on the other hand, refers to the administration of a vaccine or an inoculant.
Depending on the nature of the vaccine, it may only protect against symptoms. In addition, different vaccines have different efficiency rates.
For example, the annual influenza vaccine is only 40-60% effective. Vaccination may impart immunity but getting a vaccine does not guarantee immunity.
In this sense, the term “vaccine passport” is not appropriate. The idea here is that a vaccine grants immunity and, therefore, should permit freedom from restrictions. As this is not true, it is better to talk about a vaccine record.
A vaccine record is an official document that a vaccine was given by an appropriate health care worker and is a part of the recipient’s medial record.
The International Certificate of Vaccinations or Prophylaxis was developed by the World Health Organization and has been around since 1959. These records are useful, and have been used for decades, but they still have limitations.
Requiring an immunity certificate or a vaccine record to avoid certain restrictions raises several ethical concerns.
First, and most practical, is that this idea may be dangerous in our current circumstances.
It assumes that we know enough about COVID-19 in order to ensure that granting some people the ability to return to work, travel or avoid social distancing restrictions is safe and will not impact the spread of the virus.
That is a bold assumption, which has dangerous consequences if we are wrong. This is why it took the CDC so long to ease restrictions for fully vaccinated people.
We need time to look at the science and move forward with caution. With new data sets continually being analyzed, the guidance will likely continue to change.
Second, a vaccine passport creates a false sense of security.
The misconception of the vast majority of the public is that if you are fully vaccinated then you have immunity. Like the annual flu vaccine, this may not be the case.
A few years ago, I got the annual flu shot. Months later, I developed flu-like symptoms.
I did not go to the doctor, thinking that it either wasn’t the flu or that my symptoms wouldn’t be that bad since I was vaccinated. By the time, I went to the doctor, I had pneumonia and ended being admitted to the hospital.
Take my false sense of security about the flu and multiply the potential negative impacts given the severity to COVID-19. It’s a disaster in the making if we all assume vaccination guarantees safety without other continued mitigation efforts.
The third, and probably most morally significant problem, is the creation of an immune or vaccinated class.
I always tell my students that any time money changes hands, or a class distinction is made, we need to look for the moral consequences.
Vaccine passports are no different. They would create a class of haves and have nots. This distinction will most likely fall on economic and racial lines.
COVID-19 has reminded us of an unjust class divide both in the U.S. and globally. Vaccine passports would just make that divide wider.
While the CDC attempts to facilitate a fair distribution of vaccines, we are already seeing minority and low-income groups falling through the cracks. We are also seeing the wealthiest nations outpacing lower-income nations in vaccine availability and distribution.
So, while the more economically privileged are more likely to get vaccinated and return to work, working class people who are already financially struggling might have to wait longer.
This further widens the class divide and expands economic hardship on those who have sacrificed the most during this pandemic.
Vaccine passport supporters do not intend any of the above, but it is what always seems to happen when a class distinction is created.
Of course, vaccine passports might ultimately become necessary in order to get people back to work and to make international travel safer.
We know that we need to begin moving towards a new normal. People need to return to the office and factories. We need community social events again and, yes, we need to have church live and in person.
As we make this transition, however, we need to serious consider who is included and who is excluded, and for how long.
What seems practical today might have decades of consequences.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.
