The case, ethics and politics of vaccine certificates – By Prof. Oguamanam
On February 21, 2021, Israel introduced Green Passes, which are required as evidence of COVID-19 vaccination or presumed immunity against the virus by the pass holder. This form of certificate is called by several other names most notably, immunity passports. According to GAVI, “an immunity passport is an official document that certifies an individual has been infected and is purportedly immune from SARS CoV-2”. Israel’s launch of green passports may have received perhaps greater publicity than others. For instance, Saudi Arabia introduced the scheme earlier in January 2021. Other regions, and countries including the EU, Estonia, Sweden, Iceland, Denmark, Hungary, Lithuania, the UK, Canada and counting are either in the process of pilot-testing or considering introducing a digital COVID-19 vaccine certificate.
The idea of COVID-19 vaccine certificate is a response to global lockdown fatigue and the desperation of citizens, corporations and governments to get back to some sense of normalcy, and to open up the economy. Understandably, it is being pushed primarily by stakeholders in international travel, including airline associations, hotels and several actors in the tourism value chain. It is not as if the vaccine certificates are novel idea. On the contrary, the WHO initiated the International Certificates of Vaccination or Prophylaxis (ICVP), also called Carte Jaune/Yellow Card, for a range of vaccines including yellow fever against specific viruses of epidemic proportions, which are limited in geographical spread. But COVID-19 is a global pandemic. All policies associated with its containment have expectedly taken a global dimension, escalating ethical concerns and vulnerabilities on a correspondingly global scale, and requiring the need to craft global standardised accommodation for all contingencies and to mitigate inherent ethical risks.
Many are wondering whether vaccine passports or certificates should be accorded the priority currently ascribed to them by many countries at this point. The concern is that too much focus on the project risks distracting attention away from real priorities, such as tackling persisting vaccine nationalism, which now constitutes an obstacle to aggressive vaccination to achieve global herd immunity. Herd immunity at a global level would render mute the idea of a vaccine certificate. Another important competing priority is the intensification of research on second generation vaccines for emergent COVID-19 variants of concern, now threatening to torpedo progress on vaccine development. In addition, generally, the focus should be on tackling the broader social and extremely disruptive effects of COVID-19.
There is a strong argument to me made for some form of certification of vaccination, especially for international travel and border control as a strategy to stem the spread of SARS CoV-2 and its variants. In this regard, the WHO is currently partnering Estonia on a pilot COVID-19 vaccine certificate project with potential for global standardisation and adoption. The project is based on each individual country’s input, including certified list of health care providers or authorised entities to issue the certificates in participating countries in order to build global credibility over authenticity of source. Another emergent feature of the new arrangement is that blockchain technology and its cryptographic integrity for data protection and monitoring may be included to ensure the security of personal and health data of certificate holder. Such data is to remain with the certificate holder as original owner and its source.
As many countries signal their interest in digital vaccine certificates, it is important to note that the project raises more ethical and governance concerns at the national and sub-national levels. The Israeli example provides some insights. Candidates can download an app on their mobile device and put in some personal information to generate a QR Code, which they can swipe to access public spaces such as pubs, gyms, hotels, theatres, etc. Accommodations are made for those who do not use mobile devices; those have the option to generate and print their own bar codes on hard paper or to receive the certificate via mail – electronic or conventional. Evidently, there is a lot of technology involved, requiring interoperability and collaboration with private operators of public spaces in which citizens are required to negotiate their civil liberties with risks to privacy rights and potential for stigmatisation. Experience has shown that governments do not have good track record of electronic or digital services delivery. Issues may arise in regard to undocumented residents and citizens or migrants with limited digital literacy. Also, while much fuss is made about those who voluntarily reject vaccination, not much is heard about those who cannot take the vaccines for other reasons such as pregnant women, children, and other reasons where there is insufficient data to prove safety of vaccination, not to mention autistic citizens, people with breathing difficulties, and those on immunosuppressants.
At national and international scales, digital vaccine certificates could be a costly venture on many fronts. Financially, it may result in a waste or diversion of resources. First, given that all vaccine approvals so far are on an emergency basis, it is not clear the duration of immunity associated with the current vaccines. With the increasing discovery of highly infections variants, it is not known the extent to which the emergent strains could compromise the efficacy of the vaccines. On a positive note, should vaccination campaigns result in early attainment of herd immunity, funds spent on digital vaccines certificates may not be worth the trouble. On a related matter, there is no guarantee those vaccinated or those with antibody-mediated immunity cannot still shed the virus and sustain continued risk of its transmission, albeit on a less lethal scale. Because of these unknowns, Israel’s Green Pass has a “shelf life” of six months. It is assumed that after that period, pass holders will enter into another bureaucratic, yet unknown cycle of re-validation.
Perhaps, the most agitating aspect of digital vaccine certificate is its potential to serve as a real or potential coercive strategy to rein vaccine holdouts or vaccine hesitancy. As a coercive strategy, digital vaccine certificate could be counterproductive on many fronts. First, vaccine sceptics may be inclined to procure the certificates fraudulently as Israeli’s short experience indicates. Second, they may be inclined to be deliberately infected in order to acquire antibodies. Third, certificates may create a sense of false confidence. None of these scenarios is ethical. Fourth, as a coercive tool, vaccine certificates could amplify mistrust, stoking suspicion and escalating social divisions. As evident with the politicisation of mask wearing in the United States, digital vaccine certificates – if not handled with ethical due diligence – may play into the hands of conspiracy theorists who have linked the pandemic to an Armageddon and a satanic global world order foretold.
While there are both economic and pragmatic imperatives for digital vaccine certificates, those do not resonate on an equal basis in international and domestic or sub-national contexts. In order to move forward with the project, it must not be at the expense of ongoing priorities in the fight against COVID-19. Digital vaccine certificates must be implemented under a global standardised framework that accommodates legitimate exemptions. It must not serve as a tool to escalate social and ideological tensions, nor one for discrimination or stigmatisation against the most vulnerable. Those include categories of peoples who for reasons other than vaccine hesitancy cannot be vaccinated. They also include travellers from the most impoverished parts of the world whose inability to be vaccinated is owed to current vaccine nationalism, through which developed countries have ratcheted up a superfluous stockpile of vaccines.