WEDNESDAY, March 17, 2021 (HealthDay News) -- With tens of millions of COVID-19 vaccine doses going into American arms, pressure is mounting for a U.S. "vaccine passport" that would allow the fully immunized to travel freely and more easily enjoy other aspects of pre-pandemic life.
More than two dozen airline trade organizations, labor unions and the U.S. Chamber of Commerce have asked the White House to "establish uniform guidance" for a method of proof of COVID-19 immunity, according to a letter sent last week to White House Coronavirus Response Coordinator Jeff Zients.
Some other nations are even further along. For instance, Israel is now issuing a Green Pass to the immunized that allows them exclusive access to sports events, concerts, gyms, hotels and restaurants.
The pros of a vaccine passport program are obvious -- a boost to tourism and reinvigoration of economies hit hard by the pandemic.
"Inevitably I think there are going to be these passports because people are eager to go back to a sense of normalcy," said Dr. Mahshid Abir, a senior physician policy researcher for the RAND Corp. "From both the supply and demand side, there is impetus to get tourism and traveling back on track, and go back to some semblance of normalcy."
But there also are many troubling cons to vaccine passports, so much so that the World Health Organization has come out against them and the White House has taken a hands-off approach so far.
Last week, WHO Executive Director of Health Emergencies Dr. Michael Ryan told news media that vaccine passports should not be used as a requisite for travel due to "real practical and ethical concerns."
And on Monday, Andy Slavitt, a senior adviser to the White House COVID-19 response team, said in a media briefing that "it's not the role of the government to hold that data and to do that" when asked about vaccine passports.
"But we do believe that when that gets done, there is a right way and a way that's not as good," Slavitt continued. "And the right way is: It needs to be private; the data should be secure; the access to it should be free; it should be available both digitally and in paper, and in multiple languages; and it should be open source."
A means of persuasion
One other potential benefit of requiring a vaccine passport to travel, eat out or attend a rock concert might be that it would pressure some vaccine-hesitant folks into getting their inoculation, Abir said.
"Maybe it will encourage people to just get it done with so they can move on and enjoy the aspects of life they're missing out [on]," she said.
However, these passports could also deepen inequities around the world, create concerns over rampant fraud and privacy violation, and in the end not help halt the pandemic, said Dr. Howard Koh, a professor with the Harvard T.H. Chan School of Public Health and a former assistant secretary for health in the Obama administration.
"It could lead to many unintended consequences, particularly related to widening the divides in our society," Koh said.
First off, scientists don't know enough about the immunity conferred by vaccination to know how long such a passport should be valid, he said.
"A vaccination passport is not necessarily an immunity passport," Koh said. "We still don't know exactly how long the duration of immunity might be. Immunity could last for many years, or could be much, much shorter."
Regarding vaccine passports used to travel between countries, there needs to be some sort of agreement on which vaccines are valid and what information would be required on the document, Koh added.
The suspension of the AstraZeneca vaccine in a number of European countries due to concerns over blood clots shows this isn't a theoretical issue. Every country has been approving different vaccines for their population, and it's not clear what that would mean for travelers.
"If someone comes here and their passport says they received the AstraZeneca vaccine, what does that mean for having a standardized passport?" Koh said.
Fraud, disparity issues could arise
The form that a vaccine passport would take is another open question.
Israel's Green Pass is in both paper and electronic form, but some travel experts have said that it will be impossible to scale up a vaccine passport program unless the document comes in digital form. What does that mean for older folks who aren't tech-savvy or poor people who can't afford a smartphone?
"You've seen how difficult it's been for elderly populations to navigate websites to gain access to vaccines," Koh said. "It's yet another form of disparities that we're witnessing, not only with respect to income, but also with age."
On the other hand, a paper passport would be subject to fraud unless it's in the form of a forgery-resistant government document, like a driver's license, that would be hard for people to duplicate, Abir noted.
Globally, a vaccine passport used for travel could foster resentment against wealthier countries that will have first access to COVID-19 immunization, Abir added, to the point that it might have "national security implications."
"If it becomes common knowledge that the people who are traveling overseas from the United States are those who are vaccinated, and they are going to destinations where perhaps everyone is not vaccinated, what are the sentiments going to be towards those tourists in those countries?" Abir said.
This is part of the reason why the WHO currently opposes vaccine passports, Ryan said.
"I think there are real practical and ethical considerations that countries will have to address, because if access to vaccines is inequities, then inequity and unfairness can be further branded into the system if we continue to make decisions on what people can and can't do, where they can and can't go, on the basis of being vaccinated, when vaccination itself is not something that everyone has equal access to," Ryan said.
There's one final argument to be made against vaccine passports, Koh said: There's no evidence to show such documents would stop the spread of COVID-19.
"If this is a way to reduce transmission, that would be an ideal outcome, but we don't have any evidence of that yet," Koh said. "There are too many critical unknowns. You start looking at this, and you become humbled by how complex it can be."
The U.S. Centers for Disease Control and Prevention have more about the national COVID-19 vaccination program.
SOURCES: Mahshid Abir, MD, senior physician policy researcher, RAND Corp.; Howard Koh, MD, MPH, professor, Harvard T.H. Chan School of Public Health, Boston