The Ethics of Vaccine Passports

As the availability of COVID-19 vaccines expands and more of our family, friends and neighbors are receiving their doses, the question of whether there should be vaccine “passports” has prompted renewed attention. Passports ostensibly allow governments and other institutions to digitally verify that a particular individual has been vaccinated before entering a building, store, airplane, or school. Proponents of passports note that the verification of individuals’ vaccine status is exactly what is needed to allay ongoing public health concerns. The more businesses and other essential institutions know that their customers and clients are vaccinated, the more likely that the full range of services can be restored within the economy. Vaccines are exactly the thing that can help control future outbreaks and minimize the spread of new Coronavirus variants.

Many countries, such as the United Kingdom and Australia, are studying the feasibility of expanded use of vaccine passports and jurisdictions such as New York have already instituted limited, privately administered mobile technology for individuals to gain access to gyms, sports arenas and large wedding receptions. Some airlines and international organizations have begun using CommonPass, a digital pass sponsored by the non-profit Commons Project, as a way to verify whether an international visitor has tested negative or been vaccinated.

COVID-19 Vaccine Inequality

But what are the costs of vaccine passports? In a recent article in the New England Journal of Medicine, Mark Hall and David Studdert note one important ethical concern. Inequities in vaccine access will only produce further social inequality as vaccine requirements become the norm. If vaccination is required for things like transportation services, higher education, public recreational activities and retail shopping, then how can those without vaccines remain full participants in public life?

A finer point can be put on this problem. In the United States, according to organizations such as the Kaiser Health Foundation, the vaccination rates of racial minorities, as well as those in lower economic strata, are noticeably lagging behind those in the general population. The explanation for this difference is complicated; however, if the factors explaining lower vaccination rates include things like geographic variations in the location of vaccine centers, an inability to take time off from work, the need for technology to schedule appointments and a lack of reliable transportation, then disparities in vaccination rates should give officials pause before implementing vaccine requirements. As Hall and Studdert note, “if history is a guide, programs that confer social privilege on the basis of ‘fitness’ can lead to invidious discrimination.”

On top of these equity concerns, there is also a more basic problem with vaccine requirements that has to do with individual autonomy. We are familiar with vaccine hesitancy. But in addition to hesitancy there are individuals who refuse vaccines as a matter of religious or moral conscience. Don’t they have an entitlement to exercise such judgment? Even more challenging is the fact (often lost from view) that vaccines in the United States have only been provisionally approved by the Food and Drug Administration (FDA). As long as vaccines have not been completely deemed safe and effective within recognized research protocols, it is not unreasonable to think that some individuals have grounds to refrain from taking the vaccine. It therefore seems difficult to justify a government requirement that individuals receive vaccines as a condition for normal, pre-pandemic life when the full weight of regulators is not yet behind the vaccines.

And yet, with marginalized communities gaining greater access to vaccines daily, the need to reach herd immunity, the unique risks of exposure that exist in different sectors of the economy and the legitimate interest businesses have in protecting employees and customers, it is difficult to support a blanket prohibition on using vaccine passports by private organizations. It is one thing to be opposed to a government requirement that passports be used. It is another to prohibit their use altogether. It seems reasonable to steer a course in between these extremes.

Sharing Vaccine & Health Information via Digital Technology

Assuming that some configuration of passports will be implemented, another broad set of ethical concerns center around the manner in which a vaccine passport system—or systems—is implemented. What type of digital technology should we use? How will personal information regarding one’s testing and vaccine history be securely stored, if at all, on a digital platform? Will there be an opportunity for different businesses, organizations and other consortia to use the same system?

The security and privacy concerns raised by the use of digital platforms are nothing new. There is some reason to be optimistic that these issues can be effectively addressed. New York’s Excelsior Pass bills itself as a “boarding pass” for individuals who want to show their negative test results or vaccine history to gain access to public events and places. Any testing or vaccine center in the state of New York provides this information to the state’s public health authority. By downloading the Excelsior Pass app on your mobile device, you can provide your personal information to link your app with the state’s database, thereby creating a QR code pass that can be scanned at participating institutions. The app doesn’t store your personal health history on your phone, uses high-level encryption between your device and the relevant data servers, and all passes can be securely deleted at any time. Institutions examining your pass simply compare your name and date of birth on the pass with your photo ID.

The advantage of such a digital platform, of course, is that you no longer have to carry and provide documentation of your vaccination status to each individual business or organization that might be screening individuals for immunity. Many will find this not only convenient but also more protective of their privacy. A one-time registration with existing public health databases provides a single certification that then can be used by multiple institutions, without doing anything more than asking for standard identification each time. Imagine needing to share your vaccine history—directly—not only with American Airlines and Delta but also with Jet Blue and Lufthansa as you move between different airlines. Wouldn’t a unified system be better on both efficiency and privacy grounds?

Vaccine Passports, Data Security & Privacy

As different jurisdictions look to allow vaccine passports we should not let data security and privacy concerns rule the day. True, platforms such as Excelsior Pass need to be designed in ways that maximize consumer protections and minimize the chance that passes can be illegally forged; but just as at the beginning of the pandemic, data-insulated, vaccine verification apps have a range of legitimate purposes that should not be dismissed purely on data privacy grounds. Those challenges are real, but not the end of the story. The Vaccine Credential Initiative, a coalition of public and private organizations “committed to empowering individuals with access to a trustworthy and verifiable copy of their vaccination records in digital or paper form using open, interoperable standards,” is a prime example of how the technological complexities of digital passports can be deliberately managed to both protect privacy while minimize contact between individuals carrying the virus.

Ultimately, public agencies, large corporations and global organizations need to remind all of us that vaccine passports are just one, relatively small way that the pandemic can be managed. There are many other efforts that need to be strengthened, not the least of which is vaccine access itself. Incremental progress needs to be maintained, and advocates of vaccine passports should provide the full weight of their support to an equitable and fair rollout of vaccines in order to make the need for passports become less and less.

Passports may be useful for certain organizations, in certain industries, but improved public health outcomes and reduced virus transmission rates need to be the ultimate ground for allowing and encouraging vaccine requirements.

-----

Jeffery Smith is the Frank Shrontz Chair in Professional Ethics and Director for the .