COVID-19 Diary – Day 211

COVID-19 Immunity Passports

The idea of COVID-19 immunity passports has been brought up many times over the course of the pandemic. With some government agencies, and several businesses requesting them, and other government agencies and several experts arguing against them.

Back in May of this year the company ‘MTÜ Back To Work’, located in Estonia, began work on a new service to offer immunity passports. Over the last 5 months, they have successfully negotiated their service into trials with a selection of businesses, and even on flights between London, New York, Hong Kong and Singapore.

So how does this service work? Specific labs in limited countries are approved to use the service, and volunteers tested at one of these labs can ask to have their data uploaded to the immunity passport database. After authenticating through their service, the volunteer can generate a 1-time use QR code that can be shared with friends, family, employers, airport personnel, etc. New QR codes can be generated by the volunteer as needed. Currently, this service allows the recording of test data from either PCR swab tests or serologic antibody tests.

The FAQ on their website includes some interesting questions and answers:

We recently reported on the current state of understanding about COVID-19 immunity, and you can see our post about it here. Needless to say, there remain more questions about immunity to COVID-19 than answers at this point.

Immunity Passports – Some Concerns

When presented with the idea of immunity passports, Natalie Kofler, adviser for the Scientific Citizenship Initiative from Harvard Medical School gave 10 reasons why they would be a bad idea. These 10 reasons are summarized below:

  • COVID-19 immunity is a mystery; We don’t know how many people don’t have it after recovery, or how long it lasts in anyone.
  • Serological tests are unreliable; Performance and accuracy can vary widely and false negatives can be common.
  • The volume of testing needed is unfeasible; testing supplies already get stretched thin while testing a small portion of countries’ populations.
  • Too few survivors to boost the economy; this is not meant to imply a high case fatality rate, but rather too few people having recovered yet to be able to boost the economy in any meaningful way.
  • Monitoring erodes privacy; The whole point of immunity passports is to control movement. Thus, any strategy for immunity certification must include a system for identification and monitoring.
  • Marginalized groups will face more scrutiny; China has been accused of racially profiling residents by forcing all African nationals to be tested for the virus. In other parts of the world, people from Asia have faced spikes in racialized prejudice.
  • Unfair access; In countries with high barriers to medical services, like the USA, people who can not afford the testing costs will be unable to obtain an immunity passport.
  • Societal stratification; Labelling people based on their COVID-19 status would create a new measure by which to divide the ‘haves’ and the ‘have-nots’ — the immunoprivileged and the immunodeprived.
  • New forms of discrimination; These would introduce a new risk for discrimination if employers, insurance companies, law enforcement officers and others could require access to your private health information for their own benefit.
  • Threats to public health; Immunity passports could create perverse incentives. If access to certain social and economic liberties is given only to people who have recovered from COVID-19, then immunity passports could incentivize healthy, non-immune individuals to wilfully seek out infection putting themselves and others at risk.

The World Health Organization has also weighed in with their opinion on the matter, stating:

“At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.” People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission.”

Immunity Passports: Ethical Implementation

On the other side, a study was published recently that dealt with the idea of what an ethical implementation of immunity passports could look like. The study concluded that there would need to be a comprehensive assessment of the benefits and harms involved in such a program, and great care would be needed to ensure that the least amount of individual liberties would be restricted without increasing the risk of COVID-19 significantly.

The study also warned that pushing ahead too quickly or implementing poor policies could result in severe unintended harm and negative consequences in society. Their best suggestion was to implement sector-based policies that prioritize access to testing based on societal needs. Perhaps areas such as health care, or teachers (author’s opinion).

That’s all for now, stay safe everyone!

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