Debate surrounding vaccine passports and development misses bigger picture
As ever more governments around the world decide to introduce "vaccine passports" for vaccinated individuals to re-open travel, amid a surge of global popular support for them, an opinion editorial published in the BMJ last month has put forward a provocative argument: namely, that vaccine passports could damage sustainable development.
Penned by public health experts Stefan Baral and Jean Olivier Twahirwa Rwema of Johns Hopkins University in the United States, together with Nancy Phaswana-Mafuya of the University of Johannesburg in South Africa, the op-ed warns of the adverse effect these documents might have on low- to middle-income countries (LMICs). Pointing to the large (and growing) gap in vaccine availability between high- and lower-income parts of the world, the three experts claim vaccine passports will exacerbate existing inequalities in the freedom of movement enjoyed by citizens of different countries.
And yet, despite the valid concerns over vaccine nationalism voiced in the BMJ op-ed, this line of argument appears to conflate two different issues: inequality of access to vaccines on the one hand, and the economic imperative of translating vaccination into health passes on the other. While the former represents a serious shortcoming of the global fight against Covid-19, the latter represents a logical next step towards a post-pandemic future.
Tourism made safe with health passes
The authors' argument against vaccine passports hinges on the fact that "nationalistic approaches" to vaccine procurement have created an uneven playing field, fuelling fears that inequitable access to doses could lead to discrimination if governments decide to make health passports mandatory for travel. The BMJ op-ed's argument that vaccine passports will drive discrimination, however, appear to operate in a vacuum, whereas the reality is that much of the planet is already at a standstill. Entire global industries and the hundreds of millions of people who rely on them are desperate for solutions to return to a semblance of pre-pandemic life.
The BMJ piece highlights that there are "88 million more poorer people now globally, with the majority residing in South Asia and across Sub-Saharan Africa, as a result of Covid-19." Given that vaccine passports will allow tourists and other travelers to cross borders without undue risk to themselves or the countries receiving them, both governments and businesses in countries from Thailand to the Caribbean perceive the "unidirectional" travel the piece laments as an economic lifeline they are clamoring to have back.
While the op-ed further argues measures such as "testing for SARS-CoV-2 at departure or arrival, vaccination on arrival, or evidence of previous infection" can ensure appropriate conditions for travel, these requirements are already in place and have proven patently insufficient for resuming international transit. It's also worth noting that most extant health passes also offer verification of negative Covid tests and antibody tests.
Vaccine passports key for opening up battered economies
More broadly, much of the debate surrounding Covid-19 vaccine passports ignores longstanding precedents for health passes that facilitate travel. Certificates of vaccination such as the International Certificate of Vaccination or Prophylaxis (ICVP), which proves vaccination against yellow fever, are already in use in over 80 countries and are increasingly shifting to a digital format.
Nor are such health passes merely travel documents. In the context of Covid, they are a fundamental tool to facilitate domestic economic reopening as vaccination programs progress, including in lower-income countries which have faced their own confinements and severe economic disruptions. By the end of 2021, COVAX aims to provide 2 billion vaccine doses to countries without prior pharmaceutical agreements, driving a need for accessible documentation of vaccination status in these countries as well.
By restoring the badly-needed confidence individual people need to resume pre-pandemic activities, vaccine passports should provide benefits across all economic classes and levels of local and national development. As one physician, Dr. Leana Wen, puts it: "we're letting perfect be the enemy of the good... I think many people will feel more comfortable in engaging in activities where they're assured that people around them are fully vaccinated too."
Failing to implement vaccine passports would, by contrast, carry substantial costs. While a given population needs to reach at least 60-70 percent viral resistance (through a combination of vaccination and recovery from infection) in order to achieve herd immunity, failure to track vaccination status and reduce the burdens placed on vaccinated individuals could replace the "queue-jumping" issue the BMJ authors warn against with a "free-rider" problem, with vaccine hesitancy undermining the progress of largescale inoculation.
Vaccine passports must be bolstered by prudent policy decisions
While the arguments in favor of vaccine passports are convincing on a theoretical level, how are governments to select the best platform from amongst hundreds of options in development? Candidates such as the Certus myHealth Pass from the Swiss company SICPA stand out as flexible, reliable solutions, promising a globally interoperable digital system which, in the case of SICPA's system, is already using blockchain technology to verify negative Covid test results for maritime workers in major emerging markets such as the Philippines.
Enabling "real-time health status management and safe mobility," the Certus MyHealth Pass can generate a QR code either on a dedicated app or printed on paper in the absence of a smartphone, without the need to store sensitive data – an essential functionality amidst privacy concerns linked to vaccine passports. Other potential options include IBM's Digital Health Pass, which also relies on blockchain technology to verify data and certify immunity.
As Baral, Twahirwa Rwema, and Phaswana-Mafuya rightly point out, governments and health authorities will need to contend with potential risks of discrimination targeting certain segments of the population as they proceed with implementing vaccine passports. More broadly, however, the injustice they point to stems not from vaccine passports, but instead from the distribution of vaccines themselves. Health passes represent an indispensable public health tool, but the pandemic will only truly be over when all segments of the global population enjoy an equitable level of access to immunization.
(Devdiscourse's journalists were not involved in the production of this article. The facts and opinions appearing in the article do not reflect the views of Devdiscourse and Devdiscourse does not claim any responsibility for the same.)