Vaccine Passports: Vaccination Confirmation or a Privacy Concern?

IF TWO-PLUS years of a pandemic have reinforced old adages, one standout would be that you can’t please all people all the time. A clear example of this is Americans’ reactions to the COVID-19 vaccine and the much-publicized topic of vaccine “passports.” Rifts between groups for and against the vaccines and passports are such a point of contention that factions now belittle one another. A particularly vocal writer said in one article, “I too want to eat in a restaurant, away from the unvaccinated. But to be honest, it’s not just because I don’t want to get sick. It’s because I despise them — whoever they are — the sans-papiers. I am not proud of this.”¹ A polarizing perspective is clearly unhelpful. However, insight and wisdom can come from examining the main issues: public health, civil liberties and privacy.

Defining a Vaccine Passport

First, it’s helpful to understand what a vaccine passport is — or what it could be. With no national standard, states and companies are implementing their own rules to identify those who are vaccinated, and definitions seem fast and loose as authorities stumble toward a solution. This is particularly true with regard to international tourism. As infectious disease specialist Scott Weisenberg, MD, states, “Right now, the definition [of vaccine passport] that matters is the definition of the person in front of you helping you go through immigration.”2

In generally accepted terms, vaccine passports are a form of identifying whether a person has been vaccinated against or tested negative for COVID- 19 and, therefore, may enter businesses, attend cultural events or access public venues that require such proof. A passport could be similar to a phone app, a small paper card, a smart card or something else. Many businesses and even U.S. and international cities require some form of identification already.³

Vaccine passports do (sort of) have a history. School children are required to show proof of vaccination for classes and activities. People who travel overseas are sometimes mandated to bring a medical passport, otherwise known as the Yellow Card, created by the World Health Organization (WHO). For example, multiple countries in Africa and South America require this card to ensure the safety of international travelers, as well as nationals, against yellow fever.

Most people agree some type of safety measure is necessary to prevent COVID- 19 transmission, but few agree on what that measure should be. For many, the global vaccine passport movement has seemed ominous and monumental enough to spark fear, division and confusion. And, perhaps, these reactions are to be expected. After all, information, misinformation and no information are common frustrations for physicians and the general public.^4,5,6

Passports Already Established

In December 2021, former New York City Mayor Bill de Blasio announced the Key to NYC Pass, a vaccine ID to grant New Yorkers access to various businesses. “This approach is going to make clear that: You want to enjoy everything great in the summer of New York City? Go get vaccinated. When you hear those words, I want you to imagine the notion that because someone’s vaccinated, they can do all the amazing things that are available in the city,” said de Blasio. “If you’re unvaccinated, unfortunately, you will not be able to participate in many things. That’s the point we’re trying to get across. It’s time for people to see vaccination as literally necessary to living a good, full and healthy life.” de Blasio is also a proponent of New York State’s Excelsior Pass, a free, voluntary platform that provides secure, digital proof of COVID-19 vaccination or negative test results.⁷

From a proponent’s perspective, de Blasio’s statement is a matter of life, quality of life and death. From an opponent’s perspective, it more or less boils things down to being vaccinated or being denied a fuller life. It feels like coercion. So where is the balance? Some would say there is none, but a quick breakdown of varying perspectives can highlight what’s at stake for both sides.

Arguments by Proponents

Many proponents’ cases are very distinct. One Canadian writer states frankly: “The direct benefit of vaccine passports is clear: They would allow us to safely lift restrictions on indoor gatherings, with all the attendant benefits to the economy, culture, sports and education. They also incentivize people to get fully vaccinated.”⁸

Others are concerned about more obvious public health and safety issues. One study found that, “The benefits of vaccine mandates and vaccine passports are clear. They should increase the rate of vaccination and almost eliminate severe outcomes/hospitalizations in the general population. It has also been shown that vaccines reduce the risk of transmission to their closest contacts by about 41 percent among infected persons.”⁹

Katherine Ginsbach, JD, and Anastasia Vernikou, JD, of Georgetown University agree, stating that a vaccinated individual is far likelier to have a mild case of the illness: “Vaccine passport proponents argue that vaccine passports and immunization certificates encourage people to get vaccinated and allow a gradual reopening of the economy, and the lifting of restrictive public health measures such as quarantines, business closures and stay-at-home orders. Industries such as retail, travel and entertainment particularly benefit from a mandatory vaccine passport scheme as they will be able to resume their commercial activities in a manner that protects both their customers and employees.”¹⁰

Through use of vaccine passports, a British Medical Journal study optimistically found that only 28 cases of COVID-19 were detected in 7,764 participants who completed the full testing requirements. Another study found that had the British government decided to mandate COVID-19 passports for crowded events, it could have reduced cases and deaths by as much as 30 percent in subsequent weeks.¹¹

Policies that require people to show proof they’ve been vaccinated against COVID-19, recovered from the illness or recently tested negative for SARS-CoV-2 before they can travel internationally or go to public places that require vaccination or recovery could increase vaccination rates in countries with low uptake, according to a study of these policies in six European countries. Indeed, people younger than 30 years had the largest increase in vaccinations after these policies were enacted, suggesting restrictions might help improve vaccine uptake in younger people who sometimes are hesitant or complacent. In countries that restricted entry to nightclubs or events with more than 1,000 people, vaccinations increased among people younger than 20 years. When countries established requirements for a wider array of settings, vaccinations also increased among adults aged 30 years to 49 years.¹²

An important fact is that vaccinated individuals are much more likely to have only mild illness. “So they may be more likely to be out and about, despite being infected,” said family physician and epidemiologist Jeff Kwong of the University of Toronto. “By excluding all the unvaccinated people from these places, we are in essence keeping them safer from the vaccinated people who may be asymptomatically or presymptomatically infected with COVID, but still able to transmit, especially when everyone is unmasked. If we drop the vaccine passports, the unvaccinated are going to go into those spaces. Right now, they may be living the life of a hermit, and have managed to stay safe that way. But if we get rid of vaccine certificates, they’re like sitting ducks.”¹²

Arguments by Opponents

There are people who question who they can trust and to whom they safely grant authority. Simply following the proposals of media, corporations and even healthcare is considered blind trust to many. Much is at stake, and questions beget understanding for both sides of the vaccine passport issue. Listed are some opposing arguments.

One concern is vaccine inequality. Albert Fox Cahn, founder of the Surveillance Technology Oversight Project (STOP) and a Wired contributor, says, “Let’s look at who’s been vaccinated. Here in New York City and New York State, nearly every state in the country, it’s overwhelmingly wealthier, whiter communities that have been able to get vaccinated first. I am so worried that this vaccine passport drive will transform medical segregation into digital segregation in nearly every public space. We’re talking about something that could exclude millions of people from the necessities of basic life and compound the injustices that defined our healthcare response to this entire pandemic. Those communities hardest hit hard by the pandemic, who have died at the highest rates, who have suffered the most, are the ones who are going to be the least able to benefit from the purported benefits of this vaccine passport.”¹³

Many vaccine passport opponents foresee a two-tiered society of segregation — the haves and the have-nots. WHO is also concerned about racial discrimination because of vaccine rollout inequality. The organization believes that because the supply of COVID-19 vaccines is still limited, “preferential vaccination of travelers” could lead to a shortage of vaccinations for people who need them most. This is especially worrisome since the bulk of the vaccines are going to countries with higher socioeconomic status.³

Aaron Prosser, a researcher at McMaster University in Hamilton, Ont., Canada, found that, “the first cost [of mandated vaccines and vaccine passports] is healthcare-specific. Staffing shortages (loss of unvaccinated workers) may occur, leading to adverse effects on patient care.”⁹

Of course, there are also concerns about privacy and security and profits. A digital COVID-19 vaccination certification, or “passport,” is a mobile app that instantaneously affirms the vaccinated status, COVID test results, birth date, gender and/or other identifiers of its holder. The information is usually mosaicked in a QR code, read by a proprietary scanner and linked to a government registry. Unfortunately, there have been repeated incidents of security breaches. Numerous and very serious breaks have occurred at healthcare institutions and high-tech corporations, despite these companies demanding respect and promising healthcare records safety. Hundreds of millions of health records have been exposed, and it’s likely more will be unprotected in the future. This is especially concerning with the dark web and rampant fraud.¹⁴

What’s more, vaccine apps are not being produced by public health experts, but by large high-tech corporations. “The yellow international medical passports,” says Cahn, who believes the emerging surveillance technologies pose an unprecedented threat to civil rights and the promise of a free society, “are not the same thing at all as a digitalized vaccine ID. What we see and hear in New York City and other cities around the U.S. is a movement to expand a very different technology — a type of vaccine passport that wouldn’t be used when you fly internationally, but used when you go to work, go to school, even go to the local grocery store. And from my perspective as a civil rights lawyer and a technologist, this is really disturbing. Both because of privacy and equity impacts, but because of the fact that for all of the surveillance we’re now being sold, there’s no evidence that it actually will work. And I’m quite worried that it will actually be a step back for the rollout of our vaccines — these desperately needed vaccines.”¹⁴

Job losses are also a concern. One longtime Brooklyn public school teacher, Casey McFadden, joined the growing list of workers refusing the vaccination out of personal preference. Her fear, specifically, was a severe allergic reaction because of underlying health conditions. “Many of us are not against the vaccine,” explains McFadden. “We just don’t like the idea of someone forcing us to do something. It is about civil liberties and our rights. We are treading on some dangerous waters.” McFadden, who had retired, returned to teaching to increase her retirement income and to help decrease the teacher shortage during the beginning of the COVID-19 crisis. “I risked my life returning because the city wasn’t even testing children then,” she says. “Why are they being so mean-spirited and putting people out of work when all they had to do is bring back the weekly COVID testing?”¹⁵

Although not a vaccine passport argument, per se, safety is a concern that prevents some people from being vaccinated. From many healthcare workers’ perspectives, the vaccine is clearly helpful, not harmful, even if no vaccine is 100 percent safe. However, many citizens look back, however rightly or wrongly, on the U.S. Food and Drug Administration’s short history of major mistakes. Although the organization has many more successes, some of its errors fail to engender trust.¹⁶

Summing It Up

It’s likely that no one will ever fully comprehend how to expertly navigate the tension of the COVID-19 vaccines and passports. The arguments by each side will continue to tease and evade, just like light on a cut gem. But, it would benefit everyone, regardless of their stance, to discuss, educate, empathize and actually hear one another whether for or against. With time, further information will be gained and protocols ironed out. But for now, regardless of decisions and progress made, not all people on either side will be pleased all the time.