Those who are planning to travel abroad in 2021 might need to pack more than just their paper passport. As many countries peg freedom to travel to immunity proof or a negative COVID-19 test, the concept of a so-called vaccine passport of some kind is being floated as an international solution to a public health problem.
Earlier in February, Denmark shared its plans to develop its own digital vaccine passport that would identify those who have received the COVID-19 vaccine. "In three, four months, a digital corona passport will be ready for use in, for example, business travel," Denmark's Finance Minister Morten Bødskov told AP News.
Denmark's vaccine passport will live on one's phone, and will essentially serve as documentation that the holder has received a SARS-CoV-2 vaccine. Bødskov said that Denmark will "be among the first in the world to have it." The idea is that this digital document will ease travel restrictions for international travelers by allowing them to bypass a mandated quarantine, or perhaps avoid having to take a COVID-19 test prior to departure and upon arrival.
Denmark isn't alone in considering such a solution as a means to open up countries and revive tourism as soon as possible. Sweden is also considering implementing their own digital "vaccine passport" program. And this month, Estonia announced it will allow passengers arriving into the country with a designated certificate of COVID-19 vaccination to avoid quarantine requirements. On Monday, news broke that Greece and Israel made a deal that will allow vaccinated people who hold a so-called "green passport" to travel more freely between the two countries, once travel restarts.
Specific details about a standardized certificate proving inoculation are still being hashed out, but the groundwork is being laid. In the United States, the Biden Administration issued an order requesting an assessment of the "feasibility of linking COVID-19 vaccination to International Certificates of Vaccination or Prophylaxis" and producing a digital certificate.
The concept of a "digital vaccine passport" or "green passport" aligns with what the World Health Organization (WHO) is creating, something they call a Smart Vaccination Certificate. WHO recently put together a working group of experts to reach a consensus around security, authentication, and to develop guidance and best practices on how and when these certificates can be used.
While many details still need to be hammered out, health experts do expect a digital vaccination certificate that will allow people to bypass quarantine restrictions and other bureaucratic barriers will be a normal part of our lives in the near-future. Litjen Tan, Chief Strategy Officer of the Immunization Action Coalition, told Salon that WHO will likely set the standards of what will be globally accepted.
"The idea is there's a digital vaccination certificate that has key specifications, key standards that everyone will support and use and it will operationalize a global version of vaccination certificate," Tan said. "And I think that's exactly where a lot of policymakers are going."
Dr. David Studdert, a professor of medicine at Stanford University, agreed.
"I think they are going to be pretty broadly adopted for certain activities, and it looks like air travel will be one of the first," Studdert said. "I think there's a certain inevitability to them, but the question that I think many of us are wondering about is whether the government will get involved here, and offer some sort of public program."
Studdert said he thinks "in some countries that's going to happen," but it's not clear that it will happen in the United States. Studdert added that he forsees the private sector in the U.S. will "lead the way."
Such an undertaking will be no easy task. And there are already concerns around how mass distribution of a digital vaccine passport can be accomplished in a way that would be accepted around the world, protect privacy and remain accessible to people regardless of their socioeconomic status.
Requiring a vaccine to enter some countries isn't new; proof of a yellow fever vaccine is required to travel to many countries in Africa. However, requiring everyone around the world to get the COVID-19 vaccine in order to reconnect the planet would be a much larger undertaking.
Tan said there are pros and cons to digitizing the vaccine certificate. One benefit is that a digital version of a vaccine passport certificate is harder to manipulate, and will be easier to mass distribute.
"I think it's easy to create a fraudulent copy with paper," Tan said. "Then the second [benefit] is the idea of expiration date, we don't know how long the duration of immunity is going to be with the vaccine — but the great news is that if it's digital the moment that we know we can continue to update the status."
Tan speculated that if immunity only lasts for one year, the expiration can be immediately updated on a person's digital certificate and then a person can be easily notified that they need to get an update on the vaccine. A digital vaccine certificate is also much harder to lose.
But what about people who don't have smartphones? Indeed, some experts fear that consigning a vaccination passport to one's smartphone raises equity concerns.
"Digital certificates require some sort of digital device that you can use," Tan said. "I don't disagree that that's the best way to do this, but we need to make sure that people of lower socioeconomic status will have that access as well."
In May, Dr. Alexandra Phelan warned in an article in The Lancet that "immunity passports" granting privileges to the inoculated and immune could "pose considerable scientific, practical, equitable, and legal challenges."
"Immunity passports would impose an artificial restriction on who can and cannot participate in social, civic, and economic activities and might create a perverse incentive for individuals to seek out infection, especially people who are unable to afford a period of workforce exclusion, compounding existing gender, race, ethnicity, and nationality inequities," Phelan wrote. "Such behaviour would pose a health risk not only to these individuals but also to the people they come into contact with."
Another lingering concern relates to who precisely is immune. Indeed, it is still unclear if people who are vaccinated can transmit the coronavirus to others not.
"There's a concern that people could get the vaccine and feel like they are safe, but they could be actually infected with the virus and carry it in their nasal passages and in their airways," said Bryn Boslett, MD, an infectious disease expert at the University of California, San Francisco. And because they're feeling safe, they might be less cautious and actually spread the disease."
If vaccinated people still spread COVID-19, digital vaccine passports used to restart international travel will likely not be effective in stopping the spread of the coronavirus.
Studdert said there will need to be "regulations" around a digital vaccine passport program in order to maintain equity.
"I do see risks, but I don't think it's inevitable that this would unfold as discriminatory or a regressive program," Studdert said. "If it were done in the right way, in fact, it could be the opposite."