Written by Sairaya Chopra, a grade 12 student.

According to The New York Times, “A vaccination pass or passport is documented proof of vaccination against Covid-19. Some versions will also allow people to show that they have tested negative for the virus.” The version being worked on currently by airlines, industry groups, nonprofits, and tech companies will be something one can pull up on their mobile phone as an app or part of a digital wallet.

The idea is modeled on the proof of vaccination that several countries required even before the pandemic. For example, even prior to COVID-19, travelers from many African countries to the US or India were required to submit proof that they have been vaccinated against diseases such as yellow fever.

Vaccination passports are not a completely new or alien concept. Vaccine certification checks came under the International Sanitary Regulations adopted in 1951 by WHO member states (renamed the International Health Regulations in 1969). Some countries have started using vaccine passes and some are planning to rapidly implement vaccine pass policies to return to normalcy.  Israel, with the highest vaccination rate per capita in the world, launched its Green Pass program in February.

The program allows fully vaccinated citizens entry to concerts, gyms, hotels, restaurants, and other public places. Israelis can also use the Green Pass to enter Cyprus and Greece. Belize and Iceland welcome any foreign travelers who provide proof that they’ve been immunized, without having them quarantined or present negative COVID-19 tests.

Thailand, which relies heavily on tourism and was economically devastated by pandemic restrictions, says it hopes to install a vaccine passport policy for international visitors by the summer. The European Union has proposed its own version to help ease restrictions on movement across the bloc, while China made the controversial announcement that it will prioritize visas for travelers who are vaccinated with a Chinese-made vaccine.

Even though, on one hand, Covid vaccine passports seem crucial as they could help the world get back to normalcy, on the other hand, there are countries with a low stock of the Covid vaccines and high populations. In such a scenario, the question arises of whether vaccine passports truly are ethical.

Through this research paper, I intend to explore and answer the question: ‘To what extent are vaccine passports ethical, given the discrepancies in vaccine access amongst and within nations of differing socio-economic status’?

Background

As mentioned in the introduction, ‘vaccine passports’ are not an alien concept. The concept of requiring proof of immunization to occupy certain spaces dates back to Edward Jenner’s development of the first known vaccine in 1796. Designed to inoculate people against smallpox, confirmation of having taken this vaccine was a prerequisite for travelers at the time, mostly pilgrims, entering towns such as Pandharpur in British India or going to Mecca for the Hajj.

Continuing into the 19th century, this policy was widely implemented across the globe. In the year 1910, El Paso newspaper reported that travellers entering the United States had to show either a vaccination certificate, a scar on the arm, or a “pitted face” indicating that they had survived smallpox. Vaccine certification checks are even codified under international law with the first protocols defined under the International Sanitary Regulations Act, adopted by WHO member countries in 1951. Since renamed the International Health Regulations (IHR) in 1969, this Act allowed member states to demand proof of vaccination as a condition of entry.

While presently, yellow fever is the only disease specified in the IHR, the WHO has recommended that certain high-risk countries require travellers to provide vaccination certificates for diseases from which their population has not been sufficiently inoculated. For example, visitors to Pakistan and Afghanistan are recommended by the WHO to take adult doses of the polio vaccine before travelling due to the prevalence of the disease in those regions. As of now, the WHO has maintained a stance against Covid vaccine passports citing the risk they pose in perpetuating global inequality, a lack of evidence on vaccine efficacy in terms of herd immunity, and the substantial operational challenges that such a system would present.

According to ‘The Indian Express’, vaccine passports gaining traction include the European Union’s Digital Green Certificate, New York’s state-backed platform Excelsior Pass, Common Pass, an initiative from the non-profit Commons Project Foundation, and IBM’s yet-to-be-released blockchain-enabled certificate. Along with several vaccine passports introduced by individual airlines, the International Air Travel Association (IATA) has also called on the 290 airlines that it represents to sign up for its IATA Travel Pass, which is a mobile app that helps travelers to store and manage their verified certifications for COVID-19 tests or vaccines.

Similar to choosing between several credit cards for payments, customers will be able to shop around for vaccine passes, using different ones to avail different services. Global scientists have reiterated the importance of herd immunity before the economy can fully reopen, but a number of start-ups and major tech companies are looking to speed up the return to normalcy. Microsoft, Apple, and Google have shown interest in developing vaccine passports or certificates to usher in safer travel.

Saudi Arabia now issues an app-based health passport for those inoculated, while Iceland’s government is doling out vaccine passports to facilitate foreign travel. In January, President Biden issued executive orders asking government agencies to assess the feasibility of creating digital Covid-19 vaccination certificates.

There is a huge global debate about whether vaccine passports are ethical or not. Proponents believe that vaccine passports will help bring back normalcy in their lives and will also make it safer for people to travel without worrying about the infection. Some also feel that iterating vaccine passports would motivate people to get the vaccine. However, according to detractors, vaccine passports can raise questions of ethics due to the availability of vaccines in countries of differing socio-economic statuses.

Brief discussion

Like a coin, this discussion also has two sides to it. There are several supporters for vaccine passports including EU countries. Ursula von der Leyen, the president of the EU Commission, herself heavily supports the use of Vaccine Passports. During an interview, she stated, “It is a medical requirement to have a certificate proving that you have been vaccinated”. Perhaps this could be one of the reasons why a lot of EU countries plan to implement vaccine passports. These include Cyprus, Czechia, Denmark, Estonia, Greece, Hungary, Iceland, Italy, Poland, Portugal, Slovakia, Spain, Sweden, and numerous other countries. Even countries such as Japan and China are planning to issue vaccine passports.

On the other hand, countries that oppose vaccine passports include India, which consists of 17.7% of the world’s population. Even an organisation as respected and prestigious as the WHO is against vaccine passports. Dr. Soumya Swaminathan, WHO’s chief scientist stated “We have long been advising against using covid vaccination passports for international travel due to non-equitable availability and need for robust evidence for prevention of virus transmission post-vaccination.”  Other concerns regarding the opposition to vaccine passports include ethical issues such as the requirement of pre-existing ID or nationality status which eliminates a whole group of people including refugees and other minorities which further raises questions about ethics and fairness. As vaccine rates and access to vaccines are really low in LEDCs, the mandate on vaccine passports will decrease global mobility and this could impact foreign trade. Some countries are against vaccine passports due to privacy concerns with electronic versions.

Even though Israel has one of the highest vaccination rates in the world with 56% of the population who have received both doses, there have been a few issues with their ‘Green Pass’ vaccine passports. Foreign nationals and citizens who are not insured with an Israeli healthcare provider have been unable to get hold of the pass. Experts have expressed privacy concerns over the smartphone app, and the government has admitted the police do not have the staff to check if businesses are complying with the new rules. This further raises ethical concerns as it leaves out certain members of the community.

Interview

In order to gain further insight into the arguments for and against a Vaccine Passport, I interviewed Mr. Suraj Saigal, Research Director at IMA India, a leading economic, business, and market research firm that provides insights and analysis to top management audiences in India. Here are his views:

1. What are the advantages and disadvantages of vaccine passports?

If the system is well run, such passports would allow people to prove that they are “safe,”  enabling them to skip any mandatory quarantine requirements. It would ease the current restrictions on travel and access to various public facilities, and possibly remove the need, in most places, for incoming passengers to test themselves for the virus. A standardized, digital system would do away with the need to carry physical proof of vaccination and/or being “free” of the virus. Crucially, it would allow the hardest-hit businesses, including hotels, restaurants, airlines, retail firms, and other general services to return to normal faster than they otherwise would.

There are two main disadvantages of vaccine passports. First, countries will have different definitions/standards for a person to qualify as being “vaccinated”. India’s Covaxin and China’s Sinovac are not yet recognised by many other countries as proven anti-Covid vaccines. Therefore, someone who is recognised in his/her own country as having been vaccinated may not qualify for a passport. Second, the varying pace of vaccination drives in different countries means that many non-priority groups will have to wait a long time for their turn to get vaccinated, and therefore to qualify for a “passport”.

• What are the ethical implications of instituting vaccine passports for domestic or international travel?

This depends on how intensively passports are used, and for what purposes. With regard to international travel, most would agree that it is “fair” to require some assurance that fellow passengers on a plane or incoming tourists entering your country are free of the virus, given the potentially deadly consequences otherwise. Moreover, international travel is not something that is typically forced on someone.

Most travellers are doing so out of choice, and are benefitting from it in some form, either by enjoying a vacation or furthering their work/business interests. Just as you need to be willing to pay for a ticket, visa, hotels, etc in order to travel, getting vaccinated and carrying proof of the same is a fairly basic requirement for having the privilege to travel in a pandemic-hit world.

There are more serious ethical concerns around requiring a passport for domestic purposes, especially where no significant travel (say between cities/states) is involved. Countries are going at an uneven pace in terms of vaccinating their populations, and many people may not even have the choice of getting the jab for several months or even years. Requiring them to carry a passport, especially if they are seeking to access public space/facilities, would be unfair since it would effectively bar them from such places. More limited use of passports – such as for gaining entry into smaller, higher-risk areas, particularly those that are privately owned/run – would be slightly less “unfair”, though even here, issues of inequity would crop up.

To an extent, passports may infringe on individual rights, such as when a person/group/community has feelings of vaccine hesitancy, particularly in instances where there is cause for mistrust in the medical industry. This would mean that a passport would end up discriminating against certain individuals/groups. Yet this must be balanced against the wider need to ensure the safety of those who are willing to take the vaccine, and would be unjustly exposed to risks originating from those unwilling to get jabbed.

Finally, there are concerns around the issue of data privacy. Israel’s “Green Pass,” for instance, reveals information that those checking credentials may not need to know, such as the date someone recovered from Covid-19 or got a vaccine. The app itself is vulnerable to security breaches, and because it is not open source, no third-party experts can decipher whether these concerns are founded.

• In India, what do you think the challenges are for implementing vaccine passports?

There are two principal challenges here. First, the pace of vaccination is such that it will be months and possibly years before everyone is vaccinated. Should vaccine passports be required for domestic purposes (such as entering a workplace, hotel, or even a school), it would lead to mass chaos, inequity in access, and possibly cause major income loss to individuals who cannot work in a certain place just because they have been unable to get vaccinated yet. Second, although most people now own smartphones, a significant share of the population does not, including the poor, and many younger people, such as pre-teen children. They would be severely disadvantaged by such a system.

• In the past, countries have mandated vaccine passports for certain diseases – for example, the US and India required travelers from African countries to show proof of vaccination against yellow fever. What were the repercussions of these mandates?

There are both similarities and differences between the situation around region/country-specific diseases such as yellow fever, and global pandemics such as Covid-19. A safe, effective vaccine against yellow fever was developed over 80 years ago, and a single jab offers lifelong immunity. Although it is inconvenient to have to take a vaccine to visit a particular region, or if you are coming from such places to a country where yellow fever is not endemic, the requirement to get vaccinated is not unfair. In fact, it has probably helped prevent the disease from going global.

In contrast, Covid-19 is a truly global disease. The only way to arrest its spread is to ensure that herd immunity levels are reached, and vaccinations are the surest route to that goal.

• Why would a country be in favour of a vaccine passport and why would a country be opposed to vaccine passports?

Simply put, countries where infection rates are relatively low – either because they have vaccinated a large part of the population, or because they have so far kept out high-risk incoming passengers – would tend to favour a vaccine passport. However, they would have to balance the advantages that passports offer against the disadvantages, such as the possible loss of tourism income from travellers who do not have a vaccine passport, and may therefore choose an alternative destination that doesn’t require one.

Countries where vaccination levels are still low, and which lack the means to quickly ramp this up, would be more inclined to oppose vaccine passports. Their citizens are likely to find themselves at a disadvantage compared to people from countries where the majority of people have already been vaccinated, and who therefore are eligible for a passport. 

Conclusion

Evaluating the benefits as well as ethical concerns related to vaccine passports, it can be inferred that even though vaccine passports are a step closer to returning to the world we once knew, they are also fundamentally unjust for the citizens of certain nations. If the past two years have taught us anything, it is that we must prioritise access to vaccines and the health and well-being of all citizens, from all socioeconomic backgrounds; because one nation will only be safe when all nations are safe.

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