With the growing rollout of the COVID-19 vaccine, the race is on to create ways to quickly recognize who has been immunized and who has not.
A “COVID passport" could allow people who can prove they’ve received the full dose — or have already survived the disease and may have immunity that way — to travel with fewer restrictions, or attend concerts and sporting events without getting tested.
The need seems to be growing fast as air travel hits records this spring: On March 21, the Transportation Security Administration screened more than 1.5 million travelers in a single day for the first time since the coronavirus crisis began.
How would a COVID passport work, and what are benefits and concerns?
One option, the Travel Pass app from the International Air Transport Association, is now being tested by more than a dozen airlines.
Fliers download it on their phone, snap a selfie and scan their passport to verify their identity. Those who are vaccinated can upload a copy of their vaccination certificate or, in destinations that require it, book a COVID-19 test at an approved lab. The results will automatically appear in the app.
What is a COVID-19 passport?
Americans who get COVID-19 vaccinations receive a vaccine record card from the Centers for Disease Control and Prevention, but it's not intended to be used as a "vaccine passport." The card is too easy to forge so it's not enough to prove that someone is fully vaccinated, especially for international travel, NBC News senior medical correspondent Dr. John Torres noted.
"For now, the CDC vaccine cards are the best we have. Going forward, when COVID-19 vaccinations are widely available, some type of vaccine certificate or passport will likely be needed," he explained.
That's why tech firms have been developing ways to create digital immunity certificates.
Airlines and other companies are interested in apps that could allow their customers to enter and store immunization information, test results and other medical documents — just like carriers store a person’s TSA Precheck or Global Entry data. People who’ve had the vaccine could then show a health pass generated by the app and navigate the world much more easily than those who are still at risk for catching or spreading COVID-19.
The apps could interface with state immunization registries to verify the information, according to Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security in Baltimore and a spokesman for the Infectious Diseases Society of America
“It would be something that's easier to facilitate than having to carry and produce the card every time,” he noted.
As Israel reopens parts of its economy, access to gyms, hotels and theaters is being limited to people with a "Green Pass" showing they've been vaccinated against COVID-19 or recovered from the illness.
On March 17, the European Commission — the executive branch of the European Union — proposed creating a Digital Green Certificate that would serve as proof that a person has been vaccinated, received a negative test result or recovered. Available free of charge in digital or paper format, the certificate would include a QR code to ensure authenticity, allowing "safe free movement inside the EU."
The U.S. is nowhere near that, Torres noted.
A CDC spokesperson told him the agency "has not yet issued guidance on management of vaccinated people during travel, and there are no established international standards for vaccines or documentation of vaccination."
What are the concerns?
The World Health Organization has been critical of "immunity passports" in the context of COVID-19. In March, Dr. Mike Ryan, director of WHO's emergencies program, said using vaccine certification as a requirement for travel "is not advised."
Doctors are still learning about the new coronavirus and how long a person might be immune either after receiving the COVID-19 vaccine or surviving an infection, said Dr. Katie Passaretti, an epidemiologist and medical director of infection prevention at Atrium Health in Charlotte, North Carolina.
“So it makes it a little bit tricky to say, ‘OK, you can move around freely indefinitely,’ until we get a little bit more information,” she noted.
“We're starting to see cases of reinfection in people who had been previously infected and there's at least theoretical suggestion that vaccines may not be lifelong protection. So there’s a number of things that have to be worked out before we would move forward with this idea.”
Beyond questions about immunity, there are also ethical and privacy concerns. Given the disparities within the health care system, some people may not have easy access to a vaccine, Passaretti noted. And not everyone may be comfortable sharing their health information through an app.
Some experts also worry that by implementing a “COVID-19 passport,” society is granting special privileges to a certain population, while limiting other people’s access to the world.
“That's the point, though,” Adalja countered. “People who choose not to get the vaccine have to bear those consequences.”
That wouldn’t mean they’d be banned from traveling or attending concerts, but would need to get a test or quarantine, he added. Activities would just be “much more onerous” if someone were not vaccinated, Adalja said.
Individual businesses could also be interested in a customer’s vaccination status.
Restaurants, bars and stores can refuse service to customers for pretty much any reason — thus the “no shirt, no shoes, no service” signs — but must give reasonable accommodation for people covered by certain anti-discrimination laws, said Dorit Reiss, a law professor at the University of California Hastings College of the Law in San Francisco.
What apps are available?
Besides Travel Pass, several different platforms are being tested.
JetBlue, Lufthansa, Swiss International Airlines, United Airlines, Virgin Atlantic and Airport Council International are taking part in CommonPass, which “lets individuals demonstrate their COVID status” and started rolling out last fall for passengers on flights from New York, Boston, London and Hong Kong.
AOKpass, developed by the International Chamber of Commerce, “allows users to present digitally authenticated and secure medical records to border authorities.”
IBM and Clear are developing apps that could eventually be used for admission to concerts and live sports.
Ticketmaster is “exploring the ability to enhance our existing digital ticket capabilities” that could include testing and vaccine information with third party health providers, but said there’s “absolutely no requirement" mandating vaccines or testing for future events.
When might COVID-19 passports be in place and for how long?
It may be a while before apps listing vaccination status are officially in use and required for travel.
Passaretti was doubtful whether the idea of a “COVID-19 passport” would even catch on in the U.S.
“It’s attractive in theory, but the devil is in the details,” she said. “I think there will be significant pushback.”
The apps might be in use for the next couple of years, or until COVID-19 ceases to be a public health emergency, Adalja predicted.