The expected rollout of a COVID-19 vaccine is raising interest in creating ways to quickly recognize who has been immunized and who has not.
That 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.
Some are calling the concept a “COVID passport.”
How would it work, and what are benefits and concerns?
TODAY asked 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; and Dr. Katie Passaretti, an epidemiologist and medical director of infection prevention at Atrium Health in Charlotte, North Carolina.
What is a COVID-19 passport?
People who get the two required doses of a COVID-19 vaccine may be given a “WHO-CDC type of card” through their clinic to serve as proof of vaccination — very similar to the paper “yellow card” currently issued after someone receives the yellow fever vaccine, Adalja said.
The Centers for Disease Control and Prevention has so far unveiled a vaccine record card meant to serve as a reminder when the second shot is due, but is not intended to be used as a "vaccine passport."
There have problems with people forging yellow fever cards, which are required for entry into certain countries, Adalja noted. So when it comes to COVID-19, tech firms have been developing ways to create digital immunity certificates or “immunity passports.”
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, Adalja said.
“It would be something that's easier to facilitate than having to carry and produce the card every time,” he noted.
What are the concerns?
The World Health Organization has been critical of "immunity passports" in the context of COVID-19.
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, Passaretti said.
“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 concerns. Given the disparities within the health care system, some people may not have easy access to a vaccine, Passaretti noted.
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.
“Immunity passports would impose an artificial restriction on who can and cannot participate in social, civic and economic activities,” Alexandra Phelan, an assistant professor at Georgetown University Medical Center, wrote this spring in The Lancet.
“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?
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 starts rolling out this month 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.”
The International Air Transport Association, which represents carriers around the world, has Travel Pass, which will “manage and verify the secure flow of necessary testing or vaccine information” and is scheduled to launch in the first quarter of 2021.
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?
Since the initial supply of the COVID-19 vaccine will be scarce and immunization rolled out gradually, with health care personnel likely first in line, it may be a while before apps listing vaccination status are in use.
“It's not going to be just like in January all of us health care workers are going to have our own Madonna concert,” Adalja said.
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.