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Vaccine passports during the COVID-19 pandemic

Source: Wikipedia, the free encyclopedia.

An EU Green Pass in digital format being scanned before entering a bistro in Parma, Italy

A vaccine passport or proof of vaccination are immunity passports which have been employed as a credential[1] in a number of countries and jurisdictions as part of efforts to control the COVID-19 pandemic via vaccination. They are typically issued by a government or health authority, and have consisted of a scannable barcode, QR code or are accessible in paper form or as part of a mobile app. They may or may not use a COVID-19 vaccine card as a basis of authentication. As of 5 October 2021, more than 46 percent of the world population has been vaccinated with a COVID-19 vaccine.

The use of vaccine passports is based on the general presumption that a vaccinated individual would be less likely to transmit SARS-CoV-2 to others, and less likely to experience a severe outcome (hospitalization or death) if they were to be infected, thus making it relatively safer for them to congregate. They are typically used in tandem with policies enforced by individual businesses, or enforceable public health orders, that require patrons to present proof of vaccination for COVID-19 as a condition of entry or service.

There may be exceptions to such mandates if a person is incapable of being vaccinated for valid, however extremely rare[2][3][4] medical reasons, while some countries may also allow them to be issued to individuals deemed to have developed immunity to SARS-CoV-2 by means of a past infection. Government-mandated use of vaccine passports typically apply to discretionary public spaces and events (such as indoor restaurants, bars, or large-scale in-person events such as concerts and sports), and not essential businesses such as retail stores or health care (although they may very by region).

In jurisdictions like France, Italy,[5] Ireland,[6] and Canada,[7] vaccine uptake increased after various levels of governments announced plans to introduce vaccine passports.

Despite the benefits of vaccination in improving economic and social problems caused by the pandemic, vaccine passports are controversial and have raised scientific, ethical and legal concerns.[8][9] Critics also argue that vaccine passports violate civil liberties.[10] In the United States, there is no vaccine passport at a federal level, and some US states have preemptively banned vaccine passports in certain public and/or private sector contexts.[11] England canceled a planned vaccine passport program in September 2021.[12]

History and background

Share of people who have received at least one dose of a COVID-19 vaccine relative to a country's total population. Date is at the bottom of the map.

Many governments including Finland,[13] and Germany,[14] expressed early interest in the concept. Vaccine passports were seen as a potential way to permit a faster economic recovery from large-scale lockdowns that apply to all residents (especially within the travel and tourism industries), improve the confidence of patrons concerned for their health and safety, and to incentivize vaccination in order for a population to potentially reach "herd immunity".[15][16]

In May 2020, Chile started issuing "release certificates" to patients who had recovered from COVID-19, but "the documents will not yet certify immunity".[17] Many governments including Finland,[13] Germany,[14] the United Kingdom,[18] and the United States[19] expressed interest in the concept.

The Royal Society published a report on 19 February 2021[20] where a lead author of the report, Professor Melinda Mills, Director of the Leverhulme Centre for Demographic Science at the University of Oxford said: “Understanding what a vaccine passport could be used for is a fundamental question – is it literally a passport to allow international travel or could it be used domestically to allow holders greater freedoms? The intended use will have significant implications across a wide range of legal and ethical issues that need to be fully explored and could inadvertently discriminate or exacerbate existing inequalities.” The report lists 12 essential criteria for an international standard.

On 12 March 2021, Ecma International announced its intention to create an international standard which prevents counterfeits and protects private data as much as possible in a "Call for Participation on Vaccine Passports International Standardization" [21] that referenced the earlier report from the UK's Royal Society. In August 2021, Ecma International announced revisions to Ecma-417 (Architectures for distributed real-time access systems) relevant to standards for vaccine passports. [22]

An early advocate of immunity passports during the COVID-19 pandemic was Sam Rainsy, the Cambodian opposition leader. In exile and under confinement in Paris, he proposed immunity passports as a way to help restart the economy in a series of articles which he began in March 2020 and published in The Geopolitics and The Brussels Times.[23][24][25] The proposals were also published in French.[26] The idea became increasingly relevant as evidence of lasting acquired immunity became clear.[27]

Proponents of the idea such as Sam Rainsy, co-founder of the opposition Cambodia National Rescue Party (CNRP) have argued that immunity, whether acquired naturally or through vaccination, is a resource which needs to be used to limit the impact of the pandemic on the global economy.[28] Many people in Cambodia depend entirely for their living on a tourism industry which has been wiped out. Poor countries can also benefit from recording immunological status as this will reduce wastage of scarce vaccines. The immunity passport proposed by Rainsy was effectively adopted in the EU under the name of "health pass".[29]

As of 4 April 2021, it was not yet clear whether vaccinated people that remain asymptomatic are still contagious and are thus silent spreaders of the virus putting unvaccinated people at risk. "A lot of people are thinking that once they get vaccinated, they’re not going to have to wear masks any more," said Michal Tal, an immunologist at Stanford University. "It’s really going to be critical for them to know if they have to keep wearing masks, because they could still be contagious."[30]

In January 2021, Israel announced that all Israelis who have received their second vaccination as well as all who have recovered from infection will be eligible for a "green passport" that will exempt them from isolation requirements[31] and mandatory COVID-19 tests, including those on arrival from overseas.[32] In February 2021, Israel became one of the first countries to implement a vaccine passport system, dubbed "green pass". They are required in order to access venues such as gyms, hotels, bars, and restaurants.[33][34][35]

By region

Azerbaijan

Azerbaijan requires proof of vaccination for people over 18 to enter virtually all public spaces. This policy began 1 September 2021. A federal mandate has also required all state regulated workers to be vaccinated as of 1 October 2021.[36] Despite this effort, a report suggested there was evidence of fraudulent vaccine passports created by bribing healthcare workers.[37]

Brazil

In December 2020, the Brazilian Senate approved a document giving digital proof of all vaccinations - not just those in respect of COVID-19. However, the urgency for creating such a digital proof of vaccination came from the COVID-19 pandemic.[38]

Canada

Vaccine passport status in Canada:
  No plans for a vaccine passport
  Partial vaccine passport
  Vaccine passport

On a nationwide level, Canada will implement vaccine mandates for people 12 and older on all federally regulated travel including airplanes, trains and cruise ships. Anyone using these methods of travel must be fully vaccinated by 30 October 2021, or show proof of a negative test. After 30 November 2021, the testing accommodation will no longer be an option.[39]

All 10 provinces in Canada, and one the three territories, have currently implemented or announced plans to implement a provincially-regulated COVID-19 vaccine passport.[40][41][42][43][44][45] Each province has a different system in place with their own rules and regulations.

Alberta

In Alberta, the Restrictions Exemption Program was introduced in September 2021 due to rising cases in the province. It applies to eligible venues and events, and is described by the government as an opt-in system allowing them to operate with fewer restrictions they mandate vaccination of patrons. If a facility does not participate, they are required to comply with all public health orders, which as of September 2021 restricts maximum capacity to one-third, and prohibits the operation of dine-in restaurants.[46]

Later that month, the city of Calgary passed a municipal bylaw requiring all eligible industries to participate in Restrictions Exemption Program.[47]

Manitoba

Manitoba was the first province to introduce a passport system in Canada on 17 July 2021. The passport requirement was removed for movie theatres, museums and galleries on 7 August 2021,[48] only to be reinstated on 3 September 2021, upon Manitoba expanding its passport system. The province utilized physical Immunization Cards which faced supply shortages in production.[49]

Quebec

Quebec was the second province to implement a vaccine passport system on 1 September 2021, using QR codes.[50]

Northwest Territories

The Northwest Territories will implement an opt-in vaccine passport system on 22 October 2021 using original vaccination receipts.[51]

Other provinces

  • British Columbia has created a Proof of vaccination system which utilises a QR code. The system initially relied on paper receipts of the BC vaccine receipt and gradually migrated to a digital system. The QR code can also be physically printed out.[52]
  • New Brunswick requires a Proof of Vaccination system using original immunisation records.[53]
  • Newfoundland and Labrador has plans to release a QR code based system for their vaccine passport.[54]
  • Nova Scotia has a Proof of Full Vaccination Policy using original government issued proof of vaccination.[55]
  • Ontario introduced a passport system on 22 September 2021. The system relies on original vaccine receipts and on 22 October 2021, will migrate to verifiable QR codes.[56]
  • Prince Edward Island uses the PEI Vax Pass Program using original government issued vaccination information.[57]
  • Saskatchewan has a Proof of vaccination mandate effective October 2021, using either the government-issued vaccination receipts, or a digital or printed health record with QR code.[58][59]

China

In February 2020, China started to use digital "health codes", available on a variety of platforms including WeChat and Alipay with scannable QR barcodes displaying a "traffic light" system of colours to enter public transport, shops, restaurants and malls. It was used 40 billion times between February and March.[60]

In March 2021, an "International Travel Health Certificate" was created.[61] In March 2021,[62] the government of China rolled out the world's first[63] COVID-19 vaccine passport system through a partnership[60] with Alipay and WeChat. The system provides a health certificate that includes an individual's vaccine status and the results of COVID-19 testing.[60][63][62] Initially, the system would only indicate that an individual had been vaccinated if they received a Chinese-made coronavirus vaccine, leading to criticism, though by April 2021 the system began to accept records of receiving the Pfizer-BioNTech, Moderna, and Janssen vaccines.[64] As of March 2021, the app was optional and its use was restricted to Chinese citizens.[60] The digital health passport is intended to better facilitate travel.[65][60] Privacy advocates and Chinese netizens have expressed concerns regarding the potential invasive data collection and the use of data for non-health monitoring purposes.[60][66]

Denmark

Denmark introduced a Coronapas on 21 April 2021. Those unvaccinated with a recently negative test of 72 hours or previous infection of COVID-19 of up to 12 weeks prior were included in the pass system. Due to high uptake of vaccines, Denmark retired their system on 10 September 2021.[67][68]

European Union

The European Union offers a EU Digital COVID Certificate, a digitally-signed proof of vaccination, proof of a recent recovery, or a recent negative test, for use when travelling within the Schengen area with fewer restrictions. It launched in July 2021, and is applicable for citizens of the EU, and also for travelers from outside of the region.[69][70][71]

Some EU countries, such as Hungary, started to recognize digital vaccine passports from outside of the EU, including from Kazakhstan. However, those certificates are not applicable in the Schengen area.[72]

France

France issued a Health Pass (or Pass Sanitaire in French) on 9 August 2021, for use in non-essential settings for those 18 and older.[73][74] To obtain the pass people must be fully vaccinated or undertake a test within 72 hours of attending a non-essential space or have recovered recently from an infection of the virus.[75] The initial announcement of the pass system is believed to have encouraged an additional one million people to sign up for vaccination the day following the announcement,[74] and is credited to encouraging a further 3.7 million people to sign up for vaccination in the following week.[76] Following 1 October 2021 the pass requires anyone 12 and older to be vaccinated to attend certain non-essential venues.[73]

Ireland

In July 2021, Ireland introduced a vaccine certificate program (EU Digital COVID Certificates) which allowed vaccinated individuals to attend cafes, bars and restaurants. Due to one of the highest uptakes of COVID-19 vaccines in the world, the Republic of Ireland (but not Northern Ireland) has plans to retire their vaccine passport program on 22 October 2021.[77]

Israel

Israel was one of the first countries to issue what is known as a Green Pass in February 2021.[78] The pass was discontinued on 1 June 2021,[78] but following a surge of new infections, it was reinstated on 29 July 2021.[79] In October 2021, all existing Green Passes were voided if the most recent shot was administered more than 6 months ago. To obtain a new valid pass and to be considered "fully vaccinated" in Israel, the holder would need to show proof of a third (or booster) dose of a vaccine or show proof of a recovery within the past 6 months.[80] This change affected more than a million residents who had previously been regarded as "fully vaccinated".[81][80] A temporary Green Pass can be obtained with a negative viral test, but must be paid for by the individual unless they are not eligible for vaccination.[82]

Italy

In August 2021 the Italian government extended the requirement of the EU Digital COVID Certificate, also known as "Green Pass", to the participation in sports events and music festivals, but also to the access to indoor places like bars, restaurants and gyms, as well as to long-distance public transportation.[83] On 15 October, Italy became the first country in the world to establish a mandatory COVID-19 vaccination certificate for the entire work force, public and private.[84]

Japan

On 19 July 2021, Japan began accepting applications for its COVID-19 vaccination passport program. When issued, the passports will be in paper form in both Japanese and English, showing the holder's date(s) of inoculation and the vaccine type, and are available free of charge.[85] As of 22 July 2021, Japan vaccine passport holders are exempt from entry restrictions in Austria, Bulgaria, Italy, Poland, and Turkey. South Korea will also exempt those travelling for specific business, academic, or humanitarian reasons. Entry is also facilitated by Germany; Honduras; Hong Kong; Lithuania; St. Kitts and Nevis; St. Vincent and the Grenadines; and Thailand's islands of Phuket, Samui, Ko Pha-Ngan, and Ko Tao.[86] Japan is in negotiation with other countries (including China and the United States) to accept the passport.[85]

Morocco

Morocco currently has a nightly curfew between 23:00 and 04:30 pm, people who are fully vaccinated are exempt from curfew.[87]

North Macedonia

Residents wishing to attend events, bars, restaurants, and other dining establishments must present proof of vaccination.[88]

Saudi Arabia

Residents attending restaurants, cafes and public spaces like malls, shopping centres and markets must be fully vaccinated. The country uses the Tawakkalna app which includes information for health appointments, vaccination status and alerts users to COVID-19 exposure for contact tracing purposes.[89]

Ukraine

In Ukraine, citizens with at least one dose of a vaccine are allowed to attend certain high-risk indoor settings which would normally be closed or heavily restricted in hot spots.[90][91]

United Kingdom

In early September 2021, the NHS proposed the Covid Pass vaccine passport in England,[92] Scotland,[93] and Wales.[94] It was proposed for those who had received either two doses of the Pfizer, Moderna, or AstraZeneca vaccines; one dose of the Janssen vaccine; or "proof of natural immunity shown by a positive PCR test result for COVID-19, lasting for 180 days after the date of the positive test and following completion of the self-isolation period".[95]

England cancelled the Covid Pass program on 12 September 2021 following pushback from Conservative members of parliament and business leaders over potential discrimination and economic harm, while Scotland and Wales have retained the program.[96][97][98][99][100]

Northern Irish citizens who have been fully vaccinated for COVID-19 in Northern Ireland can apply for a certification that they are vaccinated through an automated method administered by the Department of Health.[101]

United States

Map showing (1) California, Hawaii, Illinois, Louisiana, New Jersey, New York, North Carolina, and Virginia have implemented COVID-19 vaccine passports; (2) Alabama, Arizona, Florida, Idaho, Indiana, Iowa, Montana, North Dakota, South Carolina, South Dakota, Texas, and Wyoming have banned COVID-19 passports; (3) that Alaska, Arkansas, Georgia, Missouri, New Hampshire, Oklahoma, Tennessee, and Utah have partially banned COVID-19 vaccine passports; (4) that Washington has a significant locality that has implemented a COVID-19 passport
A map showing which US states have proposed or implemented (green), banned (red), or partially banned (yellow) COVID-19 vaccine passports. Gray indicates that the state has neither implemented or banned COVID-19 vaccine passports. Also included is states that have significant localities with COVID-19 vaccine passports (Aqua). Green includes states which have created a vaccine passport mobile application, but the application is not mandated to be used in the public or private sector. As of October 2021, no US states had mandated use of vaccine passports. [102][103][104][105][106][107]

Although the country does offer a paper "Vaccination Record Card", issued by the Centers for Disease Control and Prevention (CDC) to provide a log of the patient's doses and when they are received,[1] the United States does not have, and will not implement, a federal framework for a digital vaccine passport. Federal officials cited privacy and human rights concerns in its decision, thus leaving their implementations up to individual states.[10]

Prior to the issue becoming politicized, public views on vaccine passports were evenly split and the divide crossed, rather than followed, political and ideological lines.[108] Since then, criticism and conspiracy theories surrounding the vaccines in general, and in turn vaccine mandates, have largely come from the political right; for example, U.S. representative for Georgia's 14th congressional district Marjorie Taylor Greene, a Republican, asserted that requesting the disclosure of one's vaccine status was a violation of data privacy rules for the health care industry, even though said rules only apply to entities such as health insurers.[109][110][111]

The state governments of California, Hawaii, Louisiana, New York, North Carolina, and Virginia have each rolled out mechanisms where residents can choose to receive proof of COVID-19 vaccination in the form of a scannable QR code by linking to records within each state's immunization registry.[112][113] Illinois has a Vax Verify website, where residents can download proof of COVID-19 vaccination for businesses that require it.[114] In New Jersey, residents can obtain a digital COVID-19 vaccination record through its mobile app Docket; Governor Phil Murphy has specifically avoided using the term "vaccine passport" to describe the service.[115]

Each state credential has varying degrees of interoperability with other state and foreign governments; some states have closed systems, with QR codes that are only usable within the issuing state, and others have broad interoperability, with New York offering both types of credentials for its residents.[116] Arizona, Maryland, Mississippi, North Dakota, Washington, West Virginia, Puerto Rico, and the District of Columbia have contracted with an organization[which?] that interfaces with governmental vaccination records to produce a PDF proof of vaccination, but has also moved toward scannable QR codes. Health departments in Indiana, Colorado, and Georgia can provide proof of vaccination in PDF form but not via a QR code.[117][118][119][120]

On the other hand, a number of states have prohibited state agencies from issuing vaccine passports. Twenty US states including Florida and Texas have preemptively banned vaccine passports in the public and/or private sectors, citing discrimination and privacy concerns.[1][121][122]

Los Angeles County

Los Angeles County began a proof of vaccination system for indoor bars, restaurants, venues and nightclubs on 7 October 2021.[123]

New York City

New York City began its Excelsior Pass or Key to NYC vaccine passport system for dining, fitness, events and indoor entertainment on 13 September 2021.[124][125][126]

New Orleans

New Orleans began to require proof of vaccination or a negative test to enter indoor bars, restaurants, events, fitness, and sporting events on 16 August 2021.[127]

Arguments and controversy

In April 2021, the World Health Organization (WHO) advised against the use of mandatory COVID-19 vaccine passports for travel, citing ethics and efficacy concerns.[128][129][130] In February 2021, the position of World Health Organization (WHO) on requiring proofs of COVID-19 vaccination for international travel purposes remains against on using this as a condition for departure or entry.[131]

Effect on vaccine uptake

In some jurisdictions vaccine uptake increased after various levels of governments announced plans to mandate their use.[5][7][132][133][134]

Ethical and social issues

The ethical issues that arise in the acceptability of vaccine passports revolve around the policy objectives and the intended use.[8][9] The public health restriction on implementing vaccine passports limits the freedom of an individual to perform social activities.[135]

Vandalism in Toronto, Canada (2021)

People who are privileged to receive the vaccination will have gained access to going back to normal life while low-income populations will remain disproportionately low on vaccinations which hinders their ability to participate in non-essential activities.[135] Religious people and people who refuse to get vaccinated have also restricted their own liberties.[135]

Due to the imbalance in the distribution of vaccines in the developing world, there are concerns about the inequity of vaccine passports for travellers. In an 15 April 2021 meeting published 4 days later, the World Health Organization's emergency committee opposed vaccination passports, saying "States Parties are strongly encouraged to acknowledge the potential for requirements of proof of vaccination to deepen inequities and promote differential freedom of movement".[136]

However, many countries may increasingly consider the vaccination status of travellers when deciding to allow them entry or whether to require them to quarantine. “Some sort of vaccine certificate will be important” to reboot travel and tourism, according to Dr. David Nabarro, special envoy on COVID-19 for the World Health Organization (WHO), in February 2021.[137] Countries experimenting with or seriously considering COVID-19 vaccination passports include Aruba,[138] Britain,[139] Israel[140] and Canada.[141]

In March 2021, Bernardo Mariano, the WHO's Director of Digital Health and Innovation, said that "We don't approve the fact that a vaccination passport should be a condition for travel."[142] Lawmakers in several US states are also considering legislation to prohibit COVID-19 vaccination passports.[143]

Ethical concerns about vaccine passports have been raised by Human Rights Watch (HRW).[144] According to HRW, requiring vaccine passports for work or travel could force people into taking tests or risk losing their jobs,[144] create a perverse incentive for people to intentionally infect themselves to acquire immunity certificates,[144] and risk creating a black market of forged or otherwise falsified immunity certificates.[144]

By restricting social, civic, and economic activities, vaccine passports may "compound existing gender, race, ethnicity, and nationality inequities."[145] Immunity certificates also face privacy and human rights concerns.[146]

Vaccination certificates

Natural immunity

People may acquire a degree of natural immunity from SARS-CoV-2 when they are exposed to the live virus, and develop a primary immune response which produces antibodies that can recognize specific variants.[147] As of May 2021, the World Health Organization (WHO) reported that more than 90% of individuals established recognizable antibodies in a within four weeks after an infection. For most people, these detectable antibodies roughly stay for at least 6-8 months.[148] However, antibodies may not guarantee immunity from novel variants and mutations of SARS-CoV-2. The uncertainty of the science behind immunity to SARS-CoV-2 has raised issues over their applicability within passport frameworks.[147][149]

It has been argued that the primary difference is that vaccination certificates such as the Carte Jaune incentivize individuals to obtain vaccination against a disease, while immunity passports incentivize individuals to get infected with and recover from a disease.[145]

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See also