The global focus on recovery from the Covid-19 pandemic has shifted attention to vaccines: their availability, roll-out, and take-up. Distribution is complex with this recent IDS article reflecting on the significant inequalities and inequities associated with who actually gets the vaccine, where and why. In countries such as the UK where vaccine roll-out is progressing rapidly, there are now new questions emerging including how to identify who has received the jab and whether it’s time to introduce “Vaccine passports”.
Using certification to demonstrate that a person has had the Covid-19 vaccine could be seen as an attractive way to bring society back to “normality” by allowing travel and movement both internationally and domestically. It could be used to enable people to be “free” to attend public events or enter public buildings; it might even extend to the right to be able to carry out certain employment tasks. But the idea of vaccine passports as part of the road map for a return to pre-Covid economic and social conditions also raises major concerns.
As Professor Melinda Mills, a lead author of a Royal Society report on “Twelve criteria for the development and use of COVID-19 vaccine passports”, highlighted this week: “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.”
Risks and benefits of the potential roll-out of digital vaccine passports
At IDS, we’ve been exploring some of the social, economic, and cultural implications of vaccination programmes and were delighted to join a rapid expert deliberation on vaccine passports convened by The Ada Lovelace Institute (ALI), chaired by Professor Sir Jonathan Montgomery. As part of an inter-disciplinary group, we considered the risks and benefits of the potential roll-out of digital vaccine certification schemes, discussed the evidence, deliberated on use cases, explored opportunities and risks, and identified areas of consensus to support government decision makers around the world.
The resulting, timely report “What place should COVID-19 vaccine passports have in society?” highlights the range of important issues that must be considered, and in many ways complements the findings of this recent Royal Society ’12 Challenges for Vaccine Passports’ report. As both highlight, vaccine passports may bring advantages, but before they become a viable option, we need firstly more evidence about whether viral transmission is possible by those who have been vaccinated. Secondly, we cannot develop certification in isolation from other measures. It will only be effective if it can work in secure and reliable ways within and across nations. This raises significant challenges for digital data security, privacy, security and trust.
From an IDS perspective, a key area of concern highlighted in the Ava Lovelace Institute Report is the potential for vaccine passports to further accelerate inequalities in the UK and internationally. As we’ve seen in so many contexts around the world, the pandemic has already exacerbated existing inequities and inequalities, as have many of the measures taken to try to mitigate impact of the virus on health.
There is a real danger from hasty introduction of vaccine passports as a political “knee-jerk” reaction. This could generate far more harm than good by entrenching the vulnerabilities and precarities that many people currently experience – for example by removing the rights of certain groups of people to work and earn a living because they do not have access to the vaccine or are not availing of it for justifiable reasons. There is a real risk that in many global contexts, vaccine passports could actually worsen economic conditions, by shutting large groups of people out from the formal economy.
There is also justifiable concern that the introduction of vaccine passports could reduce trust and increase vaccine hesitancy. For already marginalised groups, there is a risk that vaccine passports would be seen as introducing mandatory vaccination by the back door. It might worsen inequalities within societies where existing distrust of the state, identity infrastructure and limited access to vaccines are expected to put some groups at a particular disadvantage. As the Ava Lovelace Institute Report states “Access to digital technology, forms of identification, tests and vaccines is already unequal, and vaccine passports may unintentionally mirror and reinforce existing inequalities without wider programmes for addressing health inequalities.”
Cooperation to tackle the pandemic
As we have already observed at IDS, this type of intervention might increase inequalities between nations. We know that international cooperation in tackling the pandemic’s impacts is necessary, particularly for schemes enabling international
travel. According to the Ava Lovelace Institute Report: “scientific concerns could quickly become geopolitical ones, with countries using recognition of (and access to) vaccines as a form of political power and influence. There is pressure on governments to acquire vaccine supplies, which in turn triggers a form of ‘vaccine nationalism’ – where richer countries are able to buy up supplies of vaccines where poorer ones can’t.”
This is why it is so critical that the recommendations of the report are considered by policy makers, nationally and globally. There must be thorough public consultation on vaccine passports, including deliberation on how health data relating to Covid-19 and vaccines is used more generally. It requires engagement with civil society including experts in data ethics with a view to the long-term implications of such a scheme for groups that are disadvantaged and vulnerable to bias in technology design and data use.
Ultimately, the introduction of vaccine passports seems inevitable, not least because of a strong push for international travellers to demonstrate that they have been vaccinated and as part of an effort to control cross-border transmission of Covid-19. We believe, however, that any decisions on the introduction of vaccine passports need to step beyond political interests and the influence of the loudest voices in what is bound to be an intense public debate. Such an important move needs sufficient time, careful consideration, and consultation. This will give any scheme developed the greatest chance of success because it will be based on evidence, trust, and legitimacy that arises from a clear understanding of what trade-offs the public are willing to make.