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Should those with immunity get a COVID-19 digital passport?
THE BIG DEBATE
OPINION
The Big Debate: Should those with immunity get a COVID-19 digital passport?
By Kumanan WilsonContributors
Sophia Moreau
Sabine Tsuruda
Tue., May 12, 2020timer7 min. read
READ THE CONVERSATION
The idea of a passport to allow work, entry to events and travel for those with COVID-19 immunity is highly controversial. Done properly, Dr. Kumanan Wilson argues such a digital badge will allow a faster return to the life we knew before the pandemic. But law professors Sophia Moreau and Sabine Tsuruda argue the moral and ethic risks are too high to take.
YES
NO
YES
Kumanan Wilson
Physician/scientist
In the 1800s, smallpox ravaged the world. Fortunately, a vaccine had been developed that could protect individuals. This vaccine left a scar at the site of injection and identified the individuals as “immune.” Presence of the scar was often used as proof of immunity before people were permitted to board trains and ships.
As we look toward the future of the COVID-19 pandemic, unless the virus burns out or an effective therapeutic intervention becomes available, the only way out of our current situation will be immunity — either natural or induced by a vaccine. If so, we will need to create a digital proof of immunity, a digital version of the smallpox scar, to help society to return to normal.
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Ideally, a safe and effective vaccine will be available in the New Year. If this is the case, we will need to have effective systems in place to identify those who are immunized. Our existing system of largely paper records will not be adequate.
Here is how such a system should work.
Most provincial/territorial governments have repositories of immunization data. For the eventual COVID-19 vaccine, they will need to ensure that this data is accurate and that the individual identified did, indeed, receive the vaccine. The government could then issue digital immunization badges to citizens that they could download through a government portal.
The badges would include an easily scannable bar-code or QR code and could be downloaded and stored on a mobile device, much like an airline boarding pass. When scanned, the barcode would let the verifier know who the immunity badge was issued to and issued by and would include a digital signature so the verifier would know that the badge was authentic.
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To enter into certain venues, such as sporting events or for international travel, the digital badge would have to be presented. The bar code will be scanned and the information it contains will be and matched to an individual’s ID card, just as we do for boarding passes. This will permit entry or travel. Exemptions will exist for medical reasons. I expect our tolerance for philosophical exemptions will be much lower given the consequences on both health and the economy if outbreaks re-emerge.
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Just like 9/11 issued in a new era of metal detectors at mass gatherings and travel I expect the COVID-19 pandemic will create a new era of “immunity detectors” at these same places.
Ideally, an international standard for this vaccination record will be set under the International Health Regulations, which already provide guidance for yellow fever vaccine certificates. This guidance needs to take into account the digitization of these certificates.
More controversial is the issuance of digital badges for natural immunity confirmed by antibody testing. The science and ethics of this solution are not mature at present but that should not preclude us from considering this option.
As for immunization, antibody data from credentialed labs could be stored in immunity repositories and digital badges issued if a threshold of immunity is considered to be achieved.
The most likely initial application of this solution will be front-line workers where, if we are confident natural immunity provides protection, we can create systems ensuring certain percentages of front-line workers are identified to be immune. This will create a form of “shield immunity” disrupting the transmission of the virus and protecting front-line workers and the people for whom they care.
Important ethical considerations make applying this approach to the broader population problematic — including the potential to stigmatize the non-immune and creating perverse incentives for them to become infected.
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A digital solution will have security and privacy risks that a paper record won’t have. However, a digital solution will be agile and adaptable in a way paper records cannot be. For example, if scientific evidence emerges on waning immunity, digital badges can be revoked. Decentralized ledgers (think blockchain) can facilitate the movement of this information across borders and between institutions.
As we enter into the next stage of this pandemic, we must start taking steps to ensure we have the right technology in place when science provides us with solutions. I have confidence that the combination of science and technology with ethical and legal oversight can accelerate our return to normal. And in doing so, allow us to return to work, attend sports events and concerts, see family and friends, and the myriad other activities that enrich our lives.
Kumanan Wilson is a physician/scientist and member of the University of Ottawa Centre for Health Law, Policy and Ethics and innovation adviser at Bruyere.
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Digital immunity passports for COVID-19 raise troubling moral and legal issues.
We support widespread vaccination against COVID-19, once a vaccine is available. But there are different ways of facilitating vaccination, and they are not morally and legally on a par.
Some are proposing that we should be required to register our vaccination status with the government and carry digital passports via a smartphone app to repeatedly verify our immunity status as we go about our lives. This proposal is far more invasive than the vaccination programs that we already have in schools.
Canada aims vigorously to protect people’s privacy rights. Are we now going to require people to submit to government tracking and entrust a panoply of private actors — ranging from Apple and Scotiabank Arena, to bosses and store clerks — with medical information?
Will the application also share information about where we go and what we do with third parties, as apps commonly do? Will the app be designed to give the government this further information?
Perhaps there are ways of avoiding these privacy concerns. But we need concrete proposals for guaranteeing that the passports are not a vehicle for surveillance. And developing such legally enforceable guarantees is no small task, as ongoing legal battles with Facebook and other tech companies illustrate.
Digital immunity passports would also disproportionately burden some of the most marginalized members of society. Will undocumented workers — many of whom build Canada’s homes and grow its food — feel comfortable registering with the government? How will people without smartphones show proof of immunity?
There are less concerning alternatives. We could hand out documents certifying immunity upon vaccination. We could require vaccination only for high-exposure jobs, such as front-line health care work. Elsewhere, we could encourage vaccination without making it mandatory.
For instance, public health nurses could visit workplaces, shelters, pharmacies, and public areas offering free vaccines. This could be done without requiring government registration, and would be less invasive, less coercive, and reach a broader swath of the public. Such alternatives would be cheaper and faster than developing an application, building a government registry, and redesigning privacy laws.
What about natural immunity passports, which some suggest should be used as an interim measure before a vaccine is available? Requiring people to show proof of natural immunity before accessing employment would create perverse pressure to self-infect among those who are most disadvantaged.
The privileged non-immune would not need to self-infect in order to put food on the table. It is those whose employment is most precarious, and who have no private spaces, who would face the agonizing choice of whether to infect themselves. This is not a choice that any egalitarian society should foist upon its most vulnerable members.
Moreover, natural immunity passports will divide our population into two officially sanctioned classes, those fit to work and those unfit to work. We do not need to look to dystopian fiction to see what is wrong with this. We can look back to our own shameful treatment of Indigenous peoples; our internment of various ethnic groups during the Second World War; our marginalization of people with disabilities.
We have worked so hard in recent years to build a society in which everyone has an equal chance to participate fully in our shared public life. Why backpedal, when it is not necessary?
Our governments should be incentivizing the imaginative restructuring of workplaces and public spaces, in ways that will enable us to practice physical distancing and will be inclusive of all. We should be sharing the costs of reopening the economy, rather than placing these burdens on those least able to bear them.
Finally, because alternatives are available, and because of the unfair divide between the immune and non-immune that these passports would create, there is a real risk that denying people jobs, goods, or services because they are not naturally immune to COVID-19 amounts to unfair and unlawful discrimination.
This concern has not been a part of our public discussions about immunity passports, but it should be fully explored before we ever consider developing digital immunity passports.
Sophia Moreau is a law professor at the University of Toronto and Sabine Tsuruda is law professor at Queen’s University.
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