The Royal Society
Vaccine passports are certificates to establish proof of vaccination linked to the identity of the holder; the purpose of a passport is to aid the return to pre-COVID-19 activities and travel without compromising personal or public health.
We propose 12 criteria that should be satisfied by a COVID-19 vaccine passport, namely it should:
1. meet benchmarks for COVID-19 immunity;
2. accommodate differences between vaccines in their efficacy, and changes in vaccine efficacy against emerging SARS CoV-2 variants.
It should be:
3. internationally standardised with
4. verifiable credentials for
5. defined uses, and based on
6. a platform of interoperable technologies.A passport should be:
7. secure for personal data,
8. portable and
9. affordable for individuals and governments
.It should meet:
10. legal and
11. ethical (equity and non-discrimination) standards, and,
12. the conditions of use should be understood and accepted by passport holders.
Current evidence and precedents suggest that a COVID-19 vaccine passport system is feasible, but that not all criteria have yet been satisfied and consideration should be given to what longer term precedents this may create.
1. Meet benchmarks for COVID-19 immunity
A passport could serve two purposes. To certify that passport holders:
- are protected from illness so they can carry out the activities for which the passport is needed and avoid additional burdens on health services; and,
- cannot become infectious and transmit SARS-CoV-2 to others. Four different tests of infection and immunity might satisfy these goals:
- viral RNA test-negative (PCR test); and• viral antigen test-negative (lateral flow test) and that the subject is immune to COVID-19 illness and will not become infectious:
- viral antibody test-positive; and,
- vaccination. At present, there are only two viable passporting tests, neither of which is entirely satisfactory:
- a recent negative RNA (PCR) test within a particular time-specified interval to certify that subject is unlikely carrying a transmissible infection; and,
- vaccination to signify immunity.
2. Accommodate differences between vaccines in their efficacy, and changes in efficacy against emerging SARS CoV-2 variants: To place greater confidence in vaccine certification, more information is needed about:
- the efficacy of vaccines in preventing infection and transmission by the currently circulating viruses, including genetic variants; and,
- duration of protective immunity (both to illness and infectiousness) to determine frequency of vaccine passport renewal.
3. Be internationally standardised: The International Certificate of Vaccination or Prophylaxis (ICVP) or the ‘yellow card’ is a precedent in this area. The WHO has initiated a Smart Vaccination Certificate that will establish key specifications, standards, and a trust framework to facilitate implementation of effective and interoperable digital solutions.Some countries have already introduced vaccine certificates through website portals (Denmark), a QR code valid at travel borders (Iceland) but also link certificates to quarantine (Estonia) or to ease restrictions related to socialisation and movement (Poland, Israel). Expert bodies in some countries note that prior to introduction, more information is still required about vaccination efficacy, transmission and data protection, ethical and legal issues (Germany, Netherlands, Spain).
4. Have verifiable credentials: International and industry-based initiatives are being developed using international verifiable credentials and standards. The Common Pass and COVID-19 Credentials Initiative are consortiums working toward primarily App-based digital solutions using a QR code that can be displayed without releasing personal sensitive information. Others focus on products that allow individuals to share their vaccination and health status (to employers, authorities) while preserving privacy. Technical challenges exist such as those related to form (digital, paper), forgery, and attention to privacy and identify proofing.
5. Have defined uses: The uses of vaccine passports need to be clearly defined as they carry the risk that they could be used to discriminate in hiring or access to restaurants, health care centres, sporting or cultural events, insurance companies, or housing applications or other services. Additional concerns are whether vaccination data could be used for other unintended reasons or data linkage, such as by immigration authorities, and precedents (e.g., commercial accessibility of registers, expanded state health surveillance) it may create.
6. Be based on a platform of interoperable technologies: The technology must meet certain standards for interoperability (HL7 FHIR standards), which is the ability of systems to work together within and across organisational and technical boundaries to enable different information technology systems to communicate and exchange useable data.
7. Be secure for personal data: A fair balance of data protection and privacy requirements must be considered, in particular to guard against the use of such a passport to track populations, and for unrelated additional scrutiny of already marginalised groups, for example by police, employers or health checks. Health data – including vaccination records – are protected under the GDPR; these data must therefore be monitored, with technical and organisational measures to proactively deal with data transfers. There are potentially undesirable outcomes if vaccine status were used to compound already disadvantaged characteristics (e.g., age, ethnicity).
8. Be portable: There needs to be clarity across multiple aspects such as biometric authentication, QR codes, card readers, or paper copies to provide flexibility for individuals and governments.
9. Be affordable for individuals and governments:There must be sufficient resources to develop and sustain vaccine passports. If there are costs to acquiring a certificate or access issues, affordability needs to be considered.
10. Meet Legal Standards:
Certification needs to be consistent with various legal standard, including:
- international, regional and domestic human rights laws,
- data protection laws,• equality and discrimination laws,
- COVID-19 legislation; and,
- labour, occupational health and safety laws, but considerations need to be weighed against duty of care and commercial freedom to act.
11. Meet ethical, equity and non-discrimination standards: Core ethical concerns require further scrutiny including:• testing whether vaccine passports are inclusive,• have clearly defined uses and minimum data collection,• appropriate sharing and who gains access to the information;• where and how vaccine certification will be linked to other types of data; and, • avoidance of discrimination and exacerbating existing inequalities (e.g., vaccine hesitancy in certain groups, pregnant women, differential roll-out or access, digital divide).
12. Have conditions of use that are understood and accepted by passport holders: Ensure that individuals understand the utility of vaccine passports and monitor public acceptance and experiences. Unintended behavioural responses and resistance could arise if uses are not transparent, making it essential to monitor impacts on vaccine hesitancy, trust, incentives and responses and in communication strategies.
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