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Fri, 15 January 2021

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Ticket To Normal Life Or Threat To Freedom? Why Coronavirus 'Vaccination Passports' Might Not Be A Simple Way Forward

Ticket To Normal Life Or Threat To Freedom? Why Coronavirus 'Vaccination Passports' Might Not Be A Simple Way Forward

The NHS will give out cards to remind people to secure the second dose of the vaccine - but could the cards be used to gain entry to pubs? (PA)

10 min read

Being able to prove your immunity to Covid-19 could be the key to a return to normal life in 2021.

Policymakers in the UK have been considering the idea since the first lockdown in spring. There are two main proposals: an “immunity passport” and a “vaccine passport,” that would link either a person's proof of coronavirus antibodies or vaccination record to their identity.

The question is: should you have to prove you’re vaccinated to buy a pint or see a movie? 

And, if immunity passports were introduced, would they really prove you can’t catch or spread coronavirus?

Last week, newly-appointed vaccine tsar Nadhim Zahawi hinted that pubs and bars could soon ask punters for proof they were vaccinated against coronavirus on the door. The government quickly denied the plan, but the appetite for such measures lingers. 

Some have suggested immunity could be confirmed with a physical stamp on our existing passports, while others think it could be proven digitally through a QR code generated on an app. 

Individuals could present such proof to businesses, employers and authorities to confirm they are not at risk of transmitting the virus. 

But, this could result in those who choose not to get vaccinated being denied access to some venues and services, which some view as a constraint on our liberty. Others worry the system lacks scientific backing. 

Here’s some of the key reasons vaccine or immunity passports aren’t such a simple solution after all:

Proving immunity

When it comes to proving immunity there are two key issues: the degree of immunity induced by a vaccine varies from person to person, and the duration of immunity is still unclear. 

As Prof Janet Lord — an expert in immune cell biology at the University of Birmingham — explains, vaccination doesn't necessarily halt transmission of a disease.

“Having the vaccine is one thing, proving that you've got full immunity and won't spread it is another. And there's no way you could do that at scale,” she explained. 

“All you can say from the data we've got from the vaccine trials is that certain people are developing good levels of antibodies or good levels of these memory T cells.”

Vaccine trials are “not designed to show that it doesn't stop transmission”, Prof Lord added, but rather are aimed at preventing severe symptoms should the virus enter the body.

The system could be complicated further by the time taken for the immune system to respond fully to both doses of the vaccine. With uncertainty over when the body’s reaction to the jab peaks, when would a vaccine passport be issued? 

Vaccine trials are not designed to show that it doesn't stop transmission

Prof Janet Lord, University of Birmingham

The Pfizer/BioNTech vaccine, for example, consists of two doses taken 21 days apart. Its developers claim it has a 90% efficacy rate seven days after the second dose, but Prof Lord suggested it could take even longer for some people to fully respond.

“It should probably only be given out, say, four weeks after the vaccination because it takes about four weeks for the immune system to become fully established. I think a lot of people don't realise that,” she said.

And, when it comes to proving immunity after recovering from coronavirus, the scientific community remains sceptical that being exposed to the virus creates immunity. The idea of providing documentation to show an individual is safe from reinfection was shut down by the World Health Organisation (WHO) back in April.

In a statement, it said: “At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate’.”

But, according to an article in leading medical journal The Lancet, an immunity passport based on a vaccine is more realistic than one based on previous infection as “the stimulus is uniform and is therefore likely to have a more predictable pattern and duration of immunity than infection”.

The authors also signal that concerns over transmission of Covid-19 by those vaccinated and the length of immunity “could potentially be overcome in the coming months” as more information becomes available.

So, scientifically speaking, it’s likely that a vaccine passport could work, while immunity passports based simply on having caught the virus are unlikely to be effective. But, can we be legally required to carry them?

Legal difficulties

“Vaccine passports or similar are not a new idea,” explained Prof Ilan Kelman, Professor of Disasters and Health, University College London.

“One of the many initiatives which successfully eradicated smallpox was the requirement for a vaccination in order to travel. Today, when travelling from and to places at risk of yellow fever, proof of vaccination is sometimes required. To enter some countries, proof of a polio vaccination is still needed.

Airlines were unsurprisingly among the first to call for such a system after pandemic travel-bans led to a dramatic drop in passenger numbers.

The CEO of Australian airline Qantas recently said he viewed proof of immunity from Covid-19 as a “necessity” for international travel. The International Air Transport Association (IATA) and United Nations’ International Civil Aviation Organization (ICAO) have also said they back the idea.

In fact, a global pilot programme of a digital health pass is already being trialled on some flights. The nonprofit CommonPass initiative — which is backed by the World Economic Forum and Swiss-based foundation The Commons Project — verifies a person’s status through government data and a trusted network of labs. 

But catching a plane to a foreign country is a far cry from popping down to the local pub or buying tickets for the cinema. Can the government require vaccination for us to go about our daily lives?

Under current law: no. The Public Health (Control of Disease) Act 1984 — which gives the government powers to prevent, control or mitigate the spread of disease — has explicit exemptions to prevent a person being required to undertake medical treatment, which would include vaccination.

One of the many initiatives which successfully eradicated smallpox was the requirement for a vaccination in order to travel.

Prof Ilan Kelman, University College London

Lawyers at firm Morgan Lewis claim it is theoretically possible for employers to pressure employees into getting vaccinated. But, in reality, they warn it’s “highly doubtful” that this could be considered consensual in most circumstances.

But what about businesses? Could they deny entry to punters if they don’t produce proof of vaccination? Here, things get a little tricky. Businesses have a right to refuse service to anyone unless it is on the basis of protected characteristics, a list which does not include vaccination status. 

The government has repeatedly made clear there are “no plans” to introduce a vaccine passport, despite vaccine minister Nadhim Zahawi claiming he was “looking at the technology”.

But, this denial was complicated by the news that those getting vaccinated would receive a card confirming they’d had it.
 
Foreign office minister James Cleverly told Sky News he hoped these wouldn’t be used as “tickets” to gain entry to pubs and restaurants, but also said they were “ultimately about unlocking people's lives and the economy”. 

Amid this confusion, former minister David Jones has since called for the government to introduce legislation to ensure these cards aren’t used as vaccine passports, telling the MailOnline that it should be clarified that carrying the cards is an “entirely free decision”.

Data privacy

Another stumbling block when it comes to businesses handling your medical records is data privacy, explains Dr Ana Beduschi, an associate professor of law at the University of Exeter.

“Digital health passports may contribute to the long-term management of the COVID-19 pandemic, but their introduction poses essential questions for the protection of data privacy and human rights,” she said.

“These passports build on sensitive personal health information to create a new distinction between individuals based on their health status, which can then be used to determine the degree of freedoms and rights they may enjoy.”

The charity Privacy International has even dubbed such immunity passports “dangerous” as the digital identity industry is failing to protect against certain harms such as discrimination and the misuse of data. 

In a post on its website, the charity argued: “The social risks of immunity passports are great: it serves as a route to discrimination and exclusion, particularly if the powers to view these passports falls on people's employers, or the police.”

Immunity passports serve as a route to discrimination and exclusion, particularly if the powers to view these passports falls on people's employers, or the police.

Privacy International

Bioethicists Natalie Kofler and Françoise Baylis also remain deeply sceptical. In an article for the journal Nature, they warned passports could be “deeply problematic”.

“The whole point of immunity passports is to control movement. Thus, any strategy for immunity certification must include a system for identification and monitoring,” they argue. 

“Paper documentation could be vulnerable to forgery. Electronic documentation integrated into a smartphone app would be more resistant to fraud… But electronic documents present a more serious risk to privacy.”

However, the government’s Centre for Data Ethics and Innovation, suggested the technology could prove “valuable” in settings where there “remains a high risk of virus transmission, such as sports venues and international travel hubs”.

“The right design of the digital ID system could help to address many of the concerns around privacy, whilst a flawed design could compound them,” it said in a blog post. 

But, regardless of the practical and scientific considerations of this passport system, one overarching question remains: is it the right thing to do? And, is it morally preferable to infringe rights via a vaccine passport or continued lockdowns?

Protecting our liberty

“Vaccine passports seem problematic if we assume that pressure to vaccinate is harder to justify than lockdown-type constraints,” Thomas Douglas, Professor of Applied Philosophy based in the Oxford Uehiro Centre for Practical Ethics, explained.  

“In that case, the government might have a duty to minimise pressure on people to vaccinate, even if that meant locking down everyone for longer.” But is it the case? 

Speaking to PoliticsHome, he continued: “Lockdown involves very severe limits on freedom of movement and association, it is very disruptive of our personal relationships, and it can have devastating effects on mental health. 

“I suspect that lockdown is both more harmful and more of an affront to personal liberties than some pressure to vaccinate.”

Dr Beduschi shares the view that lockdowns are more prohibitive than vaccine passports, but she cautions that some people could have their freedoms “de facto restricted” if they could not access or afford the Covid-19 test or vaccine. 

Lockdown is both more harmful and more of an affront to personal liberties than some pressure to vaccinate.

- Prof Thomas Douglas, Oxford Uehiro Centre for Practical Ethics

“Unless the tests and, once available, vaccines are accessible to all, any large-scale deployment of immunity passports could disproportionately segment the society and potentially breach the rights to equality and non-discrimination,” she added. 

Fears that such a system could divide society are shared by bioethicists Kofler and Baylis. “Labelling people on the basis of their COVID-19 status would create a new measure by which to divide the ‘haves’ and the ‘have-nots’ — the immunoprivileged and the immunodeprived,” they wrote.

And, the ethical concerns surrounding such a system don’t stop there. Some fear creating a passport proving immunity could encourage people to ignore basic health measures like hand washing and social distancing. Others fear that effectively requiring vaccination to undertake certain activities could discourage people from taking the vaccine.

It’s for this reason, and many of the reasons set out above, that the University of Exeter’s Dr Beduschi has published a report warning that digital health passports should not be rolled out on a mass basis until Covid-19 vaccines are available to all.

“Digital health passports may contribute to the long-term management of the COVID-19 pandemic, but their introduction poses essential questions for the protection of data privacy and human rights,” she argued.  

“They build on sensitive personal health information to create a new distinction between individuals based on their health status, which can then be used to determine the degree of freedoms and rights individuals may enjoy.” 
 

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