Should we adopt COVID-19 “immunity passports”?

By Victoria Min-Yi Wang.

The COVID-19 pandemic has led the UK to impose lockdown measures that have reduced personal freedoms normally taken for granted in a liberal democracy. This loss of freedoms has been justified because it protects people from contracting COVID-19 and, consequently, prevents overwhelming the NHS.

After a year of lockdown measures, and with the rollout of COVID-19 vaccines, “immunity passports” provide one possible route out of lockdown. The definition of immunity passports is being debated, for example in The Royal Society’s recent report: what rights/freedoms would passports grant their holders? How would they be policed? What would be the logistics? What would be the biological basis for granting immunity passports? Are such passports, in principle, ethical?

Without touching on many of the open questions, and assuming that COVID-19 immunity – acquired through infection or vaccination – protects a person from severe disease and prevents transmission, I will argue that dismissing immunity passports for the sake of people’s equal treatment is not a strong enough argument against them, but that promoting immunity passports on utilitarian grounds overlooks other reasons we might have to implement them, and, in turn, who should be prioritised to receive them.

Proponents of immunity passports, Brown et al., suggest that it would be ethical to introduce these passports if they “minimise risk of harm” and “maximise potential benefit”. (NB: Brown et al. wrote before the development of COVID-19 vaccines.) On their utilitarian view, introducing immunity passports would have many good outcomes, including restoring passport holders’ freedoms and increasing individual wellbeing. They argue that this unequal treatment would not be unfair, would even be warranted, because of relevant differences between the immune and the non-immune: people with immunity pose a low risk to others, and are unlikely to require medical attention. Brown et al. rely on the levelling down objection, which Derek Parfit illustrated with a striking example. Imagine that half the world’s population is blind while the other half is sighted. An egalitarian, who values equality as a good in itself, could argue that making the sighted blind would, in some ways, be better than the inequality of the status quo. Parfit rightly calls this conclusion “monstrous, or absurd”. Brown et al. argue that keeping those immune to COVID-19 under lockdown is equivalent to making the sighted blind. (Similarly, Savulescu and Cameron use this argument to justify selective isolation of the elderly. In this case, young, healthy people forced into lockdown correspond to the sighted being made blind.)

In addition to the direct benefits of holding an immunity passport, Brown et al. argue that increased freedoms of the immune would lead to “trickle-down benefits for the economy and rest of society”. Brown et al. provide examples of responsibilities immunity passport holders, and the states providing them, might have towards non-holders. For example, passport holders could “collect groceries” or “volunteer in the health sector”; states could provide “future taxation breaks related to how long one spent in lockdown”. Together, these points make a case in favour of introducing immunity passports.

Communitarian ethicists Baylis and Kofler reject utilitarian arguments because they are based on “an ethic of liberal individualism”. For communitarians it is more important to keep communities united, on the premise that individual wellbeing will follow. Separately, these authors give “ten reasons why immunity passports are a bad idea”, including concerns about monitoring. Counterintuitively, immunity passports would require increased monitoring, for example in public spaces, such that the freedoms gained might be offset by this policing. Who would be monitored? Kofler and Baylis have good reasons to believe that “marginalized groups will face more scrutiny”. Importantly, they suggest that immunity passports could exacerbate existing inequalities and stratify society into the “immunoprivileged” and “immunodeprived”. People from some Black, Asian and minority ethnic groups have had higher rates of COVID-19-related hospitalisation and mortality, and vaccine uptake in this group is lower compared to the national average. The introduction of immunity passports could reasonably be assumed to deepen these existing inequalities.

Is there a more nuanced view? I think the levelling down objection is a strong argument in favour of granting those with immunity more freedoms. Imagine asking someone who is not immune, “What if you were immune?” Often the non-immune person could rationally agree to  immune persons being given more freedoms. It would be cruel of the blind to rationally agree to the sighted being made blind.

However, in appealing to this objection, Brown et al. assume that the level everyone is being levelled down to is equally low for everyone. This seems like an indefensible assumption: for example, bankers in the City of London continuing to be paid while working from home, or philosophers continuing to read, think and write, are clearly differently affected by lockdown compared to, for example, a Bangladeshi running a restaurant in East London, or an employee in non-essential retail.

If, as I am suggesting, being in lockdown is in itself equivalent to having a mixed population of the sighted and the blind, then the levelling down objection does not work so neatly. Instead, on Parfit’s priority view, we “have a moral reason” to redistribute one eye from the sighted to the blind. This is because we should give greater priority to those less well off.

Brown et al. propose that healthcare workers, who contribute to the “public good”, should get antibody tests first. Beyond this, however, they implicitly assume, by alluding to “economic recovery”, who should be prioritised for immunity passports: people who can most strongly stimulate the economy. Rather than arguing for immunity passports (and hence, vaccines) for those able to “maximise benefits” according to this economy-driven utilitarian scheme, we should ask: First, who is, on a broad view of wellbeing, least well off under lockdown measures? Second, can these people be made better off by being granted more freedoms? Third, how can increasing freedoms for those relatively well off under lockdown contribute to the wellbeing of the least well off?

Though it might be difficult to assess who is least well off under lockdown, I think it is uncontroversial to say that the City banker and cosy philosopher are (at least relatively) well off. Once they receive their vaccines and immunity passports, how can their freedoms help raise the level of those worse off? I think these people have moral reasons to help those worse off, even if this might lower their own level slightly, and in more active ways than suggested by Brown et al.

One proposed solution is to couple these freedoms – especially those of the well off – with counterpart obligations. Going further than Brown et al., I suggest that passport holders have certain duties towards non-holders and those less well off. This proposal raises many practical questions. The exact nature of these duties is up for debate, but I envision some form of buddy system, to pair “sighted” with “blind” persons. These obligations could involve actions currently being taken by mutual aid networks, such as working in vaccination centres, grocery shopping, securing medical support, and interacting with the less well off.

Tethering those with greater freedoms to those less well off might even foster senses of community; emphasising the flipside of freedom – obligation – might contribute to narrowing the divides communitarian ethicists point out, and might highlight that being “sighted” or “blind” is often a matter of luck.

 

Author: Victoria Min-Yi Wang

Affiliations: Sir Henry Wellcome Postdoctoral Fellow, Cancer Research UK Beatson Institute, UK

Competing interests: None declared

Social media accounts of post author: @vwang93

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