Will vaccine passports make skies friendly?

By Nancy S. Jecker

Should we use vaccine passports for global or domestic travel? Before answering, ask yourself this: Do we have fair, equitable access to vaccines? Until we can say yes, arguments in support of vaccine passports fail the test.

For international travel, we have a long way to go. Just 85% of shots that have gone into arms worldwide have been given to people in high and upper-middle income countries, while only 0.3% have been administered in low-income countries.  Vaccine passports would only deepen global inequalities, barring those who test negative for COVID-19, yet lack access to vaccines, from travel.

Why not vaccinate the world and simultaneously implement vaccine passports? In reply, at the current rate, there will not be enough vaccines to cover the world’s population until 2023 or 2024. If during the intervening years, wealthier nations form their own exclusive travel club, what message does that send?

Yet isn’t it hypocritical to use passports for yellow fever, not COVID-19?  Not so fast. There’s a tad bit of difference between the two. Yellow fever vaccines are a single shot, using a World Health Organization preapproved preparation, administered in regulated centers with defined standards for vaccine administration and documentation. By contrast, COVID-19 vaccines were rapidly rolled out, are still emergently authorized, and display a range of efficacies.

A cautionary tale is the tragic cases of Mongolia, Bahrain, and Seychelles. After receiving vaccines from China, they launched vaccine campaigns on the promise of a return to normal life.  Today, these same countries are battling surges in infections. Experts now suspect that the Chinese vaccines they relied on are not particularly effective against the Delta variant. Unlike yellow fever virus, which has a slow evolutionary dynamic, SARS-CoV-2 virus mutates often, and vaccines must keep pace.

What about domestic travel? Should we use vaccine passports in wealthy nations where vaccines are widely available? Unfortunately, health equity concerns persist.  Consider the USA. During the first 4.5 months of its vaccination program, high social vulnerability counties had lower COVID-19 vaccination coverage than low social vulnerability counties. Other countries, such as Britain, are also reporting lower rates of vaccination among their minority groups.

Another worry is enforcement. Vaccine passports could lead to racial profiling of people in racial, ethnic, or religious groups with lower rates of vaccination.  According to Human Rights Watch, racial profiling related to COVID-19 testing has already taken place in the southern city of Guangzhou, home to China’s largest African community. The government reportedly began a campaign to forcibly test African’s nationals for the novel coronavirus; eventually, landlords started evicting African residents, while hotels, shops, and restaurants started refusing to serve African customers.

It’s tempting to think ‘that would never happen here.’ Yet racial justice movements like Black Lives Matter remind us how widespread and deep-seated racism is.

Some insist unvaccinated people are free riders –enjoying benefits of population-level protection without taking responsibility to get vaccinated. In reality, there are many reasons people refuse vaccines.  Some can’t afford time off work, find transportation, or cover childcare. Others, based on a long, sordid history of unethical research, don’t trust the researchers.  Undocumented immigrants may fear being deported if they show up at a vaccination site where people in uniform ask for identification. Some Catholics oppose particular vaccines on religious grounds, despite the Vatican’s approval of them. Others have been fed misinformation on unregulated e-commerce and social media sites.

Putting vaccine passports in place too fast will not make the skies friendlier –it will further divide us.

What should we do? Timing matters –we should ensure vaccines are widely and equitably available before requiring certification. Flexibility matters –we should accept negative COVID-19 tests in lieu of vaccination. Science matters — we should monitor the virus and be ready to make changes fast if new information comes to light.  Privacy matters —we should protect it.  Antidiscrimination matters –we should have policies to prevent racial profiling. Addressing these ethical concerns matters.  It’s the only way to build trust and make the skies truly friendly.

 

Paper title: Vaccine Passports and Health Disparities –A Perilous Journey

Author: Nancy S. Jecker

Affiliations: University of Washington School of Medicine, Department of Bioethics and Humanities and University of Johannesburg, Department of Philosophy

Competing interests: None

Social media accounts of post author(s): Twitter: profjecker

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