April 11, 2021 ☼ The Intersection ☼ Covid-19 ☼ information age

Vaccination certificates need a framework to govern their use

India has done well so far to take the future-ready middle path of providing vaccination certificates without taking a position on their use. It is now time to put in place a framework to govern their use.

Mint This is from The Intersection column that appears every other Monday in Mint.

The ongoing international debate over ‘vaccine passports’ is as exasperating as it is important. The exasperation is because the term ’vaccine passport’ mixes up a travel document with a multi-purpose domestic vaccination certificate, which are two different things. The importance comes from the fact that both can be useful instruments in resuming some form of economic and social activity in the current phase of humanity’s struggle against the covid pandemic.

Given that pandemics are closely linked to international travel, it should not surprise us that governments have imposed health-related travel restrictions since the time humans got a rough sense of how epidemics spread. The very word ‘quarantine’ acquired its modern meaning when in 1377 the Republic of Venice started keeping ships arriving from plague-stricken countries off its port for 40 days. For many years since the late 19th century, the US required those entering its territory to carry a scar, certificate or pock marks on the face to demonstrate they had immunity to smallpox. Vaccination against infectious diseases is an internationally accepted criterion for entry, although the only item currently in the list is yellow fever. That list once also had typhus, smallpox and cholera on it. Should the World Health Assembly of the World Health Organization (WHO) so decide, covid-19 can be added to the list.

Whether or not the WHO approves, we should not be surprised if countries make vaccination certificates a requirement for entry. The alternatives are mandatory quarantine, vaccination or denial. The first two are not feasible if the numbers are large, and the third is not sustainable, so it is easier for governments of the world to require certificates of covid vaccination to be produced for visa applications and at immigration counters.

People are used to the fact that countries can have arbitrary entry requirements and that they have no choice but to comply. There is little domestic political pressure on governments to make immigration less onerous. For their part, governments can reasonably argue that protecting their people and economy from a debilitating epidemic is a matter of supreme national interest, and it is their sovereign right to decide who they will admit into their territory, and on what terms.

The main problem is that vaccination certificates are easy to fake and hard to verify, even if they are digital. So some form of an internationally- accepted vaccination credential is likely to emerge. Given the dysfunctional nature of the multilateral system and domestic politics in the world’s leading countries, it is likely that at least initially, there will be several different standards and formats for accepted vaccination credentials. It is possible that the airline industry’s solution—the IATA Travel Pass that 24 international carriers have under trial—will become a de facto standard if it comes to be adopted by more airlines.

The most strident debate over vaccination credentials, however, is in the context of their use for various domestic purposes. Should you need to show such a certificate to enter a shopping mall right after passing through its metal detectors and explosives scanners? Should you need it to access public transport? Can firms require it of their employees? What recourse would a person have who is barred from a place or denied service for not possessing such a certificate? What are the rights and obligations of entities that demand them of their customers, employees or students?

The answers get complicated because privacy, equity and ideological considerations intersect with those of public health, at a time when tech platforms and social media have already upended the edifice of policy. Vaccination credentials that are not verifiable against a database can easily be faked; but databases in the absence of robust privacy frameworks pose other risks. Wherever inexpensive, universally-available and easily- accessible vaccination is absent, certificates empower antibody-haves, potentially worsening pre-existing social inequities.

The fundamental public health argument against vaccination credentials arises from it being seen as a coercive tool to get people vaccinated. And coercion reduces trust, thereby promoting vaccine hesitancy and prolonging the pandemic. Harvard epidemiologist Martin Kuldorff, a prominent critic of ‘vaccine passports’, argues that, “The idea that everybody needs to be vaccinated is as scientifically baseless as the idea that nobody does.” Thus the non-vaccinated risk getting socially ostracized and excluded from economic activities, making ‘vaccine passports’ unjust and discriminatory.

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Many of these issues can be addressed by upholding the right of individuals and private entities to choose. Businesses that wish to only cater to covid-immune customers should be free to do so; as should those that do not. Customers, likewise, should be free to choose where to go. Employers must be prohibited from discouraging vaccinations, but those that require their employees to be vaccinated must bear the cost. It is hard to make a case that sacking an employee who rejects covid vaccination on non-medical grounds is discriminatory. Public policy must not prohibit individuals and private entities from reasonably protecting themselves. Access to government offices and public services must not be denied on account of vaccination status, but various arrangements can be made based on the risks people pose others.

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