Covid passport: a secure tool or a discriminatory one?

BarcelonaEurope has taken the first steps towards the creation of a covid passport. Initially, the European Union is only discussing the design of a digital vaccination certificate, a report "for medical purposes" on the immune status of the population: whether they have already received the vaccine, whether they have had a recent diagnostic test or whether they have antibodies. But experts consulted by ARA take it for granted that states will not be satisfied with a mere informative document, but will want to use it the sooner the better for the benefit of their population and economy. "An immune certificate is needed, this is irrefutable. The question is how it will be used. Can it be a valid enough criterion to determine whether it can be used for travel? It depends on the politicians and the social and economic pressure they receive", summarizes the director of the epidemiological response area of the European Centre for Disease Prevention and Control (ECDC), Josep Maria Jansà.

As vaccination campaigns progress and the most fragile populations are vaccinated, people will want to regain their freedoms, and economic sectors, such as tourism, will want to revive after a year's pause. It is now up to the European authorities to decide whether or not it is in their interest to agree on the basis for turning the vaccination certificate into a tool that can free their citizens from quarantine or negative evidence to move within the Schengen area once they have been vaccinated. Countries such as Greece are calling for this to be done this summer to save the holiday season.

The covid certificate would not be the first vaccination certificate that would allow Europeans to move - it is already done for yellow fever to enter several African countries - but it would be the first within the EU. Indeed, there are several reasons that will make this not an easy discussion in the European Commission. For example, access to the vaccine. Most likely not everyone who wants to be vaccinated will have been able to access the vaccine in June due to the shortage of doses and prioritization strategies. Delays in vaccine supply have meant that only 4.3% of the population in EU states - 9.6% in Europe as a whole - has been vaccinated and the target of immunizing 70% of the population has been postponed until the end of September. 

"European countries have to preserve the general interest and guarantee that immunity does not give more rights to a part of the population, which is why a covid card or passport has not yet been implemented", Isaac Cano, a researcher in digital medicine of systems and health at the Augusto Pino y Sunyer Biomedical Research Institute (IDIBAPS) and the Hospital Clínic, explains. He believes that, when the vaccine is available to everyone, this tool would make sense. "Right now, putting it in place could be good for reactivating the economy, but it would be privileging one group over the others", Cano points out. 

Denise Naniche, scientific director of the Barcelona Institute for Global Health (ISGlobal), a center promoted by the La Caixa Foundation, agrees with this and believes that a vaccination certificate used as a passport would cause inequalities and discrimination. "It is unethical to organize society into two levels, the vaccinated and the unvaccinated, when we already have minors or pregnant women excluded from vaccination and the majority of the population unvaccinated", explains the expert.

Naniche also points out that, as a European citizen, this strategy only makes sense if, in the event of not having access to the vaccine, governments allow and pay for free diagnostic tests. In fact, the World Health Organization (WHO) and the ECDC reject a certificate understood as a requirement for travel (passport) in a context of lack of doses. Ten European countries and the United States are sharing 80% of the doses.

According to the WHO, a covid passport could benefit part of the population for health-related reasons and would send a message about the obligatory nature of the vaccine which, in terms of public health, could be very dangerous and could revive denialism. "From the ECDC we give technical recommendations with the current knowledge, but there are economic and governmental interests that make the guidelines be short-circuited", admits Jansà. 

Further digitized

However, in addition to ethical problems, there is a lack of knowledge about the immunity that vaccines can confer. In fact, it is still not known how long the antibodies last or if the vaccines prevent transmission and, therefore, if a vaccinated person can generate new infections. Moreover, it is too early to know whether some variants can escape vaccines and cause reinfection, as is said of the South African or Brazilian variants, respectively.

For Naniche, it is too bold to assume that vaccination will provide total protection to consider standardised mobility through a vaccination certificate. "Any activity will be safer the more people are vaccinated, but we still don't know if someone who is vaccinated can transmit the virus", he explains. However, Jansà stresses that in June it will be six months since the vaccination was launched in Europe and that the immunity data will be "more consistent". "If, with a good part of the vaccinated population, it is demonstrated that we do not become infected after vaccination, the certificate could be an advance in the long term", admits the epidemiologist. 

The researcher Isaac Cano, who since the beginning of the pandemic has been working on the development of a covid certificate, agrees with this. This is the Certify.health project, an initiative funded by the European Institute of Innovation and Technology and identical to that now Europe wants to develop, but on a small scale: it collects the results of diagnostic tests and vaccines in relation to the covid of the professionals of the Hospital Clínic. "The project was born with the spirit of generating an immunity passport, but we soon realized that we lacked evidence of immunity and we ended up reducing it to a digital certificate", he explains

What is of interest today, says Cano, is that, beyond being able to use it to travel, this certificate that the EU is preparing is digitally verifiable and not manipulable. "They have to reach a consensus, define standards for everyone, because not all countries have the same digital maturity. In France the passport is on paper, while in Spain it is electronic", the researcher exemplifies. "In pandemics we have to see windows of opportunity as it has been done with vaccine research. In one year more information has been generated on covid than on all diseases in fifteen years. Let's take advantage of it, let's harmonize criteria and stop confusing people", Jansà reminds.

All this, however, conditions a debate that in Spain already detonated in April last year. At that time, experts recommended leaving it in the hands of Europe and deliberately postponing the decision until vaccines had been obtained. Ten months later, and despite the availability of three vaccines, there are ethical and immunological unknowns that the EU has yet to weigh up.