Entry Title

Vaccine "Passports" - An Overview

What is a vaccine passport?
A "vaccine passport" is an electronic record showing verifiable proof of vaccination, likely displaying the information after a bar code or QR code is scanned, that is easily accessible through a smartphone or possibly stored on a device - i.e. this is essentially a mobile app technology that will allow Americans to prove they have been vaccinated for Covid-19. 

These digital health certificates (digital badges) - which are oddly enough misleadingly called “vaccine passports” as if they are administered by governments - could be similar to digital boarding passes for flights or concert tickets. Documentation would be provided by your doctor or the site where you received your vaccine.

In order for a user to get approval for being considered vaccinated, users of the digital applications would enter basic information such as date of birth, zip code, and the date, time, and kind of vaccine they received. This information is then verified by an appropriate health authority - leveraging the documentation referenced above. 

The Goal
The goal in developing vaccine pasports to make them simple, secure, private, free, open source, accessible to people both digitally and offline and limited to only confirmation of your vaccination (not your full medical record). These application creators are looking to become private repositories for validated health data (tests, vaccines etc.) with the ultimate goal to put health data in the hands of individuals so it is easily accessible.

Equally important, these digital record would need to be widely adopted to be meaningful - i.e. by governments checking travelers, by airlines and cruises screening passengers, by businesses managing admission and by health care providers, government agencies and pharmacies giving shots. Especially as it relates to international travel - one of the clearest use cases - we need to develop a global, standardized way to validate and authenticate country regulations regarding Covid-19 passenger travel requirements. Vaccine passports - and digital tools in general - are becoming more sophisticated and electronic verification could soon become commonplace for international air travel and admission to crowded events or spaces. 

The Case For Yes

-   Alignment to find the right solution - Governments, technology companies, airlines, cruises, event vanues and other businesses are testing different versions of "vaccine passports" and are trying to come up with common standards so there is compatibility between various systems and health records can be leveraged in a safe and controlled way.

-   Safety and Security a Priority – Developers are arguing that the digital infrastructure is secure and will help speed up the process of reopening society and reviving travel - a national vaccine passport could help create a single standard that could be used everywhere and would be potentially difficult to fake. 

-   Passport Already Exists - New York became the first state in the US to launch a digital health certificate called the Excelsior Pass, which verifies a person’s negative coronavirus test result and if they are fully vaccinated (generally needs to be shown with a photo ID to prevent fraud)

-   Proof Required For Other Vaccines - Portable vaccine records are not a new concept - travelers to parts of the world (yellow fever) and children in school (measles) have had to supply them as proof they have been vaccinated against diseases 

-   Immediate Use Case (International Travel) - As referenced above, in the short term the clearest application may be in international travel and the reason is becoming increasingly more obvious at any major airport. Passenger volume is well below prepandemic levels, but there are still long lines at airline desks and passport control. As travel growth continues to come back and restrictions ease around the world, many nations are expected to begin requiring proof of vaccination or negative tests to enter or not quarantine. The current manual processes are not sustainable and there needs to be some level of automation introduced into the system. 

-   Addressing Privacy – Privacy is arguably the most significant concern but there are several efforts ongoing to address it
     -   Vaccine Credential Initiative (VCI) aims to  create a common, hard-to-forge digital standard and digital vaccination credential for applicaitons to use, addressing security concerns. Techology companies, healthcare providers, and electronic health record companies (e.g. Salesforce, Microsoft and Walmart) have agreed to use VCI’s common framework
     -   CommonPass Initiative is one that does not hold health records –  e.g. if a participating airline needs to know whether a passenger has had a negative test or vaccine, and a participating pharmacy has the information, CommonPass can communicate with both and return a simple yes or no answer without transmitting any specific data
     -   World Health Organization (WHO) is working on its own initiative called the Smart Vaccination Certificate
     -   More buy-in can result in less opportunity for fraud. Even with some early vaccine resistance, ongoing new realities may convince people to use vaccine credentials - travelers especially to foreign countries may want to show proof of vaccination or a negative test to avoid quarantining requirements. Certainly vaccination credentials do not prove definitively that one is safe from contracting or transmitting COVID-19, they can put people at ease about eventually reemerging into the world and creating a new sense of normal

The Case For No

-   Equity (Digital Access) - An exclusively digital system would leave some communities behind, especially those with no smartphone or internet

-   Equity (Vaccine Transmission and Interest) - The World Health Organization (WHO) has focused on equity concerns along with uncertainty over whether vaccination prevents transmission of the virus. In addition, discrimination against people unable or unwilling to get the vaccine can become a significant concern.

-   Equity (Vaccine Access) - WHO recommended governments not roll out technology now since it could further national and global divides created by unequal access to getting vaccinated. “Jobs lost to the pandemic will go to people who were able to gain earlier access to the vaccines” – widening divides given not everyone has access to vaccines yet. Furthermore, it indicated that it currently did not support mandatory proof of vaccination for international travel.

-   Generational Divide - With people under 16 not yet eligible for the vaccine, a vaccination credentialing system could create a generational divide, depriving young people of access to many of the pleasures of their elders

-   No US Government Mandate - Federal government said it will not introduce digital vaccine passports by federal mandate nor create a federal vaccination system / centralized database - although this does not preclude a federal agency from using a privately developed electronic health credential to screen international travelers.
     - States hold public health powers and have authority to require vaccines. Because there is no centralized federal vaccine database, states collect information and are required to share registries with the CDC but data is not public and could be withheld. Developers of digital vaccine certificates in the US would have to obtain vaccination data from states, which could be challenging in states that oppose these initiatives (see below)

-   Officials Ban Vaccine Passports - Some states and organizations have denounced immunity passports fearing two classes of citizens based on vaccination - e.g. Texas and Florida banned agencies and businesses that get state funding from requiring 1) vaccine passports or 2) documentation proving vaccination against Covid-19. Several other states—e.g. Idaho, Nebraska, Georgia, Missouri, Tennessee etc.—have already taken steps to ban vaccine passports over concerns about individual privacy.
     -   Interestingly, legislatures can regulate state businesses and can prevent local governments from issuing vaccine credentials. Governors acting on their own has no inherent power to regulate businesses other than through emergency or other health powers that the legislature gives them

-   Easy To Scam - Currently, Americans are issued a white paper card as evidence of their Covid-19 vaccine but these can be forged, lost or stolen and there are reports of online scammers selling false and stolen vaccine cards. Furthermore, States have focused on shots themselves and less on the process of documenting vaccines in a standardized, secure way - opening an opportunity for people to fake their own credentials
     -   While pharmacies and health systems do well identifying, vetting and documenting those they are vaccinating (insurance reimbursements), mass state vaccination sites may not (focus may be on distributing vaccines vs. developing verifiable list of those vaccinated
     -   Airlines are facing the challenge of passengers showing false Covid-19 health certificates (where Covid-19 results are required by countries on arrival). IATA tracked fake certificates in multiple countries (France, Brazil, Bangladesh, Afghanistan) and border authorities & police reported arrests of people selling them in U.K., Spain, Indonesia and Zimbabwe.
     -   Challenge with international travel (the primary use case for vaccine passports) vs. domestic (which typically do not require certification) is that staff are not equipped to handle and police new health certifications needed. Airlines dependent on cross-border travel are still wary of the summer rebound - any perceived proliferation of fake health certificates exposes logistical blind spots as airlines navigate post-pandemic travel standards and update systems to manage compliance and drive demand

-   Sheer Number of Solutions - There are at least 17 "vaccine passport" projects underway which makes the whole effort difficult to navigate and can lead to a fragmented adoption - venues, states, airlines etc. are offering their own technology making it confusing to determine which and when to use. For certificates to be useful, countries, airlines and businesses must agree on common standards and the infrastructure they use will need to be compatible - examples of certificates in the works:
     -   New York State launched the Excelsior Pass, a QR-code-based smartphone app developed with IBM
     -   World Economic Forum and the Commons Project (technology nonprofit) are developing a QR-based certificate for travel called CommonPass (to verify passenger Covid-19 test results before they board flights)
     -   International Air Transport Association (IATA) is running pilots of its TravelPass (being tested by 20+ airlines and allowing passengers to upload health credentials necessary for international travel)
     -   European Union has endorsed electronic vaccine certificates but each member country will be able to set its own travel requirements
     -   Israeli residents must show electronic “Green Passes” at public venues and the country plans to require visitors to take blood tests upon arrival to prove vaccination. 

-   Privacy Concerns - There are legitimate concerns about privacy or identity theft as "passports" require personal information and it remains unclear how various systems will record, store and facilitate sharing of data
     -   US has the added complexity of getting individual states to share immunization data with different certificate platforms while maintaining the privacy of resident
     -   Terminology matters as a "passport" is typically issued by a government and certifies personal data including a person’s legal name and date of birth. People fear if they are required to have one related to the coronavirus, they will be handing over personal and sensitive health data to private companies that could be stolen or used for other purposes

Certainly there is more to come!



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