Immunity passport

An immunity passport is proof that an individual has immunity or been vaccinated against a contagious disease. It may be used to determine if an individual is permitted to attend school; participate in some event, such as a live musical performance; enter a place, for example to board a cruise ship or a plane or enter a sports stadium; or to return to a workplace, among other reasons. Immunity passports, which are sometimes referred to as vaccine passports, have been in use for at least a century in international travel. For example, as more vaccines were developed throughout the twentieth centuries, countries required visitors to produce proof they were inoculated against yellow fever, smallpox, and other diseases, or had recovered from these ailments and were therefore immune. However, medical experts have repeatedly advised against evaluating immunity from SARS-CoV-2, the highly contagious virus that causes COVID-19, because of the limitations of testing for antibodies.

Background

Immunity is an organism’s ability to resist infection. This protection is provided by the presence of antibodies that target a specific virus or bacteria. The two types of immunity are active and passive.

Passive immunity occurs when a person is given the antibodies to a disease instead of producing them naturally. This provides the person with immediate but temporary immunity. One example is the immunity infants receive from their mothers before birth through the placenta. Blood products such as immune globulin, which contain antibodies, can also provide a person with passive immunity for several weeks or months.

Active immunity is acquired when an individual is exposed to a disease organism. This causes the immune system to produce antibodies to fight that specific disease. Exposure can take place through infection with the disease, which creates natural immunity, or vaccine-induced immunity, which occurs when a killed or weakened form of the organism is introduced. When the individual encounters the disease organism again in the future, their body immediately produces the antibodies to fight it. Active immunity takes longer to provide protection—usually several weeks—but is long-lasting and sometimes lifelong. For example, 99 percent of those who receive the polio vaccine are protected for at least eighteen years.

In the case of COVID-19, several types of vaccines were developed in 2020. Vector vaccines contain a modified version of another virus into which material from the COVID-19 virus is placed. Protein subunit vaccines contain pieces of the virus that are harmless but trigger antibody production. Another type, mRNA vaccines, teaches the human body to produce a protein found on the spikes of the coronavirus; the protein prompts the body to create antibodies that will recognize the virus if the body is infected.

Overview

Immunity passports have a long history. The first example of widespread vaccination was the smallpox vaccine during the eighteenth century. By the late nineteenth century, US border officials screened people entering the country. Travelers were required to provide documentation of vaccination or physical proof of immunity: a vaccination scar or smallpox scars. Employers began requiring proof of vaccination as a condition of employment and many schools demanded proof as well. In South Asia, people were prohibited from boarding ships without government-issued smallpox vaccination certificates. During an outbreak of plague in British India about the end of the nineteenth century, documentation of vaccination against the plague was required to travel.

Documentation of vaccinations became even more widespread in the middle of the twentieth century, when air travel became more common, because outbreaks could spread from continent to continent. The World Health Organization (WHO) implemented International Sanitary Regulations in 1951. These became International Health Regulations in 1969 and led to documents proving vaccination against yellow fever that remain in use in modern times.

During the COVID-19 pandemic, some countries permitted visitors to enter without proof of vaccination if they tested negative for the disease. Others required visitors to quarantine. Some countries required both a negative test and a brief quarantine.

Use of an immunity passport first requires means to acquire and prove immunity. One method is vaccination. Although many countries, including the United States, Israel, and the United Kingdom, had acquired large quantities of COVID-19 vaccines as of early 2021, other nations struggled to do so or were hampered from administering vaccines by obstacles such as low population density. This inequality of vaccine distribution into mid-2021 led many officials and organizations to caution against the use of immunization passports at airports and other entry points.

Many organizations, including WHO, believed countries should rely on proof of a negative COVID-19 test to grant entry. One argument for this approach was the lack of data about the duration of natural immunity. Medical experts were studying people who had recovered but were unable to determine how long natural immunity might last. WHO cited potential problems with immunity passports, including ethical concerns and legal and technological issues. WHO noted that vaccine passports could significantly affect individuals from countries without ready access to vaccines and those who could not be vaccinated because of age or medical concerns. These effects included economic opportunities such as employment and access to education.

Despite WHO’s advice to wait, many industries and countries began requiring vaccine certification or proof of immunity. Israel’s Green Pass allowed vaccinated people or those who had recovered from COVID-19 to attend certain events and go to places such as night clubs that barred people without the pass. The Green Pass was displayed in a phone app or could be printed as proof of vaccination and presumed immunity. Computer science experts argued the Green Pass revealed private health information and was vulnerable to security breaches.

Developers in the United States were experimenting with scannable paper cards with multiple QR codes. Some codes would provide vaccination status only, which could be used to enter venues such as arenas, while other codes would provide more information that could be used by health care providers.

In April 2021, the European Union (EU) agreed to allow Americans fully vaccinated against the virus to enter. EU and US officials were working to figure out how to create vaccine certificates that would be readable across many countries. One possibility was for the EU to provide an official certificate to visitors who provided proof of vaccination issued by the traveler’s government. EU citizens in some countries could obtain digital green certificates for travel use. New York State was the first to offer government-issued vaccine passports in March.

Bibliography

Baran, Michelle, and Tim Chester. “These Countries Are Open to Vaccinated Travelers.” Afar, 28 May 2021, www.afar.com/magazine/travelers-with-covid-vaccines-can-visit-these-countries. Accessed 1 June 2021.

Chan, Kelvin. “COVID-19: How Vaccine Passports for International Travel Will Work.” Stuff, 28 May 2021, www.stuff.co.nz/travel/news/300318758/covid19-how-vaccine-passports-for-international-travel-will-work. Accessed 1 June 2021.

“FDA In Brief: FDA Advises Against Use of SARS-CoV-2 Antibody Test Results to Evaluate Immunity or Protection from COVID-19, Including After Vaccination.” US Food and Drug Administration, 19 May 2021, www.fda.gov/news-events/press-announcements/fda-brief-fda-advises-against-use-sars-cov-2-antibody-test-results-evaluate-immunity-or-protection. Accessed 1 June 2021.

Hassoun, Nicole, and Anders Herlitz. “How to Make ‘Immunity Passports’ More Ethical.” Scientific American, 24 Feb. 2021, www.scientificamerican.com/article/how-to-make-immunity-passports-more-ethical/. Accessed 1 June 201.

“‘Immunity Passports’ in the Context of COVID-19.” World Health Organization, 24 Apr. 2020, www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19. Accessed 1 June 2021.

Kritz, Fran. “The Vaccine Passport Debate Actually Began in 1897 Over a Plague Vaccine.” National Public Radio, 8 Apr. 2021, www.npr.org/sections/goatsandsoda/2021/04/08/985032748/the-vaccine-passport-debate-actually-began-in-1897-over-a-plague-vaccine. Accessed 1 June 2021.

Murphy, Heather. “A Look at COVID-19 Vaccine ‘Passports,’ Passes and Apps Around the Globe.” The New York Times, 28 Apr. 2021, www.nytimes.com/2021/04/26/travel/vaccine-passport-cards-apps.html?action=click&module=RelatedLinks&pgtype=Article. Accessed 1 June 2021.

Reynolds, Sharon. “Lasting Immunity Found After Recovery from COVID-19.” National Institutes of Health, 26 Jan. 2021, www.nih.gov/news-events/nih-research-matters/lasting-immunity-found-after-recovery-covid-19. Accessed 2 June 2021.

Stevis-Gridneff, Matina. “E.U. Set to Let Vaccinated U.S. Tourists Visit This Summer.” The New York Times, 25 May 2021, www.nytimes.com/2021/04/25/world/europe/american-travel-to-europe.html. Accessed 1 June 2021.

Taylor, Jordan E. “The U.S. Has Had ‘Vaccine Passports’ Before—and They Worked.” Time, 5 Apr. 2021, time.com/5952532/vaccine-passport-history/. Accessed 1 June 2021.