Any discussion on vaccination seems guaranteed to polarise public opinion. The most recent iteration of debate concerns the ethics, value and practicalities of rumoured so-called ‘vaccine passports’, issued by the government, which would allow those who have been vaccinated to follow less stringent lockdown rules and have greater freedom of movement.
Boris Johnson’s announcement of England’s ‘roadmap’ has the nation fixated on regaining their civil liberties after almost a year of restrictions – and, at face value, vaccine passports sound like a plausible path towards enabling this vision. But they are littered with scientific and ethical dilemmas.
First, the science. The rationale for verifying vaccination is twofold: to protect the individual from society, and ensure they themselves are of low risk to the rest of society too. For this to work, vaccines must demonstrate their ability to provide twofold security – fortunately, clinical trials across all coronavirus vaccines suggest substantial protection against severe disease progression and death.
Preliminary data from Israel also suggests that symptomatic and asymptomatic transmission can be significantly thwarted. Still, several known unknowns remain; in particular, the resilience of vaccine protection to current (and inevitable future) Covid variants, and the duration of immunity.
Second, there are the ethics. Vaccine passports risk dividing society. In the UK, where older groups have been prioritised, we could see the country split into an older, vaccinated group and a younger group stuck inside awaiting their jabs. Can we say vaccine passports would really give us freedom if the population is effectively segregated? History accounts for many more failures in this approach than successes.
Throughout the pandemic, pervasive inequalities have been exposed and exploited by the virus. The proposition of vaccine passports will only exacerbate these inequalities further.
“Pervasive inequalities have been exposed and exploited by the virus. The proposition of vaccine passports will only exacerbate these inequalities further.”
For example, children are not currently included in the national immunisation programme, making the already existing complexities of intergenerational interaction even less feasible for even more of the population. And vaccine passports could also exclude the small minority medically unable to receive a jab.
If the past year has distilled just one learning point, let it be that our societies are rendered frail when we attempt to co-exist with inequality. Surely the pandemic has illustrated both the need and the urgency to build back better. The opportunity to rebuild a ‘new normal’ is ripe, instruments as blunt as vaccine passports could set us back.
The debate around vaccine passports also reinforces the familiar false dichotomy between public health and economic growth. The raison d’être of passports would be stimulating economy recovery by coaxing out those who are now low-risk.
Proponents of the scheme would argue that it is insufficient to merely identify the social risks, and instead the extent of risk should be advised to inform policy. Though, the same can be argued about the extent to which rolling out passports would actually generate economic benefits. Another to add to the list of known unknowns.
“Vaccine passports would not be the route to liberty but the route to segregated liberty.”
As the government is reportedly considering making the passports digital, careful attention is required around the challenges of privacy. These mirror the concerns expressed previously over stringent contact tracing systems in Asia.
The list of challenges goes on. Could people resort to acquiring fraudulent passports? What are the implications for job security? If 130 countries have not received a single dose, how many years will it take to ensure equal access to opportunities globally?
A stronger case for passports may be presented in due course, if and when clarity over scientific, ethical and practical aspects emerge. But right now, there is little evidence, and too many challenges, to support their use. Vaccine passports would not be the route to liberty but the route to segregated liberty.
At least if they were digital, we wouldn’t have to argue about their colour.
Jay Patel is a Researcher at the Global Health Governance Programme, Usher Institute, University of Edinburgh