Digital Health

Understanding the Vaccine Certification Debate

Vaccine certification for vaccination

Charles Alessi, MD, Chief Clinical Officer, HIMSS

With the slow easing of this phase of the pandemic in some countries and the increasing effects of national vaccination programmes, as well as the dire economic effects of maintaining populations globally, vaccine certification of COVID-19 has suddenly become a very hot issue and column inches are full of debate, some of which is quite impassioned. 

There are some real insights to be drawn out of the debate and it is worth delving into the arguments to highlight these.

The Arguments in Favour

There is no doubt that used judiciously, the digitisation of vaccine certification (proof of having had the vaccine or a recent COVID-19 infection) will help speed up the opening of the economy both in the hospitality, travel and entertainment industries. It will also assist people who are now exhibiting more obvious signs of lockdown fatigue and start to return us to an environment where we can at last socialise. 

Digital vaccine certification also makes sense. I still have a vivid memory of mislaying my “yellow fever” certificate just before I got to immigration in South America many eons ago. The scraps of paper or card we are using as certification even in digitally empowered countries is quite extraordinary as their lack of security is obvious and their longevity questionable. In international travel, we also have a history of using these certificates and accept them as a matter of course.  

There are also other potential benefits and uses. In large-scale events, alongside other accepted measures like masks, social distancing and a robust test and trace facility, they can offer an element of added surety.

There is also a whole industry around their development. The European Union is developing its “digital green certificates” whilst individual countries like Denmark, Sweden and Iceland have already jumped the gun by developing their own varieties. Israel has a “green passport” system that allows those who are fully vaccinated, have tested negative or have recently recovered from COVID-19 to attend restaurants and mass events. Airlines are also joining the party developing their own versions to accelerate the uptake of air travel as countries start to open up.

Clearly it would be beneficial if we had some standardisation and less duplication but, given the urgency which some economies need to adopt to survive after a really difficult time, one would hope that this would follow in due course.

Surely there is no doubt this is the preferred way, or is it all that clear? Why is there such a cacophony of sound against proceeding in this direction?

The Arguments Against

There are a whole list of reasons why using digital identification of vaccination to sift through populations has its problems.

Perhaps it is best to start with the science around vaccination. The vaccines that we are using to combat COVID-19 are a wonder of science, they are effective at protecting people from death or serious illness and are remarkably free of adverse effects, although it is still very early to be certain of this. The rare side effects of some vaccines are certainly less likely to harm most people that COVID-19 itself unless we are talking of particularly young people and selected populations. We are however assuming that the vaccination works every time in every person and although the rates of efficacy are high, efficacy under laboratory conditions does not always equate to efficiency under the real-world conditions of societies. Also, some of those who are vaccinated will still be hospitalised and some of those who are will sadly die although these numbers are small. In some countries, notably central European ones, and amongst certain ethnic, religious, or socially disadvantaged groups, the numbers of people who refuse vaccination are also notable.  What this all translates to is that even in apparently effective vaccination programmes, this disease is here to stay and the impact of vaccination certificates, although beneficial, will be limited.  

Other arguments around digital vaccine certification like discrimination around those who are not digitally enabled are also been well articulated.

The underlying worry however, and one where the passion may well be greatest is the debate between personal privacy and the duty of citizens to their communities and to this is added the levels of mistrust which seem to exist in some jurisdictions around governments becoming more and more intrusive in this digital age.

To be frank, the governments do have some “form” here in that everything from income tax being a temporary imposition in the U.K. in 1799 as a result of the costs associated with the Napoleonic wars, the imposition of opening hours for pubs to assist the armaments industries in the Great War as a temporary measure, and a whole raft of “emergency measures,” all tend to be quick to set up and take forever to be swept away. Even the introduction of sunset clauses for legislation is fraught with difficulty as the devil is in the detail. 

Which takes us nicely to the issue of trust. Yet again, this is part of what this debate is about. We still seem to be dragging our feet around when to start having conversions with citizens about secondary use of data and this is an international phenomenon with few exceptions. COVID-19 may have another unexpected consequence, like it did around the acceleration of digital transformation, perhaps it will open the gates to discussions around the use of dynamic consent, which is a long overdue discussion. 

I have no doubt there will be a host of deployments of green certification and also a host of legal cases and increased discussion and debate. It cannot come soon enough. We need to have these debates. 

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