Posted on May 3, 2021 at 5:00 AM
by Brian M Cummings M.D. and John J. Paris S.J.
Vaccine passports are likely to become a necessary part of our lives until we achieve herd immunity and no longer need worry about contracting a potentially life-threatening virus from strangers. Such ‘passports’ might not be the first item on our wish list. But the arguments for their use are basic and compelling. As Gostin and colleagues’ recent article notes, vaccine passports encourage people to be vaccinated and allow a reopening of the economy. For those who want—as much as possible– to recover life as it was prior to the pandemic, they will seemingly becoming a necessity.
Vaccination is not a risk-free action; it involves an assessment of both risks and benefits. Individuals whose position does not significantly impact public safety are free to decline to be vaccinated. With the adoption of a vaccine passport requirement, such declinations may cost people opportunities for social interaction and economic engagement. Such is their choice. But the benefit calculation of vaccination certainly improves with the prospect of open restaurants, sporting events and unrestricted activities. Vaccine passports simultaneously encourage vaccination and provide a quick way to assure a public concerned about Covid that they can safely enter public venues.
The public will need to understand and trust any vaccine passport system to accept the limits on their personal freedom. Attempts to force people to do something lacking an understandable rationale or which seemingly violates their freedom tends to promote hesitancy or opposition. Restraints on personal freedom need to be rational, explained, and agreed to by the public before being adopted as public health policy.
We have been down this road before. An early case pitting public health interests against personal liberty, is the 1905 United States Supreme Court’s opinion in Jacobson v. Massachusetts. The landmark ruling upheld the Cambridge Board of Health’s authority to require vaccination during a smallpox pandemic. A century after the Court’s initial ruling, Wendy K. Mariner and colleagues noted neither public health nor constitutional law is the same explaining “Programs essential to today’s public health…[that] would have been struck down in 1905 are routinely upheld today.” They noted such statutes provide balance with personal liberty interests. The intervening century has seen significant developments in the in the tools of public health: science, drugs, and vaccines. The authors conclude with prescient advice: “The public will support reasonable public health interventions if they trust public health officials to make sensible recommendations that are based on scientific data and where the public is treated as part of the solution instead of the problem.” The public can be a major part of the solution in the pandemic, by protecting themselves and others through widespread vaccination to achieve ‘herd immunity.’ Vaccinating 70-90% of the population limits the number of people able to spread of the virus, and the pandemic will end.
Widespread vaccination verified through vaccine passports seems to be a less restrictive public health measure than lockdowns, quarantines or the shuttering of businesses. The current situation in Michigan illuminates the tension between vaccination and shutdowns. The Center for Disease Control (CDC) advised a widespread lockdown of the state rather than the proposed alternative put forth by Michigan governor, Gretchen Whitmer, of allocating more vaccine to the state. Gov. Whitmer, who encountered armed protests in May 2020 and who continues to confront a public skeptical of governmental lockdowns, resisted calls to close down the state. Without the CDC allocating more vaccine, and without the governor relenting, cases have slowly decreased in Michigan.
Local communities generally enjoy a greater degree of trust and support than does the national government. State and local regulation of health care has been a long-time feature of our political system. The areas of authority of the federal government with regard to health care are generally restricted to activity at points of entry (airports/seaports), military bases, tribal lands and federal properties. Expanding that authority would require Congressional action, a form of behavior that is, at present, seemingly in short supply. Trust in the federal government has fallen from a high of about 80% in the Eisenhower era to a low today somewhere in the 20th percentile. Given the highly polarized political reality of the nation, it is probably a positive rather than a negative feature of our system, that state and local government enjoy greater support than does the national government. And even during a pandemic, the Supreme Court, as recent rulings demonstrate, has an aversion to upholding restrictions on religious liberty.
In the past local communities have been successful in requiring vaccine records for common childhood sickness such as mumps measles, polio, and rubella as a prerequisite for school admission. The 2019 measles outbreaks in California resulted in a public demand and then enhanced legal requirements to ensure vaccination with a successful increase. However, for Covid, this is further complicated by the growing cottage industry offering forged and fraudulent vaccination documentation. The logistics are clearly going to need to be worked out, and quickly.
Covid-19 highlights many of the social and ethical challenges encountered in the inequitable distribution of health care. Gostin and colleagues noted, “As long as there is supply scarcity, [vaccine passports] would unfairly exclude individuals who cannot readily access vaccines.” There’s no ambiguity that Black and Latino communities have markedly lower vaccination rates than those in the general population. Justice demands that racial minorities have ample access to vaccination so they are not left behind in economic recovery. To preclude inequities based on wealth or race, vaccines- and their related passports- need to be free for all.
It is not clear children will require passports, as it remains unclear if or when they will qualify for vaccination for COVID-19. The lack of clarity on children has certainly been illustrated by the variation in in person school decisions nationally and internationally. Until there is an effectively demonstrated vaccine for, and a need demonstrated to contain public spread, children should remain exempted from vaccination and vaccine passports. Encouragingly, Israel has shown a sustained decrease in COVID-19 without childhood vaccination, adding questions if this population is necessary to end the pandemic.
France now requires vaccine certification for use on airplane flights. Multiple universities have announced they are going to require students and staff to have ‘vaccine passports’ to be on-campus next fall. Many other venues are considering requiring evidence of vaccination before allowing entrance to the facilities. There is no question that vaccine passports are an inconvenience, though minor in comparison the lives many lived for the last year. Passports for international travel are also an inconvenience, but prove acceptable to those who want to travel. Once trust in the authenticity of such certificates is established, vaccine passports could provide a way to alleviate hesitancy about Covid vaccination. Vaccine passports provide a public service to assure a public concerned about Covid that mitigation policies based on data and science are not only available, but are being utilized by those we encounter in public venues.