In some ways it seems like science fiction, in some ways the notion of a “vaccine passport” is a familiar one. For starters, having mandatory vaccinations for travel isn’t a new concept—frequent travelers probably have a yellow immunization card tucked into their passport carrier to show proof of yellow fever vaccination in the many countries that still require it. Now that we have been living with destinations requiring COVID-19 test results for months, neither is the notion of access to travel on the basis of your health status.
What has changed since the mid-1900s when the World Health Organization (WHO) created the International Certificate of Inoculation and Vaccination (aka the ICV, carte jaune, or yellow card) is technology.
As we turn the corner into 2021, “the role of digital health credentials will be key to enable cross-border travel at scale,” says Christoph Wolff, head of mobility at the World Economic Forum, which has partnered with Swiss-based nonprofit the Commons Project to develop a digital health pass called CommonPass. CommonPass is among several tech-enabled solutions that have emerged during the pandemic that will likely serve as a “vaccine passport” of sorts once proof of a COVID-19 vaccine becomes a requirement for entry into countries, onto planes, or into events.
But first, let’s back up a bit to better understand where we are on the journey toward a vaccine passport in the context of the current health crisis. In the blurry early days of the coronavirus pandemic, numerous observers (AFAR included) almost immediately started conjecturing about what kind of vaccine or immunity passports would emerge for what would surely be an imminent post-COVID recovery. Remember? This was all going to be over in a matter of weeks or a few months, tops. We were ready to pounce on next steps.
Once the reality sank in that vaccine development was going to take a bit longer, we put those observations on ice and the world turned to shorter-term solutions, namely testing. As we emerged from spring lockdowns, various governments began experimenting with COVID-19 testing requirements as a way to more safely open up to some travel and tourism while we waited on vaccine progress.
What that process showed us is that whether it’s testing or vaccines that are required for entry, the development of rules and regulations for movement amid a pandemic is not a simple effort. Governments have grappled with what kind of tests should be required. The polymerase chain reaction (PCR) COVID-19 tests eventually emerged as a standard bearer (posing some challenges because results for PCR tests can take up to a few days, versus the quicker but less reliable rapid antigen tests). Officials struggled to figure out the right formula for when tests should be taken. Within three days prior to departure became a popular time frame. Some destinations decided they also wanted a test after arrival coupled with a quarantine until results were ready. Most countries still don’t allow this testing bypass, requiring either a quarantine or simply maintaining an outright ban on inbound travel. The same challenges will carry on into the vaccination period as governments try to decide whether some types of vaccines will be accepted over others, or whether additional health measures such as mask wearing or social distancing will still be required even for the vaccinated.
While COVID-19 testing as a means to open up borders and travel is still in its infancy and remains a fluid process, there have also been a lot of learnings from attempts at its implementation over these months, including laying some of the infrastructure needed for the secure collection, storage, and sharing of personal health data. These developments can be applied to the prospect of vaccines now that the vaccines are actually, finally, really on their way.
The vaccines are coming, now what?
It’s the moment we’ve all been waiting for. This month, healthcare workers in the United States began receiving their first dose of a Pfizer vaccine for COVID-19 after it was granted an emergency use authorization by the U.S. Food and Drug Administration (FDA). The Moderna vaccine has been granted emergency use authorization by the FDA as well, and a tidal wave of inoculations are set to be administered in the coming weeks and months, first for healthcare and essential workers, followed by Americans over the age of 74, and eventually the rest of the population.
So, what’s next? Travel industry insiders believe that for the first half of 2021, as the vaccine rollouts continue in the United States and abroad, COVID-19 testing will remain the dominant pathway for allowing travel to continue to open up more—for now.
“I don’t think [vaccines] will be a topic for the first six months of 2021,” said Dangui Oduber, minister for health, tourism, and sport of Aruba, during a December 17 media briefing when Aruba announced it was becoming the first government partner of the CommonTrust Network; this is a growing collection of public and private entities that have agreed to recognize and work with the CommonPass health app. At the moment, “Aruba is focusing more on stimulating travel using the tests,” said Oduber.
Oduber added that starting in the second half of 2021 is when we are likely to see many countries pivot from requiring testing to requiring proof of vaccination from travelers entering their borders.
Thus, governments, organizations, and private enterprises that have been working to facilitate travel through testing protocols will likely continue on that path for the next several months. Those efforts include a growing collection of digital health apps and platforms meant to help facilitate the fulfillment of COVID-19 testing requirements, such as the CommonPass mentioned above. The International Air Transport Association (IATA) is working on its version of a digital health pass called IATA Travel Pass, and IBM has a version it is calling IBM Digital Health Pass.
Additionally, airlines and airports have been ramping up access to testing, and airlines have been experimenting with concepts such as “COVID-free flights” on which all passengers onboard need to test negative for COVID-19 prior to boarding.
Further opening up of travel will depend on governments deciding what they will allow and when, whether that’s testing in the near-term or vaccine requirements later. All of which, too, relies heavily on the course of the virus itself, which continues on its rocky up and down path of surging, receding, and mutating.
“At the end of the day, the governments are going to make the decision on where and when it’s allowed to travel and under which conditions,” says Eric Piscini, global vice president of blockchain for IBM Watson Health, which is developing the IBM Digital Health Pass.
Already, some countries have indicated that they will be asking for proof of a COVID-19 vaccine in order for travelers to enter without a quarantine. Cyprus and Israel are among the countries that have said they will require it when the time comes, and Australia’s Qantas Airlines has said it, too, will ask international travelers to show proof of vaccination.
What are vaccine passports and how will they work?
In its simplest form a vaccine passport is really just an immunization record, proof that a person has been inoculated against a certain virus or disease. And in this case the disease in question is COVID-19.
Currently, as U.S. citizens begin to get their COVID-19 vaccines, they are being handed a white slip of paper issued by the U.S. Centers for Disease Control and Prevention (CDC) called a “COVID-19 Vaccination Record Card.” It has the patient’s name on it, date of birth, and their medical record number, followed by a line to manually write in when the first dose was administered, the manufacturer of the dose, and the healthcare professional or clinic that administered it. A second line is available for the second dose as the existing vaccines both require two doses. Who knows if we will eventually need additional doses as the virus and our understanding of how to fight it evolves?
While the paper-based proof of inoculation is simple and somewhat effective, it is also problematic.
The paper certification format poses not only “an issue of fraud and people losing their piece of paper, but it’s also an issue of convenience. Because if you want to check into a flight or submit your status before you check in or as you check in, a piece of paper is not going to be useful,” says IBM’s Piscini. “The need is here to have digitized credentials.”
According to Piscini, the 21st-century version of a vaccine passport can, should, and will be more sophisticated than its yellow card predecessor.
IBM is working to facilitate the digitization of the process by creating a platform that will allow users to upload their health data in a secure way so that it can be used by any government, company, or organization that will eventually want to verify that someone has been vaccinated before granting them access.
That means making sure those who administer and/or register vaccines—from large retail pharmacies to smaller pop-up clinics to reporting agencies such as the CDC—are connected to the platform, something IBM hopes to help them do. Governments, airlines, hotels, car rental companies, employers, event venues, and any other institution that will want to verify vaccine status will need to get connected to the platform as well. Piscini is convinced that IBM has the global tech muscle to help pull off this feat at scale.
He envisions a world where part of the check-in process for a flight will include submitting your vaccination status, or where entering a concert venue or conference hall will require scanning your QR code verifying you have been vaccinated. This is where it all starts to feel a little more sci-fi and a little less like those low-key, carte jaune–toting travel days of yore.
For travelers, many of whom are ready to hit the road the minute that second dose is administered, what all of this means is that there is a lot of effort taking place behind the scenes to get these systems up and running. And that while there may not be a fully functioning, comprehensive, global digital health passport system and corresponding border requirements ready to go the minute you are inoculated, numerous efforts are in the works based on the notion that there ultimately should be such a system in order for us to move forward.
Some of the emerging solutions will require us to be more active participants, perhaps in terms of downloading an app and uploading our health data to it or having a provider upload it for us. Others will be integrated into existing or new processes, such as flight or hotel check-in procedures, in a more seamless format that will simply look and feel like another step of the booking process—one that just happens to include your vaccination status.
Starting in summer 2021, “I think we’re going to be at a point where it’s going to be expected from an individual to be able to demonstrate their [vaccination] status. And I think we’re going to be in that world for quite some time,” says Piscini.
The ethical quandary of a vaccine passport
While many feel it is inevitable that COVID-19 vaccines will be a requirement for entry once vaccines are more widely distributed, there are concerns about how to ensure that that eventuality doesn’t further divide the world between the haves and have-nots, between those with access to the vaccines and to technology and those who don’t have access.
When it comes to digital health passes, “How do we make sure that we head in that direction in the most transparent way, and in a way that also provides the greatest amount of access that doesn’t shut people out?” says Michele Goodwin, director for the Center for Biotechnology and Global Health Policy at the University of California in Irvine, School of Law.
She adds, “Not everybody has access to sophisticated smartphones. These are very expensive phones. Or if they have a phone, they may not have the data plan. What you don’t want to do is to deny individuals things that are looking to become a societal privilege or right simply based on their socioeconomic status.”
Her advice to policymakers and private enterprises spearheading the efforts on COVID-19 immunizations and the resulting vaccine passports that will likely serve as our tickets back to some sense of normalcy is “to be as comprehensive as possible” and make sure the process brings together people who can reach and represent everyone in all communities.
Many in the travel industry have advocated for using the Great Pause in travel as an opportunity to bring travel back better—more sustainably, more inclusively, more thoughtfully, more responsibly. The hope is that we can do the same in the realm of vaccines and vaccine passports as well.