“Vaccine passports could further erode trust”
Reopening services only to those who've been vaccinated against covid-19 could worsen inequities and mistrust of health officials, says a leading expert.
Experts are debating the pros and cons of covid-19 vaccine passports or other types of certification as they attempt to begin reopening public spaces. The idea seems simple on its face: those who can prove they’ve been vaccinated for covid-19 would be able to go places and do things that unvaccinated people would not.
There’s early evidence that the vaccines authorized by the Food and Drug Administration for emergency use are “highly effective.” Tech and health companies are unveiling proposals that use vaccination as a prerequisite to participating in various public activities, but the concept raises a host of questions around community health, equity, and how much we really know about covid-19 immunity.
Nita Farahany is a leading expert on how technology and bioscience affects society. She is a professor of law and philosophy at Duke University, where she is also the director of the Initiative for Science & Society. From 2010 to 2017, she was on a presidential committee on bioethics.
This interview has been condensed and edited for clarity.
Q: Do we know enough about the science of covid-19 to use a vaccine pass system with confidence that it will prevent transmission?
A: We have really early limited data from the Oxford-AstraZeneca and Moderna studies that suggest potentially a reduction in transmission but not an elimination in transmission. A person can be vaccinated and not suffer severe disease burden if they become ill—in fact, they might be completely asymptomatic—but they may still spread the virus to other people.
Q: We know the basics of how vaccines are starting to be distributed. How might a vaccine pass create inequity?
A: Basing reentry into society on just when you get the vaccine could just further entrench inequalities that have arisen. Trust by minority populations in healthcare and health institutions is very low right now. Conditioning their reengagement into society based on whether or not they take a vaccine when they already have such high levels of public distrust is deeply problematic. I think it further erodes trust. It could set back vaccine policy, healthcare, and trust in health and science even more than it already has.
The people who are willing to take the vaccine and who have higher levels of trust or who had earlier access because of wealth, or networks, are the ones who would have first crack at jobs as businesses reopen. They would get first crack at schools and slots in each of these different activities, tickets to events. You end up with a much longer-term impact of entrenchment of these inequalities that have arisen as part of the pandemic.
Q: Are there historical precedents for limiting access to services in the way that some are proposing?
A: I think about literacy tests that people in the past have tried to implement as a way to exclude an entire section of society from being able to vote. It further entrenches those people who already had access to greater resources to be better educated. Those kinds of literacy tests were ultimately rejected because of the stratification and the exclusion that they introduced.
Q: Couldn’t we just require people to get the vaccine?
A: Emergency-use authorization is not the same thing as full regulatory approval of a drug, device, or vaccine, which can come only after that drug is studied for a longer period. If people want to opt to wait and see more data, particularly at a time when public mistrust is at its highest and confidence in public health agencies has really been challenged through this pandemic, I think we ought to enable people to wait without suffering the consequences of exclusion from society for choosing to do so.
I could imagine once we get to the point where the covid-19 vaccine is widely available and where we have very good data on its use, we might need to have a requirement. I’m not advocating an absolute ban on vaccination status. I’m arguing it shouldn’t be a widespread practice. Not yet. Not now.
Q: When should we consider abandoning emerging technologies or systems that we previously thought could be a solution?
A: We need guidance now that says you cannot use vaccination status as a basis for discriminating against people for their participation in employment, in schools, in leisure activities, until further notice. Further notice could be updated once we have better data, once [the vaccines] gain full regulatory approval, once they are widespread and fully available.
[In the US] the secretary of Health and Human Services can define the terms on which society takes or doesn’t take the vaccine right now. They could issue guidance to say you cannot condition participation in society based on vaccination status, or a more qualified approach to that: you can if you’re in the following settings, and the restrictions are justified under those circumstances.
Q: So how can we balance safely returning to life before covid-19 with protecting civil liberties?
A: I think policymakers ought to be thinking about how to restore public trust in public science. The more we can restore public trust in public science, the more likely people are to adopt the kinds of social distancing, masking, and other procedures that can help us get to the other side of this global pandemic. Vaccines are one part of that, but they’re not the entire answer. Doing the work to restore public faith such that people can adopt those multifaceted mechanisms to safeguard themselves and others will mean that we’ll get out of this a lot faster.
Q: What would you say to those who are willing and able to get the vaccine and don’t see a problem with requiring vaccination to participate as things open up again?
A: The kind of society we live in, the kind of norms that develop, and that kind of fairness of society is something that actually impacts all of us. Whether or not you’re in the privileged class this time, you might not be next time. Early in the pandemic, a lot of people said things like, let’s just require the people who are the most vulnerable to stay at home, and the rest of us should be able to go about our merry way. But it turned out that everybody is related to or knew somebody who is vulnerable, and that the virus is not as discriminating as people might have hoped or expected.
We’re getting very close to the point where everybody knows somebody who’s been affected, and realizing that it’s not about how much money you have, or how well you’re educated. That this kind of tragedy can befall you or befall somebody that you love, should encourage us all to realize we’re in this together. The only way we get out of this is if we all get out of this together.
This story is part of the Pandemic Technology Project, supported by the Rockefeller Foundation.