What are immunity passports? They are a form of identification that could be issued to individuals who have been infected with the coronavirus, recovered, and have developed antibodies. People who have been tested and considered immune to the COVID-19 virus would then be issued a pass to go outside, travel to other countries, attend a concert or convention, or go to work. The idea is that these individuals would no longer need to shelter in place or follow social distancing guidelines. They could go out and assist the economy in recovering by going back to work, eating out, and participating in other social and civic activities. These certificate programs are being considered in the US, Germany, the UK, and Italy. In fact, Chile launched its Immunity Card Program in April of 2020. The underlying case for these passports seems solid. But there is debate on the accuracy of antibody tests, how long antibodies last in a recovered person, and concerns for discrimination and privacy.
First, let’s break down some of the science terms and concepts that are surrounding the immunity passport. This idea of immunity passports is not new. Many schools in the United States have required certain immunizations of children before enrolling. Health care workers are tested for immunities to Hepatitis B before being hired to work with patients. Individuals also cannot travel to certain countries without having certain immunizations. An example of this would be yellow fever or malaria. It would make sense that during this uncertain time that individuals want the comfort of knowing that someone they come in contact with is not going to infect them with COVID-19.
Herd immunity occurs when a large portion of the population has become immune to an infection. There are two methods to create herd immunity. The first can be done by immunization, and the other is through natural infection. Actually, herd immunity is also not a new idea. A few decades ago, families would get together with another family who had a child in the throes of the chickenpox virus. Thus exposing their children to the virus and possibly controlling when and how their children would contract the disease, and hoping that their child would contract a mild case of chickenpox. While doctors may not recommend this, some individuals now are hoping for natural infection of coronavirus and crossing their fingers for having a mild case.
Antibody testing, at this point, is not reliable enough to create an accurate immunity certificate. The evidence suggests that antibodies become detectable one to three weeks after the virus symptoms start. But based on the fact that a large percentage of these types have a false positive or a positive-negative, a second test should be conducted. There is also a concern about the scarcity and cost of these tests as well. Recently a study out of the UK stated that coronavirus antibodies can start to fade away within weeks. If that is the case, individuals could then contract the virus a second time and even a third time. It has been stated that testing is free, but the office visit, urgent care, and laboratory fees have not been. Patients have been getting medical bills starting around $100 to thousands of dollars. The availability is still not where it needs to be. We have seen the news showing lines of cars waiting several hours to try and get a test, including antibody testing.
If there is a medical discovery that proves to be a valid option for tracking virus immunity, how passports or certificates should be issued is another question. Harvard University’s Edmond Safra warns that paper copies could be easily counterfeited. He recommends that a digital certificate be created. The UK was looking into creating the certificates as a wristband. This type of certificate would be on the individual at all times, unlike a digital certificate that would be housed on a smartphone through a possible app. Or the certificates would be housed within a universal database that could be accessed from anywhere. It would be encrypted with a unique identifier and verified by the immune individual. Healthcare providers and public health testing laboratories would be the issuers of the credential and therefore be legally responsible for the accuracy of the information. The central notion underlying all of the certificate options is the need for security and an avenue that could not be easily counterfeited. Ultimately the passport or certificate would need to be globally universal.
Not having an immunity passport could impose an artificial restriction. Individuals cannot participate in social, civic, and economic activities. They will need to follow stay-at-home orders and should practice social distancing. As stated above, the antibody tests may be inaccessible or expensive for many races, ethnicities, or other nationality inequities. This system may disproportionately hinder low-income and minority communities. It would create a feeling of injustice for those that cannot obtain an immunity passport. They would not have the freedom of movement between states and worldwide. This group would see the elite having fun, eating out, and going to bars. Individuals would be conveting those certificates, and they would try to get infected on purpose. Unfortunately, if they are successful in getting infected, they will infect others in their community. This social immunity passport divide could create further civil unrest.
This pandemic set the world upside in just a short amount of time. We learn more about it every day. Immunity certificates or passports are ideal in nature, but they also pose considerable scientific, practical, and equitable challenges. At this point, all the challenges are still evolving and have not been solved. Until that time, immunity passports or certificates are an interesting concept.