Would Covid passports be damaging to public health?

The government is trialling them but some scientists think they could be counterproductive. Two experts go head to head

Graphic of Covid-19 passport
Illustration: Hlcarpenter.com Design/Getty Images
Illustration: Hlcarpenter.com Design/Getty Images

Last modified on Wed 7 Apr 2021 13.27 EDT

Melinda Mills: Covid passports could be workable, but they’ll need to meet certain criteria

Melinda Mills

Many have argued that Covid passports – certificates showing whether someone has had the vaccine or a negative test, or has Covid immunity – wouldn’t work. In our recent Royal Society report, we concluded that they could be feasible in some cases, but only if they meet certain criteria. The crux is how and where these passports would be used.

For international travel, where testing infrastructure and a “yellow card” system are already in place, Covid passports seem a reasonable move. The UK government is also trialling Covid passports at large gatherings such as sports events. Earlier this month, when the Texas Rangers played in front of a sold-out baseball stadium, we got a glimpse of what can happen when the floodgates open without restrictions: there was no social distancing in place and few people wore masks – all in a context of rising infections and when only a fraction of the population had received their second jabs.

When used alongside other measures such as ventilation, social distancing and an effective test-and-trace system, Covid passports could offer added certainty at large events. But they need to meet certain immunity and infection benchmarks. There are four ways to show whether someone has Covid: proof of vaccination or the results from a PCR, lateral flow or viral antibody test. In our report, we concluded that only proof of vaccination or a PCR test result would be viable benchmarks for Covid passports.

This is because antibody tests aren’t a reliable measure of infection, and lateral flow tests aren’t as effective at identifying people who have Covid but only have a low viral load. The latter can be unreliable, particularly when they’re not administered by an expert.

The government has correctly drawn some red lines. Certification would never be required for essential services, such as supermarkets or transport. But entry into nonessential outlets, such as pubs and restaurants, will be a battleground for this measure. The prime minister noted on Monday that a number of fences will have to be jumped before it’s clear where Covid passports would be required, but business owners may feel that the government is sitting on the fence rather than jumping it.

Ministers may want to shift some of the responsibility for administering Covid passports on to individual businesses, but this would be mired in legal and ethical issues. The US Equal Employment Opportunity Commission, for instance, recently informed businesses that if employees cannot get vaccinated because of a disability or religious belief and businesses are unable to take additional measures, it would be legal to exclude them from workplaces.

These are only some of the issues that Covid passports will face. It will be crucial to ensure they don’t discriminate or exacerbate inequalities, particularly among those who may be hesitant about getting tested or receiving a vaccine. There are also questions about the technology they would use and the extent of data collection. Would they work across different devices and via the NHS app? How could paper passports be built to resist forgery? And how would they ensure people’s data remains private and secure? The government also needs to be clear about whether it intends Covid passports to be the birth of a digital healthcare system, or whether this policy will have a “sundown clause”, like Denmark’s Covid certification, where data is soon deleted.

These are all questions that require detailed attention. Covid certificates could provide added certainty – but only if they meet these criteria.

  • Prof Melinda Mills is director of the Leverhulme Centre for Demographic Science at the University of Oxford, a member of Royal Society SET-C committee and participant of the Sage behavioural subcommittee. She writes here in a personal capacity

Stephen Reicher: Making people prove they’re vaccinated will harm everyone’s health

Stephen Reicher

The government has flown so many kites about “Covid passports” and “vaccine passports” that we have ended up with a hopelessly confused debate where people are disagreeing over entirely different things. Certificates that allow people entry to potentially crowded spaces could take one of two forms: a “Covid passport” would show the results of a recent Covid test, whereas a “vaccine passport” would show whether people had been vaccinated.

So let’s focus on vaccine passports. First, a crucial distinction: there is a world of difference between requiring a vaccine to undertake activities that are seen as nonessential and applying this requirement to activities that are basic to our everyday lives. In the former case, vaccination is perceived as a choice, whereas in the latter it becomes effectively compulsory.

Once people begin to see vaccines as compulsory for everyday social participation (going to the pub, even going to work), two things follow. Those who aren’t vaccinated are, in effect, excluded from society. They will view the threat of such exclusion as a means of controlling them and forcing them to get a jab.

Vaccination would cease to be something that is done with and for people. It would instead be something imposed by an external agency – and hence both political and medical authorities would be repositioned as the “other”. All this would do is generate anger, and lead people to reassert their autonomy by refusing the vaccine.

This is bad enough in itself, but it is raised to a whole new level of significance when you consider the divisions between those who are and those who aren’t vaccinated. These divisions aren’t random: they map precisely on to existing social cleavages. In the UK, those who have a more troubled relationship with authority have lower vaccination rates. Increased deprivation is closely related to decreased vaccination. Ethnic minorities, particularly black people, also have greater concerns about Covid vaccines. Based on painful historical experience, they need to be convinced that vaccines are being rolled out for them, rather than being done to control them.

Passports would undermine the take-up of vaccines and feed the very concerns that fuel hesitation among minority communities. They would also nurture the narratives of anti-vaxxers, whose mantra is that vaccines are about control rather than health. Compulsion fosters alienation among the very people who are most likely to feel hesitant about getting the vaccine at the very point where this reassurance is most urgently needed.

Vaccine inequity plus vaccine passports will translate into vaccine apartheid. That is why we must immediately take down these “vaccine passport” kites and instead focus on what public health practitioners have long known: good health depends on sustained community engagement. Vaccine passports threaten both our physical health and the health of our society.

  • Stephen Reicher is a member of the Sage subcommittee advising on behavioural science and a leading authority on crowd psychology

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