Vaccine Passports or Certificates: In One Form or Another They May be Here to Stay

As the United States continues its emergence from the pandemic, there are several challenges remaining for us to address. Among the questions is: what percentage of Americans must be vaccinated for us to have a chance at durably vanquishing the coronavirus? At some point, if the virus cannot find enough viable hosts, then it could die off. But until that time, it will continue to circulate in our population, and vulnerable people–those who have not been vaccinated or those with compromised immune systems–will be at risk.

One of the tools available to us to help achieve durable control over the virus is what is referred to as vaccine passports or certificates. The idea is simple: to attend certain events (especially indoor events), fly on a plane (especially when travelling internationally) or to get on a train or bus, we would be required to show proof of vaccination or a negative test in the last 24 hours.

The technology is not complicated. It involves a QR code like ones used by restaurants for touchless menus and a handheld reader or cell phone. The reader would “read” the QR code, which would connect to a vaccination record, which in turn would be compared to an ID for matching purposes.

The whole process of verification would take mere seconds. The information would not be stored by the reader, and this is not a violation of HIPAA or health privacy—a regulation Pierce helped author. HIPAA protects our medical information against theft or sharing by those not authorized or covered by the law. But a vaccine passport is a voluntary sharing of specific information and thus, is not a violation of the regulation.

The rationale for creating a widespread program of vaccine passports is simple. With vaccines highly effective in protecting individuals from contracting the virus and from spreading it, the real risk going forward is with the unvaccinated populations. The highest risk to spread the virus among the unvaccinated is at large events, generally inside, where people are near one another over a long period of time. Even if only 30% of those attending an indoor concert or flying cross country on a plane were unvaccinated, this could be enough to allow spread, which would in turn bring the virus to a community that has a low vaccination rate and risk an outbreak with all the subsequent consequences of preventable hospitalizations and deaths. Also, even among the vaccinated, due to various medical conditions, not all vaccinated people are as well protected as most and thus have a greater risk of contracting COVID-19. Therefore, requiring people to prove they are vaccinated in certain circumstances is a helpful tool in preventing the further spread of the virus. But as we’ve seen for the last year, nothing involving this pandemic is simple. But just as there continues to be debate over the vaccination itself, the debate over vaccines passports is contentious and divided primarily between Red and Blue America.

The cruise ship industry is the current battle ground over requiring vaccine passports. A prime environment for virus spread–close quarters, lots of indoor interaction over a long period of time, people from all over the country, sometimes antiquated air circulation systems–the history of cruise ships and disease outbreaks, even before the pandemic, is legendary. The prime culprit for past cruise ship outbreaks has been the norovirus. A highly contagious virus that often causes severe gastrointestinal symptoms, the norovirus has caused ships to quarantine passengers in their rooms and return to port, canceling entire trips.

For this reason, several cruise ship lines, wanting to create and promote a safe environment regarding COVID-19 outbreaks, are making it policy that in order to board one of their ships, customers and staff must prove they have been vaccinated. This policy is widely supported by those who have or want to go on a cruise. However, it is not supported by Florida Governor Ron DeSantis, who signed an executive order banning vaccine passports. The Florida legislature followed suit and passed a law that included large fines for violations, making it illegal for any business to require a vaccine passport.

For the cruise line industry and the State of Florida, this sets up a consequential confrontation. For the Florida economy, the cruise line industry contributes billions in revenue and wages. Governor DeSantis is also an acolyte of former President Trump and therefore, populist in his politics. He believes that requiring a person to show proof of a vaccination violates that person’s liberty, and he places individual liberty above any other considerations, in this case protecting the public’s health.

As for the cruise line industry, its leaders have stated they believe the best way to reestablish trust with their customers and get them to return is by having a safe and coronavirus free trip. The only way to do this, they reason, is require everyone on board—passengers and staff—to be vaccinated. For this to be successful, cruise lines must apply the saying used by Ronald Reagan when dealing with the Russians, “trust but verify.”

While the phrase is new to the American lexicon, the concept of vaccine passports is not new. All 50 states, with few local exceptions, require that school children be vaccinated before entering school. Many hospitals and states require all employees from the CEO on down to get a flu shot each year or risk being fired. For international travel, many countries require “Yellow Cards” indicating you have been vaccinated against Yellow Fever among other diseases (Pierce had to have one for an official trip to Africa as part of 9 vaccinations he was required to get before he left). The federal Equal Employment Opportunity Commission has ruled employers can require vaccination if they follow federal guidelines.

So, requiring a vaccine passport of certificate does not break new ground in the US—we already have them. The clash is political.

In this latest political conflict—a second-coming of the mask mandate—the cruise ship industry is only the tip of the iceberg. Employers, especially hospitals, are considering requiring all employees show they are vaccinated and so are colleges and universities. To travel within the European Union, a vaccine passport is likely to be required.

Thus, it is clearly legal for countries, companies and others to require proof of vaccination. In an early test case, Houston Methodist Hospital required all its 26,000 employees to be vaccinated. A small group resisted and filed suit. The case was recently thrown out of court when the judge said federal law does not prevent such a mandate. This does not mean there will not be other suits, nor an appeal, but most experts believe such requirements are legal and will hold up in court as the history of employers requiring various conditions of employment is long and traditional. And, of course, we live in unique times, when we have vaccines that can immunize us against pandemic-creating viruses.

So, while perhaps annoying to some, or a violation of personal liberty for others, the overall benefit of a vaccine passport seems greater than the objections. It’s time we moved forward with this simple and beneficial public health measure.

Future of HealthHealth PolicyPost COVID-19 WorldVaccination