From politicians like New York State Governor Andrew Cuomo to celebrities like Madonna, many have suggested that COVID-19 is the great equalizer.
Biologically, this narrative holds true. SARS-CoV2 can infect anyone – rich or poor, young or old, White or Black. Everyone is at risk of contracting the virus and passing it on to someone else.
The data, however, belie this truth. In the United States, Black, Asian and Latino Americans are at higher risk of infection and death. In the United Kingdom, people of African and Asian descent are at increased risk.
The reasons for this deep inequity are many and include major health disparities (diabetes, cardiovascular disease), increased risk with certain jobs (support workers in nursing homes, grocery store clerks, mass transport employees, custodial staff), poverty, precarious housing and environmental exposures – all of which are functions of systemic racism and structural discrimination.
In Canada, people of colour are overrepresented among frontline workers, Black Canadians experience high health disparities and COVID-19 is amplifying existing inequities faced by First Nations, Inuit and Métis. And yet, provinces and municipalities aren’t collecting COVID-19 data on minority populations.
Two recent articles published in the Journal of the American Medical Association have re-framed inequitable harms to health as potential benefits of so-called “immunity passports.”
One article imagines a future in which people who have recovered from COVID-19 are granted privileges not available to others. Those with government-issued, immunity-based licenses would not be subject to the burden of “strict public health restrictions” and be free to “hold certain jobs or travel.” The other anticipates “certification for work, school, worship, romance or other highly valued human interactions.”
In these respective views, disadvantaged minorities could benefit from an immunity passport program in direct proportion to their increased rate of infection, provided they survived and could demonstrate immunity. In their article, Mark Hall and David Studdert make this point explicit: immunity passports could remediate “disparities wrought by the pandemic,” operating “more as a leveller than a class divider.”
This reasoning is convoluted, misguided, and dangerous and not only because it is premised on the false assumption that immunity certification is the only way to end large-scale stay-at-home orders.
Immunity passports cannot serve as equalizers in a world deeply stratified by race, ethnicity and socio-economic status. As already demonstrated during this pandemic, structural and systemic inequities have resulted in disproportionate harms to identifiable minority groups. With an immunity certification program, these harms would manifest as unfair access to certification, increased police scrutiny and discrimination and threats to privacy.
While there are numerous technical and practical challenges with validating COVID-19 immunity, countries like Chile, Germany, Estonia, the U.S. and the U.K. are considering immunity certification programs as part of reopening their economies.
Moreover, immunity passport phone apps are currently being developed by the private sector – not only to verify employee health status but also to limit fan access to sporting events and guest access to hotels. Proponents of immunity passports argue that a government-issued certification program would be the best way to regulate how businesses restrict employee and customer access on the basis of infection-acquired immunity.
Governments, however, should focus on evidenced-based policies to safely restore freedom of movement for all citizens, not just the few with presumed immunity. If the early lessons of this pandemic have taught us anything, it’s that policies must be centered on social justice. Immunity passports would only serve to entrench existing inequity and create novel forms for discrimination between the immunoprivileged and the immunodeprived, triggering repercussions felt long after this crisis.
Instead, governments should reject immunity passports and invest in public health measures including physical distancing and contact tracing, vaccines and treatments. If an effective and scientifically validated vaccine is made available for free to everyone, then vaccine certification for COVID-19 could be permissible (as with other vaccine certifications) as long as accommodations are made for those with underlying health conditions that preclude safe vaccination.
While the world waits for effective vaccines and treatments, it is important to reflect carefully on individual access to certain high-density, high-risk locations such as nursing homes and penitentiaries. To protect vulnerable populations, regulatory-approved, high-quality viral test kits should be used to verify health status and monitor access.
Immunity test results should not limit general freedom in society.