Opinion

Vaccine passports: Moral baggage or all-inclusive destination?

I’m 100 per cent in support of vaccination against COVID-19, very grateful to have had both doses, and keen to support family and friends getting their shots. And I’m 100 per cent in support of mandating vaccine uptake among those caring for individuals who cannot receive or respond to COVID-19 vaccines.

But vaccine passports/certificates are a more nuanced proposition and it is unclear to me why the dialogue around vaccine passports, even by organizations such as Ontario’s COVID Science Advisory Table, has far exceeded any discussion to mandate vaccines for those who work with vulnerable populations.

In health care and education, patients and students (particularly those under 12 years old or those who are immune-compromised) are often unable to receive COVID-19 vaccines or unable to mount a response to vaccination. Protecting such vulnerable individuals is a laudable goal – why do we not have a prominent discourse prioritizing mandatory vaccinations for teachers or health-care workers (and attendant supports to ensure effective access to vaccination in these settings)? Other jurisdictions have tackled this, but in Ontario no such policies are in place (although the UHN has taken some steps). In this context, it feels like the focus on vaccine passports is misplaced.

We must be clear about what vaccine passports are going to achieve, and for whom.

In some ways, they serve to help the upper- and middle-class feel safer about activities where space is shared with strangers. And that isn’t a morally flawed ideal in itself – in fact, it is consistent with the unspoken social contract which outlined vaccination uptake as a pre-requisite to re-opening communal activities. Everyone dining out at an upscale restaurant who has not been vaccinated is likely vaccine-resistant rather than vaccine-hesitant. In such cases, there is no real argument against vaccine certificates as a way of motivating (or punishing a lack of) engagement in a vaccination campaign whose effectiveness is predicated on maximal public participation.

But there are ways a vaccine passport, enacted broadly, can create unseen costs. Presumably, the kitchen staff will have to be fully vaccinated if a restaurant requires a vaccine certificate from its customers, and yet there will be many whose employers will not reimburse time lost to accessing vaccines and/or recovering from vaccine side-effects: This financial burden might be the cost of a bottle of wine for the consumer but may represent a whole day’s wages for some staff. Further, think of individuals experiencing homelessness who have food insecurity and rely on spending significantly less money at the local McDonalds; perhaps they are turned away because they don’t have a phone to show their electronic certificate. COVID-19 security for some can thus translate into food insecurity for others.

To some extent, vaccine certificates might reinforce the walls between social classes rather than providing meaningful social good.

It is, of course, true that vaccine passports will increase vaccine compliance (there is data supporting this but it is also common sense). Surely that is a meaningful social good and a significant population-level reason to adopt such a mandate.

However, it comes at a price.

There has been much nuanced conversation around why some individuals do not get vaccinated. Some, who draw the ire and rightful polemic fire of those in favour of vaccine passports, are true “anti-vaxxers” who resist vaccination due to a fundamental lack of critical thinking. Others, however, cannot overcome economic barriers to vaccine access or live in mistrust of a medical enterprise implicated in historical abuses predicated on race, gender or socioeconomic status. Others might wish to be vaccinated but are constrained by communities or spouses (or parents, in the case of adolescents) who prevent them, perhaps even violently, from getting their jab.

“There are ways a vaccine passport, enacted broadly, can create unseen costs.”

Vaccine passports might “close the gap” on the outcome measure (i.e., the per cent of the population that has been vaccinated) but will do so in a way that, for some, exacerbates rather than solves the barriers that created that gap in the first place by demanding proof in spite of poverty or by countering mistrust with force (especially where a vaccine certificate is broadly applied and its absence equates to exclusion from shopping centres, libraries, or other places where attendance may not be optional for a given individual).

An incredible amount of work has been done by community partners to catapult Canada’s COVID-19 vaccination numbers to where they are now – it would be wise to safeguard this hard-won trust rather than compromise it with heavy-handed measures, even if those measures offer a more rapid increase in vaccinations.

We also need to keep the long game in mind – what is the best strategy to adopt now to navigate the years ahead (COVID-19 booster shots; increasing options for younger children)? How can we balance population-level planning with effective sensitivity towards individual circumstances?

One starting point might be a careful limitation of the scope of any vaccine passport. Among the proposed certification mandates, there are clear instances of consensus regarding the importance of upholding public safety measures to ensure that (elective) access does not compromise public safety: air travel represents one such situation (others might include mass gatherings such as sporting events). There seems to be little danger that those contemplating travel, with some exceptions, would be unable to access vaccination (some might still see a vaccine certificate as an imposition that worsens mistrust of the medical system, but no one would simultaneously assert a right to spend thousands on air travel per se).

Beyond air travel or large public events, the other ways in which a certificate might dictate how citizens engage in public life are more fraught: i.e., where can you draw a line beyond which, for the most vulnerable, the good of a vaccine passport outweighs its unintended and unseen social consequences?

I can’t say I have a clear answer; I only urge that we tread carefully – vaccine certificates are likely inevitable but we can work to minimize the extent to which they are inequitable.

A focus must be maintained on ensuring that vaccines are readily available in an equitable manner. Viable options such as continued access predicated on masking must remain available to those who cannot be vaccinated (e.g., young children, for now) or those who are unvaccinated for reasons that transcend anti-vax hysteria. And appropriate oversight must be invoked to ensure privacy concerns are anticipated and addressed and to ensure that vaccine certificates are used with care in settings where they risk turning individuals away from much-needed resources (e.g., public libraries, food banks, etc.).

Perhaps the ends justify the means – vaccine passports will increase vaccinations and thus reduce infections and benefit everyone.

But if there are other ways to improve vaccination uptake; and if we have yet to make vaccination mandatory for those who work with vulnerable populations; and if the benefits of a vaccine passport are paid for by a deeper mistrust, greater food insecurity or economic hardship among those who would never use such a passport to dine on caviar, then perhaps we must admit that vaccine certificates are, at best, only a small part of the solution.

For further reading from the Canadian Civil Liberties Association (CCLA): https://ccla.org/vaccine-passport-faq/

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5 Comments
  • DEZ says:

    I can’t get vaccinated due to allergies. Vaccine Passports don’t make me feel safe. You can’t vow to protect a room of people with a vaccine that is 39% effective. 1 out 3 cases in Ontario are in vaccinated people and were at 800 cases a day. You can’t depend on a passport without regular testing and masks no matter their vaccination status. As long as no one requests scientific evidence proponents will promote this with more crocodile tears and shaming. But they will wither under facts.

  • Gyvor says:

    Pathetic. Once again people who choose not to get vaccinated with this particular vaccine are called stupid (lack critical thinking ability). The fact is many of us, who choose not to, have researched this much more than others. We are getting information from other experts in immunology and biology that hold a different opinion to the ones presented in main stream media. We also have learned about the mechanism of how the vaccine works, how the virus works, and used this knowledge to make sense of both side of the argument. There are many concerning open questions about this vaccine and this has to be considered very carefully in conjunction with your own personal risk profile. If you as a doctor don’t understand this then you are the one lacking in critical thinking.

    • Adelaide says:

      Here here! I fully agree. I loathe the term “anti-vaxx” due to the stigma attached to it, and encouragement of singling these unvaccinated individuals out as being the scourge of society – uneducated. In fact, as you say, many are far more educated than you think. Remember, this entire Covid vaccination push is still Phase 3 of a massive clinical trial. We are all still guinea pigs in a giant experiment. People have viable reasons for not getting vaccinated, and we must respect those rather than judge and label. I myself an not vaccinated because I had the virus and still have antibodies after being tested. So why should I be excluded from being able to travel, or be mandated to be vaccinated in my profession as a teacher? This is as I see it, a clear human rights violation.

  • Douglas Wright says:

    Good day Andrew there is a moral conundrum here. Should we have a vaccine passport to allow persons to meet in public. I say yes and here is why.
    1) for the same financial reasons you state as a reason not to do it. The cost of this Covid outbreak has been phenomenal. A passport program would be far cheaper than continuing limits on getting out and spending money to simulate the economy. Restaurants and other public venues were not designed financially to operate at 1/5 capacity. We need to end this lockdown fast before they all go bankrupt. With 80% out spending and living normally again our economy would do just fine. I also suspect that at least 10% of the fence sitters would opt for vaccinations really fast if the choice was to stay home or go out and party?
    2) the choice not to vaccinate for the majority is a moral decision. Those persons are making a choice not to vaccinate and therefore in the interest of both their safety and the general public should isolate.
    3) Persons who have recovered (likely more immune than those of us vaccinated now) or have medical conditions (those person should isolate for their own safety) can get special passports stating so from the Health department. For example restaurants might offer a few isolated tables for those persons? Just as we reserve parking spots for handicapped persons.
    4) for those without smart phones, holographic ID cards could be produced.
    5) businesses could make individual calls here. Joes bar could mandate a passport while down the road Jill’s Bar could advertise no passport needed. However in such cases public health isolation and distancing would need to be maintained. You have a choice allow full occupancy.
    6) We live in a democracy. if 20% choose not to vaccinate they do not get to rule.

    • Gyvor says:

      Doesn’t make sense when you consider that it has now been shown that the vaccines do not prevent spread because they don’t provide mucosal antibodies coupled with the fact the antibodies have a half life of about 200days. Just read the CDC report on the July outbreak in Provincetown on the east coast. 469 confirmed infections, 74% were fully vaccinated. Yes about 75% of that population was probably fully vaccinated but this shows us there is almost no protection against contraction of the disease (75% vs 74%). Look at Israel. They are now, within one year, onto a third shot for people over 60 and soon those over 40. WHY??? Based on this is does not make sense to have a vaccine passport. Beyond that the idea is technocratic authoritarianism. Do you think it would stop there? Once something like this takes hold it spreads and is much worse than any damage from a virus.

Author

Andrew Helmers

Contributor

Andrew Helmers is a critical care physician at the Hospital for Sick Children and associate prof at University of Toronto in Pediatrics. He has an MHSc in Bioethics.

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