Are Vaccine Passports Inevitable in the U.S.?
Tanzina Vega: As the summer beckons and vaccines are getting into arms, many people are dreaming of traveling right now, but with the Coronavirus pandemic still raging, we may all soon need a different kind of passport to travel anywhere. I'm talking about a vaccine passport or documentation showing you've been vaccinated against COVID-19. In a number of countries including China and those in the EU, recently announced their plans to implement vaccine passport programs.
In Israel, where half the population is now vaccinated, residents have started using vaccine passports called the Green Pass to do everything from use the gym to eat out at restaurants. While supporters of the vaccine passports say they'll help us return to some sense of normalcy, some other experts say they may do more harm than good. Nita Farahany is the Robinson O. Everett professor of law and philosophy at Duke University and she joins me now. Nita, welcome to the show.
Nita Farahany: Thanks for having me.
Tanzina: What's the primary purpose behind these vaccine passport programs?
Nita: I think everybody's looking for a way to be able to safely reopen and try to identify the people who pose the lowest risk to other people. A vaccine passport seems like a promising way for some people to make that happen.
Tanzina: You say they seem like a promising way.
Nita: Yes, I have my doubts about it.
Tanzina: Do tell, what are the doubts? It sounds like, "Great. I've got my card. I've got my passport, I can go." You have some doubts. Tell us what those are.
Nita: Well, I mean, first is just, will they be effective? There's some encouraging data about some of the vaccines that suggest that people who have been vaccinated are unlikely to become infected themselves and spread it to other people, but we don't have that conclusive proof yet. What we have is information that shows that if you have been vaccinated, the risk to you of getting severe disease goes dramatically down and the risk of getting sick goes dramatically down.
It doesn't necessarily mean that you don't pose a risk to other people, so there's this potential false sense of security and false sense of hope that people may have in relying on vaccine passports as the way to reopen. I think it might result in people letting down their guard more than they should, choosing not to do things like social distancing and masking and other kinds of procedures that we've put into place to try to increase safety. From a safety perspective, I have my doubts, but from an ethical perspective, I have much more serious doubts.
Tanzina: I think that's really where- I think from safety obviously it's important, but the ethical concerns here. I've heard people say things like, well, is it fair to have gatherings or to leave people out or to say vaccine only are allowed, for example. Is that what you mean when you say ethical concerns?
Nita: It is. Let me start by saying, I could imagine a future in which vaccines are widely available to everyone, they have gained full regulatory approval and we say under certain conditions you have to be vaccinated in order to participate in different activities in society. We do that already. We have vaccination requirements for schools, we have health care workers who have to be vaccinated, so I can imagine some future scenario in which it would be ethical to have a Coronavirus vaccine requirement in certain settings.
Right now, that's not what we have. We don't have vaccines with full regulatory approval and we certainly don't have widespread equal access to the vaccines. If you start to say, "We're going to condition your participation in society on whether or not you have been vaccinated," when it isn't even a choice for many people to be able to get the vaccine, what you have is a widening gap between the haves and the have nots, the people who can get early access and the people who can't.
We haven't even prioritized vaccination based on who has been most severely impacted economically by the pandemic. Instead, we've looked, because of the moment of time that we're in, who's at the greatest health risk? Those are the people who are getting the vaccine first or the people who have figured out how to get the vaccine first, which is generally not the people who've been most disadvantaged by the pandemic to begin with.
Tanzina: There's been an ongoing discussion about those folks on my Facebook page. We're talking about vaccine passports and what it means for us in the near future. It's The Takeaway. The issue here, I wonder if, as you said, not everybody has access to the vaccine. What about questions of privacy? I mean, a lot of these passports might be pieces of paper. A lot of us are getting cards when you get your dose. The card you can put away, but will some of this be appified, if you will? Will some of this be information that will be available to people that can track whether or not we are vaccinated, and does that cross any ethical or health care lines?
Nita: Yes, there are so many ethical and serious concerns for us to consider. We haven't even talked about the differential impact on minorities, but let's focus on this privacy and surveillance issue. A lot of times when you have a major crisis, like take 9/11. Suddenly there's a rollout of a lot of different procedures and provisions to try to get us to a place where we can safely engage in some of the activities we want to engage in, like travel. The result in the short term is that people are encouraged because it opens up their ability to do the thing that they're scared to do: Get on an airplane, know that it's safe, go into a grocery store, go into a restaurant.
The problem is, once you put those procedures in place, they're almost never rolled back. With vaccine passports, you see a number of companies, whether it's IBM or Microsoft, earlier on Google and Apple talking about partnerships to do so, different governments who are rolling out these types of passports, who are going to collect your health information. Some of these are entities who haven't traditionally had access to your health information, and they already have a lot of other information about you.
What are the safeguards to prevent the commingling of that information and will there ever be a rollback? Once you give that healthcare information to these companies, do you ever get it back? Now, some people might say, "I don't care if people know about my vaccination status." What I worry about is opening up the gateway for these companies who don't have traditional privacy practices for healthcare information. They're not covered entities under our traditional health care privacy settings. For those companies to suddenly have access to a lot of this information, it opens the gateway for collecting all kinds of biometric information without any privacy or surveillance safeguards in place.
Tanzina: We talked about the inequities when it comes to privacy, but what about the inequities when it comes to communities of color?
Nita: This is an area that I'm particularly concerned about. First, we've seen in this country that the minority populations have been hit the hardest by the pandemic. That's true economically, as well as in terms of health consequences. That's due to traditional inequities and access to health care and access to adequate health care, but it also suggests a difference in their ability to do things like work remotely, stay home.
They've been in the firing line of the greatest risk. So now, these individuals who could have been prioritized for access to vaccines, and certainly the World Health Organization and the CDC made that recommendation, states haven't done so, and so they're not getting early access to the vaccines, which means that the people who've been the hardest hit by the pandemic are not the ones who are already vaccinated or likely to get vaccinated soon. The result is they're the ones who are excluded from being able to go to restaurants, from getting jobs, from being able to participate in the society. You see this widening gap. Some people think, and the early theories were, it was due to significant public mistrust that there was a hesitancy to get the vaccination but--
Tanzina: I actually think that narrative was a little overdone frankly, right?
Nita: That's right, yes. In fact, what we're seeing is, it's more likely access to technology, the kind of who you know and how you can get the vaccine appointments. A lot of people are figuring out through tech, through who they know, through gaming the system, how they can get early access. That's not true in the population that's been the hardest hit. I worry that this just means you're going to see an increase in inequities, an increase in the widening gap. Which means putting into place a vaccine passport as a way to gain access to goods and services and jobs, means that we're just going to continue to exacerbate the kinds of inequities that the pandemic already introduced.
Tanzina: We're also not requiring people to get vaccinated, so there are people who could say they don't want to get vaccinated, and then really just sort of be left out entirely, right?
Nita: That's true. I think for those individuals who can't get vaccinated for health reasons, or who have legitimate concerns about the fact that they don't have full regulatory approval yet, it doesn't make sense to say those people can't participate in society. Now, maybe when we get to the point where everybody has access to the vaccine, it's widely available and we have great data that is longer term data about the safety, maybe then we would feel comfortable in certain settings saying, "Everybody needs to be vaccinated for the safety of others."
Tanzina: Is there a way to do this equitably? We've got a minute left.
Nita: Well, I'd say at the point at which we can do it equitably, we probably don't need vaccine passports. That is, once we actually have widespread availability of the vaccine such that anybody who wants one can get one, the likelihood of having an unchecked pandemic like this goes way down. Then whether or not you have vaccine passports almost becomes irrelevant because the risks to people of going to a restaurant or going to their jobs or going to school or participating in everyday normal activities, really won't continue to persist, at least we hope.
There is a point at which you can do it equitably, I just don't think it'll be necessary when that happens. I think the right answer is, we need to focus on making the vaccine widely available to everybody and we need to figure out a way to enable people to participate in society without conditioning it on their vaccination status.
Tanzina: Nita Farahany is the Robinson O. Everett professor of law and philosophy at Duke University. Nita, thanks so much.
Nita: Thanks for having me.
Tess: Hi, this is Tess in Newport, Rhode Island. I don't agree with the idea of a vaccination passport. It's looking increasingly likely that we're going to be needing boosters, repeat vaccinations, similar to what we do with the flu shot. I don't see how that process can be accomplished in any simple way. That's not [unintelligible 00:11:08] No, I would not be in favor of that.
Joseph: My name is Joseph. I live between Massachusetts and the south of France. I just flew to Nice today, left the United States with my COVID test. [unintelligible 00:11:21] Nice, checked in, no problem. When I come back to Boston, I just walk off the plane, walk into the luggage area and leave. It's business as usual, so for COVID vaccine passport, no, thank you.
I don't want to take the chances. I'd rather get a COVID swab test, which are available all over Europe for free. It's harder to get a test in [unintelligible 00:11:43] Massachusetts where there's 800,000 residents and two COVID centers. South of France in Cannes, 75,000 people, 15 COVID centers.
Sherry: My name is Sherry. I live outside of St. Louis, Missouri. I would like a COVID passport for my own safety but I don't know that it's fair for minorities and those with lower income because they just don't have access to vaccines as much as I do.
Speaker 1: Yes, absolutely. I agree that we should be asking for proof of vaccination for people to be able to travel or go to events this summer in the United States. We should see more outdoor events for summer even with reduced seating capacity, but I want to know that those around me are safe to be around. I respect that refusing the vaccine is a personal choice, and with all choices there are consequences, or so my parents taught me years ago.
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