Published by Malay Mail, Focus Malaysia, The Star & Khmer Times , image from Focus Malaysia.
AS it would take time for nations to reach herd immunity, mechanisms to help re-open the economy and international borders such as health passports have been met with increased enthusiasm and strong support from economic sectors.
However, issues related to immunological uncertainties, social-ethical concerns related to its implementation as well as operational challenges in global standardisations have to be addressed in order for vaccine passports to be effective.
Firstly, vaccination passports are not the same as immunity passports. There are still chances for some vaccinated individuals to not be successfully immunised. As for those who gained immunity, we don’t know yet how long it would last.
Unless there is a way to track, measure and link this to health passports, it carries uncertainties (that may increase over time) regarding the passport holder’s actual immunological status. In these two cases, health passports provide a false sense of confidence, risking the passport carrier as well as others.
Furthermore, even if passport carriers successfully retain immunity, they may still transmit the virus to others. Although there appears to be growing evidence that vaccination reduces infectivity, the ability to completely stop transmission (through sterilising immunity) is still inconclusive. In this case, passport carriers may still pose a spreading risk, especially to non-vaccinated groups, questioning the ability to achieve herd immunity altogether.
On top of this, health passport carriers may still be vulnerable to infections and severe symptoms from emerging COVID-19 strains, further complicating the validity of health passports.
As it stands right now, a vaccination passport is merely a receipt, or a proof of vaccination. It’s hard to formulate effective health policies without better visibility on the mentioned uncertainties.
In light of these unknowns, it’s best to consider more data over a longer period of time from local and global observations before making decisions on vaccine passport. The Health director-general also have alluded to the need for such longer-term observations before implementing this as an “immunity passport”.
Secondly, there are social, legal and ethical dimensions to be considered for vaccine passport implementation.
Depending on how the proposed health passport would be used and enforced in reality-be it for domestic purposes or international travels-this could present itself as a discriminatory system for people who are medically-unfit to receive vaccines and people with other potential medical conditions that have not been sufficiently elucidated through clinical trials.
It could also discriminate against people who are currently not recommended as vaccine recipients due to lack of clinical and real-world data such as children and pregnant or breastfeeding women.
Any discriminatory impact may only be justified for those who opt-out without valid reasons and only in the case where there is clear risk to the many. Though this may still be arguable from lens of human rights, Malaysians don’t actually have a choice to opt-out from the epidemiological perspective, notwithstanding uncertainties in virus transmissibility especially in relation to herd immunity.
Taking into account those below 18 years of age which makes up 29% of the population along with other groups mentioned earlier, we have to vaccinate (and successfully immunise) all adults in order to cover 70% of the population, which could be the lowest threshold for herd immunity.
Thus, prioritising health security for the many appears to supersede the socio-ethical concerns, which could be shaping current public policies. As mentioned by researchers Iñigo de Miguel and Jon Rueda, differentiation (even if it appears discriminatory) of immune and non-immune people will be needed for public health reasons.
The issue gets more complicated if health passports are linked to personal data and digital ID, raising privacy concerns on top the mentioned personal liberty issues.
Reportedly, according to Health Minister Datuk Seri Dr Adham Baba, the health passport could be in a digital form displayed in the MySejahtera app as proof of vaccination, or a physical form that could be accepted by other nations.
Perhaps authorities should consider a ‘self-sovereign’ ID whereby personal data is both owned and controlled by the individual. According to Accenture, a trusted and secure form of digital ID can be enabled through technologies such as blockchain and biometrics.
Given that health passports could be used for international travels, there could be a future scenario where it would be linked to a standardised form of global digital ID such as the one developed by ID2020 Alliance (global partnership maximizing the potential of digital ID to improve lives).
In addition, Computer Weekly reported how a company has developed its own digital health pass that has been certified to meet the 41 technical requirements under ID2020 Alliance which claims to address privacy, security and ethical issues.
If so, adopting these technical requirements as part of Malaysia’s own National Digital ID could provide a more seamless transition to participate in a foreseeable globally-implemented health passport.
Of course, such decisions must be made in balanced and careful consideration of national interests, security and sovereignty.
This touches on the third part of the equation related to operational issues of global standardisations. At the moment, this mostly concerns international travel.
The Edge reported that according to Tunku Datuk Seri Iskandar Tunku Abdullah, former president of the Malaysian Association of Tour and Travel Agents and former chairman of the Pacific Asia Travel Association, there has yet to be standardisation of the various health passport versions from other countries and that an acceptable version would be endorsed by the World Health Organization (WHO) and the World Tourism Organization (UNWTO).
Airline industry support of such opinion can be observed through a travel pass being developed by the International Air Transport Association (IATA), which was reported to be in support of WHO efforts to build global standards of digital vaccine records.
However, despite industry’s apparent reference the WHO, interim position paper by WHO related to this matter dated February 5 states that “national authorities and conveyance operators should not introduce requirements of proof of COVID-19 vaccination for international travel as a condition for departure or entry, given that there are still critical unknowns regarding the efficacy of vaccination in reducing transmission” and “WHO also recommends that people who are vaccinated should not be exempt from complying with other travel risk-reduction measures.”
Thus, it would appear health concerns are still at odds with the deserving enthusiasm from certain economic sectors to quickly push for health passports.
Relatedly, and circling back to ethical issues, a global health passport may discriminate poorer nations with lower access to vaccines. Proponents of a global digital health pass, digital ID and global health authorities should put equal (if not more) focus in ensuring equitable access of vaccines to low- and middle-income countries.
These concerns are consistent with a February 14 report published by the SET-C (Science in Emergencies Tasking: COVID-19) group at the UK’s Royal Society, where it recommends addressing a set of “demanding criteria” prior to introducing a passport system. Oxford University also reported and summarised the 12 criteria in the report, which include issues covered in this article and should be considered by the authorities.
We have to ensure that our desire for normalcy does not come at the expense of public health, with serious considerations of ethical, legal, technical and social issues. Rushing this may lead to failing both public health needs as well as economic sectors that desperately depend on its successful adoption and implementation.
Ameen Kamal is the Head of Science & Technology at EMIR Research, an independent think tank focused on strategic policy recommendations based on rigorous research.
