The Ethics and Safety of COVID-19 Vaccine Passports

Globally, millions of people have now received a COVID-19 vaccine, and some countries have already started planning the implementation of “vaccine passports”. The purpose of these passports is to allow people to travel, attend large gatherings, access public venues and return to work without compromising personal safety and public health. But are vaccine passports ethical?

We spoke to Tasnime Osama, honorary clinical research fellow at Imperial College London to learn about the ethical considerations surrounding vaccine passports and how ethical hacking could improve their security.

Kate Robinson (KR): Can you explain the premise of vaccine passports?

Tasnime Osama (TO): Vaccine passports are accessible certificates confirming COVID-19 vaccination linked to the identity of the holder. The idea of vaccine passports is not new – they already exist and are permissible under International Health Regulations. The World Health Organization (WHO) already endorses certificates confirming vaccination against yellow fever for entry into certain countries. Unlike immunity passports which may, perversely, incentivize infection, vaccine passports incentivize vaccination. They can, therefore, be considered an international public good with benefits that extend to individuals as well as to the general population.

In a lot of ways, they appear to be justified. The public health principle of least infringement states that to achieve a public health goal, policymakers should implement the option that least impairs individual liberties. Therefore, restricting the civil liberties of those who are immune and who pose minimal risk of spreading infection, at this stage of the pandemic, may be unethical. Vaccine passports also have the potential to prevent harms caused by lockdowns which, up to recently, were a required public health intervention against the COVID-19 pandemic. However, to ensure that health inequalities, on a national and international level, are not exacerbated, there are practical and ethical challenges that must be addressed before their implementation.

KR: What are some of the ethical considerations and concerns surrounding vaccine passports?

TO: There are various ethical concerns regarding the societal divide that these passports could cause.

Firstly, vaccine passports could enable coercive and stigmatizing workplaces that have the ability to compound current structural disadvantages.

Secondly, to prevent exacerbating existing societal inequalities and worsening of the health divide, it is essential that vaccine passports are made available and accessible to all. Vaccines are still scarce and access remains unequal, both globally and within countries. This means that those facing vaccination access issues will not meet the eligibility criteria for vaccine passports. We have to also remember that COVID-19 vaccines may be contraindicated in some people with serious health conditions and allergies.

Moreover, while pregnant women are at an increased risk of severe COVID-19 illness, they were not included in the clinical trials. Hence, the uncertain risk of vaccination during pregnancy may also lead to understandable hesitancy in this group. Due to genuine concerns, ethnic minorities are also more likely to be vaccine hesitant. We need to ensure that the various reasons that undermine the trust required to mobilize public behavior for population health benefits and maximize on the benefits of vaccine passports are addressed adequately.

KR: Should vaccine passports be internationally standardized?

TO: Yes, vaccine passports need to be internationally standardized. They also need to have verifiable credentials that safeguard against problems including loss of privacy and forgery. WHO does not currently endorse COVID-19 vaccine or immunity passports because of these concerns. It has, however, initiated a Smart Vaccination Certificate Working Group to establish key specifications and standards for effective and interoperable digital solutions for COVID-19 vaccination. Passports must be linked internationally with this WHO Smart Vaccination Certificate which is based on credentials and standards that are verifiable and have been internationally agreed upon. This will ensure that specifications and standards are all trustworthy, effective and interoperable.

KR: How could the breach of an individual’s personal information affect them?

TO: All individuals have the right to have their confidential information protected.  Health data is usually considered highly sensitive. For this reason, vaccine passports should comply with the principles and requirements of the General Data Protection Regulation (GDPR) to ensure that patient-sensitive information is not misused or utilized for other purposes. Legally, it is still debatable whether workplaces, airlines and entertainment and leisure venues should have access to vaccination data as it may perpetuate a form of “elitism” within societies. Hence, before implementation, we need to fully understand who will have access to this data, how it will be used and what mechanisms are in place to protect patient-sensitive data from potential cyber breaches.

KR: What is ethical hacking, and could this approach be used to improve data security?

TO: Ethical hacking, sometimes referred to as penetration testing, or pen testing, is a legally authorized access into a computer system to test and verify an organization’s defenses by replicating strategies of real hackers. This is likely to improve data security pertaining to vaccine passports as it will allow security vulnerabilities to be identified and resolved before they are maliciously exploited by hackers. Ethical hacking may, therefore, enhance data protection. It is essential that security experts ensure vaccine passports are safe and risk-free before roll-out.

Tasnime Osama was talking to Kate Robinson, Editorial Assistant for Technology Networks.