Immunity passport

An immunity passport, also known as an immunity certificate, recovery certificate or release certificate, is a document attesting that its bearer is immune to a contagious disease.[1] The concept has drawn much attention during the COVID-19 pandemic as a potential way to contain the pandemic and permit faster economy recovery.[2]

Concept

Immunity certificates are a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease. These antibodies can either be produced naturally by recovering from the disease, or triggered through vaccination. Such certificates are practical only if all of the following conditions can be satisfied:[3][4]

  • Recovered patients have protective immunity that prevents them from being reinfected
  • The protective immunity is long-lasting
  • The pathogen mutates sufficiently slowly for immunity to work against most strains
  • Immunity tests have low false-positive rates

If reliable immunity certificates were available, they could be used to exempt holders from quarantine and social distancing restrictions, permitting them to work (including high-risk occupations such as medical care) and travel.

COVID-19

As of May 2020, it remains unclear if any of these conditions have been met for COVID-19.[3] On April 24, 2020, the World Health Organization (WHO) stated that "At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an 'immunity passport'".[1]

History
An Italian health pass (fede di sanità) for travel during times of plague, 1722

Quarantine has been used since ancient times as a method of limiting the spread of infectious disease. Consequently, there has also been a need for documents attesting that a person has completed quarantine or is otherwise known not to be infectious. Since the 1700s, various Italian states issued fedi di sanità to exempt their bearers from quarantine.[5]

In 1959, the WHO created the International Certificate of Vaccination (Carte Jaune) as a certificate of vaccination, particularly for yellow fever.[6] However, these are certificates of vaccination, not immunity.

An early advocate of immunity passports during the COVID-19 pandemic was Sam Rainsy, the Cambodian opposition leader. In exile and under confinement in Paris, he proposed immunity passports as a way to help restart the economy in a series of articles which he began in March 2020 and published in The Geopolitics and The Brussels Times.[7] [8] [9] The proposals were also published in French.[10]

In May 2020, Chile started issuing "release certificates" to patients who have recovered from COVID-19, but "the documents will not yet certify immunity".[11] Many governments including Finland,[12] Germany,[13] the United Kingdom,[14] and the United States[15] have expressed interest in the concept.

Arguments

Ethical concerns about immunity certificates have been raised by organizations including Human Rights Watch (HRW).[16] According to HRW, requiring immunity certificates for work or travel could force people into taking tests or risk losing their jobs,[16] create a perverse incentive for people to intentionally infect themselves to acquire immunity certificates,[16] and risk of creating a black market of forged or otherwise falsified immunity certificates.[16] By restricting social, civic, and economic activities, immunity passports may "compound existing gender, race, ethnicity, and nationality inequities."[17]

On the other side, it is argued that it would be disproportionate to deprive immune persons – who can neither infect themselves nor others – of their basic freedoms. This would instead effectively constitute a case of collective punishment.[18] Accordingly, Govind Persad and Ezekiel J. Emanuel stress that an immunity passport would follow the “principle of the ‘least restrictive alternative’“ and could even benefit society:[19]

“Just as the work of licensed truckers benefits those unable to drive, the increased safety and economic activity enabled by immunity licenses would benefit the unlicensed. For instance, preferentially hiring immune individuals in nursing homes or as home health workers could reduce the spread of the virus in those facilities and better protect the people most vulnerable to COVID-19. Friends, relatives, and clergy who are immune could visit patients in hospitals and nursing homes.”

Covid-free certificates

In contrast to immunity certificates, so-called Covid-free certificates assert a person's Covid test result for a short period of time (typically in the range of a few days). In this context, Covid-free certificates link a person's identity to the Covid test result.

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References
  1. ""Immunity passports" in the context of COVID-19". World Health Organization. April 24, 2020. Retrieved May 1, 2020.
  2. A. Chotani, Rashid; Ashraf, Syed S.; Mize, Charlie; Clark, Terry (April 30, 2020). "'Immunity passport' key to containing spread of coronavirus". UPI. Retrieved May 1, 2020.
  3. Altmann, Daniel M; Douek, Daniel C; Boyton, Rosemary J (April 2020). "What policy makers need to know about COVID-19 protective immunity". The Lancet. doi:10.1016/S0140-6736(20)30985-5. PMC 7185915. PMID 32353328.
  4. Cyranoski, David (4 May 2020). "Profile of a killer: the complex biology powering the coronavirus pandemic". Nature. 581 (7806): 22–26. doi:10.1038/d41586-020-01315-7. PMID 32367025.
  5. http://www.passaporto-collezionismo-scripofilia.com/category/fedi-di-sanita/
  6. "International certificate of vaccination or prophylaxis". World Health Organization. Retrieved May 1, 2020.
  7. The Geopolitics, How to Prevent COVID-19 From Paralysing the World’s Economy, March 27, 2020
  8. The Brussels Times, Immunity Passports: A proposal to revive tourism, international trade and transport April 12, 2020
  9. The Geopolitics, International Immunity Passports Can Help Restore Freedom of Movement, April 8, 2020
  10. http://www.gavroche-thailande.com/actualites/ailleurs-en-asie/111853-cambodge-coronavirus-l-appel-de-sam-rainsy-pour-des-passeports-immunitaires-afin-de-combattre-l-epidemie-mondiale-de-covid-19?fbclid=IwAR0z21dP7To08ukzp1rKgoxUmGlfrcn4NXoBuWdtede0fnzYlm6BnR58548
  11. "In reversal, Chile says coronavirus release certificates will not prove immunity". Reuters. April 29, 2020. Retrieved May 1, 2020.
  12. Mutanen, Annikka. "Suomalaiset tutkijat kehittivät vasta-ainetestin, joka paljastaa, kuka on jo sairastanut koronaviruksen". Helsingin Sanomat (in Finnish). Retrieved May 1, 2020.
  13. Day, Joel (April 1, 2020). "Coronavirus breakthrough: Germany roll outs promising antibody test to end lockdown". Daily Express. Retrieved May 1, 2020.
  14. "Britain looking at COVID-19 immunity certificates but more research needed". Channel News Asia. April 3, 2020. Retrieved May 1, 2020.
  15. Kristine, Lofgren (April 10, 2020). "Anthony Fauci Says Government Is Discussing Immunity Cards For Coronavirus Survivers". Inquistr. Retrieved May 1, 2020.
  16. Roth, Kenneth; Sparrow, Annie (April 28, 2020). "Should People Without Coronavirus Antibodies Be Second-Class Citizens?". The New York Times. Retrieved May 1, 2020.
  17. Phelan, Alexandra L (May 2020). "COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges". The Lancet. doi:10.1016/S0140-6736(20)31034-5. PMID 32380041.
  18. Anika Klafki, "Der Immunitätsausweis und der Weg zurück in ein freiheitliches Leben", Verfassungsblog (in German), retrieved 2020-07-10
  19. Persad, Emanuel: The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”). 2020, p. 2241.
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