Ethical implementation of a coronavirus 2019 (COVID-19) immunity passport program would require centralized, sector-based policies that prioritize access to testing based on societal need, according to a perspective article published in the Journal of Infectious Diseases.

Immunity passports for COVID-19 could help reduce the risk of international epidemic spread by serving as a permit for travel, much like vaccination certificates. However, current scientific uncertainty on the extent and duration of antibody-mediated immunity to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) makes such a program challenging. Ill-conceived policies have the potential to cause severe unintended harms that could result in greater inequity, stigmatization of certain sectors of society, and heightened risks and unequal treatment of individuals due to erroneous test results.

As equity principles require needs assessment rather than equal access, more vulnerable economies should be prioritized over more resilient ones. Financial barriers to testing should also be considered, as allowing market forces to dictate access has the potential to exacerbate inequities. Thus, “pooling of funds from international agencies and public-private partnerships should be considered to help finance testing in low-income countries,” noted the authors. 

At an individual level, priority access to immunity passports should be available for workers in certain sectors including healthcare, emergency services, social services, law enforcement, and education. The cost of immunity certification for those needing to return to work urgently — such as day-wage earners, migrant laborers, and low-income families — should be the responsibility of state governments, either directly or through employer-based financing schemes.


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In order to avoid stigma and until vaccines become widely available, immunity passport policies should be communicated as stop-gap measures within wider, multipronged approaches to help society transition out of restrictive measures.

Unequal liberties and privileges between immune-certified and noncertified individuals could bring about unintended harms. For example, a person might deliberately increase his/her SARS-CoV-2 exposure in order to return to work sooner. In addition, in order to resume normal activities, individuals may commit fraud by falsifying blood samples or test results. In some countries, a black market for counterfeit certificates has emerged.

As waning immunity is a recognized feature of other coronavirus infections, “given current uncertainty in how measured immune responses correlate with the level and duration of protection, policies must also consider the duration of validity of immunity passports and what consequences there would be for passport holders if they subsequently became infected with SARS-CoV-2,” stressed the authors.

Concerns of inequity, stigma, and unintended harms can “be reduced through a centralized policy with clear guidelines for which sectors of society to prioritize for testing and rigorous mechanisms to validate test results and identify cases of re-infection,” concluded the authors.

Disclosure: Clarence C. Tam, PhD, has received funding from Roche.

Reference

Voo TC, Clapham H, Tam CC. Ethical implementation of immunity passports during the COVID-19 pandemic [published online June 24, 2020]. J Infect Dis. doi:10.1093/infdis/jiaa352