Vaccine passports: Pandemic spurs rise of portable health records

On a snowy April morning, Laurie Riley is heading to Aruba. Prior to the pandemic, she would come to Boston’s Logan Airport with her ticket and passport. Now, she also carries her COVID-19 test results before boarding the flight. She printed them out and also put them on an app in her cellphone, called CommonPass.

In Aruba, the pass will give her access to dedicated immigration lanes designed to speed her through. 

“It does seem a little bit 1984,” says Ms. Riley of the app. “But everything now seems like 1984. My fingerprints are out there. My ID.” Ms. Riley, a middle school teacher in Cambridge, Massachusetts, says she doesn’t mind the technology “if it keeps everyone safer.” 

The coronavirus has quickly advanced on an international scale something many U.S. health professionals have dreamed about even as privacy advocates have fretted: portable health records. Digitized and accessible to any health provider a customer chooses, they could be carried on cellphones or as a certificate with an embedded chip much as people carry a driver’s license today.

But the same technology that promises to boost convenience, save money, and possibly cut down on medical mistakes also raises questions about privacy, vulnerability to hackers, and equity of access, privacy advocates say. These issues are moving front and center for businesses like airlines that are hoping for a broad economic reopening.

Corporations are acting cautiously. It’s not easy to know what’s best for business – and also for their image as responsible citizens – at a time when vaccines are increasingly available but not mandated by governments. Some firms are demanding that customers or employees show proof of vaccination or a negative COVID-19 test. At present, these are rare instances, concentrated in industries like travel, tourism, and public events.

“Companies are not going to eliminate even a modest percentage of their clientele by putting in place mandatory vaccination policies for services or travel unless the vast majority of their customer base demands it,” writes Summer Johnson McGee, dean of the University of New Haven’s School of Health Sciences, in an email.

And public views vary widely. For example, almost exactly half (49%) of working Americans say employers should require vaccination proof for those employees returning to the workplace, according to a new national poll, conducted by Ipsos for Eagle Hill Consulting. Similarly, a Consumer Reports poll found 42% of Americans say theme park visitors should face a vaccination requirement, but 33% disagree.

Florida’s theme parks and cruise ships

Center stage in the debate is Florida.

Disney World has stayed open for all (face mask required).

But, as cruise lines work to convince the federal Centers for Disease Control and Prevention to lift regulations that have made it all but impossible to sail from the United States, several of them have proposed requiring proof of COVID-19 vaccination for all adult passengers and crew. Royal Caribbean International has ordered it. Norwegian Cruise Line has proposed it to the CDC as part of a plan to start sailing early in July. Other lines are also suggesting it. 

Cruises are a key part of Florida’s important tourist economy. But the state’s Republican governor, Ron DeSantis, has ordered a ban on so-called vaccine passports, citing privacy concerns.

“It’s completely unacceptable for either the government or the private sector to impose upon you the requirement that you show proof of vaccine to just simply participate in normal society,” he said. “You’re going to do this and what, give all this information to some big corporation? You want the fox to guard the hen house?”

U.S. law gives companies wide latitude to set the rules of access for their customers and employees. But states have the authority to regulate them, including limiting them from requiring vaccines, Dorit Reiss, a professor of law at the University of California Hastings College of Law in San Francisco, writes in an email. “It would be an unusual use of state authority – usually states act to increase workplace safety, not decrease it – but it’s constitutional.”

Texas has ordered a similar ban, and several other states have voiced opposition to the idea.

“The global need for this”

These states are pushing against a rising tide of corporate, government, and nonprofit activity, however, spurred by the pandemic.

“What COVID has done is really accelerated the global need for this,” says Paul Meyer, CEO of The Commons Project Foundation. The nonprofit began work nearly a year before the coronavirus hit with a plan to create open standards and advocate for portable health records in the United States. Now, it is one of more than a dozen initiatives around the world to digitize, standardize, and quickly verify COVID-19 test results.

So many governments and companies – from amusement parks to cruise ship operators – are clamoring for such a digital infrastructure that it’s quite possible digital health certificates (advocates avoid the term “passports”) will become a fixture even beyond the pandemic. 

The industry where it’s coming together first is international air travel.

“The standards are pretty close and a couple months maybe from being finalized,” says Shavon Pinkerton, senior vice president of legislative and regulatory policy at Airlines for America, an industry group. “I don’t know if you use Apple Pay or not, but the concept is very similar... . You have a digital health wallet on your phone.” The measure would be completely voluntary, she hastens to add.

The app is so far limited to providing airlines with coronavirus test results, not vaccine status. And it is designed to speed passengers through what is now a cumbersome, paper-based process. London’s Heathrow Airport, for example, has been slammed with arriving passengers often waiting up to six hours to get through passport control even though the airport is handling only one-tenth of its normal passenger load.

The paper records are not standardized, often come in foreign languages, and can be forged. Officials at Heathrow as well as airports in Canada, France, and Mexico have found fake vaccine test certificates. Fraudulent tests are for sale on the dark web.

That’s why the International Air Transport Association, eight airlines including JetBlue, and other companies such as IBM and Mastercard have joined with the Commons Project Foundation and the World Economic Forum to create the CommonTrust Network and infrastructure around it, including the CommonPass. So far, 32 nations have signed up to use the system.

Inevitably, the system will begin to incorporate vaccine status as well. In early April, Iceland began requiring tourists arriving from outside continental Europe to show proof they had been inoculated with an approved COVID-19 vaccine. On Monday, United Airlines announced it would start daily service in July to Iceland for U.S. passengers who could show they had been vaccinated. Delta will begin Boston-Reykjavík flights for vaccinated Americans on May 20. 

Sports venues are also beginning to implement certain restrictions based on one’s health status. The Miami Heat, for example, had offered preferred seating in its home arena to customers who have been vaccinated against the virus. But it discontinued the practice after the governor’s ban. In New York, the Buffalo Bills football and Buffalo Sabres hockey teams have announced that all fans attending home games will have to be vaccinated to be let in.

They will encourage use of New York’s Excelsior Pass, created with the help of IBM, that arenas, stadiums, and concert halls can use to quickly determine test results or vaccine status. By May 1, Hawaii also hopes to roll out a pilot vaccine passport for inter-island travel.

A number of U.S. colleges and universities have also mandated that students and employees this coming fall will have to be vaccinated. (In some instances, state or federal law may make exemptions available for religious or medical reasons.)

Questions of equitable treatment

Such moves raise a number of ethical issues about equity and access. For example, providing a perk such as better seats for vaccinated customers shouldn’t get a sports team in any ethical trouble. Still, companies have to be careful, bioethicists say.

“Modest incentives can be acceptable,” says Ms. McGee of the University of New Haven. “But discriminating on the basis of immunity status should always be avoided.”

Neither the World Health Organization nor the Biden administration backs the idea of government-mandated vaccination passports. “There will be no centralized, universal federal vaccinations database and no federal mandate requiring everyone to obtain a single vaccination credential,” White House press secretary Jen Psaki said late last month. Instead, the administration is creating guidelines to make sure that private-sector initiatives offer equal access to the technology.

For example: People without cellphones shouldn’t be discriminated against, bioethicists say. For customers whom it vaccinates, Walmart is offering to upload digital confirmation of that vaccination to the CommonPass or the CLEAR Health Pass, a separate initiative. If customers prefer, they can have Walmart print out a paper form.

Back at Logan Airport, the future of digital health certificates is in some doubt because even the current technology isn’t working as expected. Kim Carroll, a Boston-area financial adviser, tried to download the Common Pass for her family, but she could only download it for herself. So she printed out the information instead.

Does she worry about a Brave New World of limited access based on health records? “You do what you have got to do,” she says. After all, it’s been snowing in Boston. And Aruba awaits.