In March of 2020 Bill Gates said to expect immunity passports for travel. In April I laid out things we didn’t know enough about the virus for the idea to be viable. We now know, though, that re-infection is rare at least during the first year after recovering from Covid-19 and that vaccinations protect people from both symptomatic and asymptomatic infection to a significant degree. The CEO of Qantas even declared last fall that you’d need proof of vaccination in order to fly.
As a result the E.U. and others are working on the idea of a vaccination passport or ‘certificate’ for those who find the nomenclature more palatable. 62% of Americans even believe vaccination should be required for air travel.
However there are several challenges that make it hard to create such a document, though certainly some countries will put in place vaccination requirements either for entry, for waiting testing requirements, or for avoiding quarantine on arrival.
- Proof of vaccination isn’t secure Singapore may be using the blockchain to validate vaccination status, but the U.S. hands out easily replicable cardstock. How would Americans actually prove they’re vaccinated?
- Different levels of efficacy. Different vaccines offer different levels of protection for the individual and against spread, including differences in how prophylactic they are against continued mutations in the virus. Will passports be accepted for some vaccines and not others?
- Different vaccines are approved in different places would AstraZenecea be accepted, approved in much of the world but not the U.S.? Would a Russian who received the Sputnik V vaccine, or a citizen of the U.A.E. who received China’s Sinopharm vaccine, be eligible for entry into the U.S.? South Africa has suspended use of AstraZeneca out of fears it isn’t as effective against their dominant strain of the virus, would a U.K. citizen who received that jab have their vaccine passport recognized on arrival in Johannesburg?
- What counts as vaccination? Many experts recommend a regimen of ‘first doses first’ delaying second doses in order to get first jabs into as many arms as possible as quickly as possible. That’s the strategy the U.K. has pursued, because it provides the greatest level of societal protection.
Does a first dose of Moderna count as vaccinated, when clinical trial data showed greater effectiveness against symptomatic Covid from one dose than the Johnson & Johnson vaccine which is a one-dose vaccine? Would it make sense to require two Moderna shots but only one from J&J for this purpose? What if Sinovac’s 50% effective vaccine counts for vaccination?
- Booster shots are coming, are they required too? Different vaccines may have different lengths of efficacy, and boosters may be required. How long will a vaccine passport be valid for and will it vary by shot received? At what point does a booster dose become required? And does it matter which one? (Would a Pfizer booster dose be accepted for someone initially vaccinated with Moderna, and would these requirements change on a country-by-country basis?)
Some problems though aren’t so hard to overcome. Tyler Cowen thinks that having different rules in different places is too big a challenge,
How many different passport systems would a flight attendant or gate agent have to read, interpret and render judgment upon?
The likely result of all this: Many foreign visitors to the U.S. would never quite know in advance whether they could board an airplane or attend a public event.
However we have this now. Each country has its own entry rules, and did so prior to the pandemic (passport restrictions and validity rules, visa requirements, fees etc.). The rules are loaded into TIMATIC and each airline employee can look those up based on an individual’s citizenship, residence, transit point, origin and destination.
Things have gotten more complicated during the pandemic with testing and quarantine rules, but they’ve been handled in much the same way. The rules are laid out in a database, and airlines have contracted with third parties to validate an individual’s health credentials where needed.
This doesn’t always work perfectly. Hawaii has rejected valid tests results (and accepted ones they shouldn’t) for instance with passengers flying home before bureaucrats realize their mistake. But in most cases this is manageable up front.
As Cowen observes though vaccine passports would have the benefit of encouraging people to get vaccinated because it would increase their opportunities and would encourage people to get booster doses when needed, to maintain access to those opportunities.
Ultimately though the U.S., with its paper vaccination cards and slowness approving new approaches, may not be able to create a vaccine passport while it still matters. Other countries, hopefully, will accept our cardstock.
I believe all US states are required to report vaccination data to their state health department so vaccination data is more than just a piece of paper – although there is no mechanism to verify that all right now.
The bigger issue is that countries may not consider someone as vaccinated unless the vaccine has been approved in a specific jurisdiction. Some EU countries do not have confidence in the UK vaccine but do in US developed vaccines. Vaccine acceptance could become a patchwork worldwide until case numbers fall far enough that everyone quits arguing theory and looks at the success that humanity has had in controlling if not eradicating this disease.
With all the recognition differences mentioned in the previous comment, I don’t see the difficulty of each country issuing a self-adhesive visa-type of document, that is easy to stick to your normal passport.
States must record all covid vaccinations in their state immunization record system. The simplest solution would be a system that pulls those records for an individual and then presents verification either through an app or “wallet” entry.
The answer to # 1 is each states Immunization registrar. in CA that site is https://cairweb.org/
this information, once individuals sign off on its release, can be made available to a central federal database with both usa public and foreign facing interfaces used for validation. as to the rest, thinking foreign carriers are going to just open up to the usa without some sort of jab proof is a pipe-dream. IATA – https://www.iata.org/en/programs/passenger/travel-pass/ is working on it and the ownership of BA https://www.fnlondon.com/articles/british-airways-owner-calls-for-digital-vaccine-passports-to-kickstart-travel-boost-ailing-industry-20210226 has called for its use among others. where I agree with some of your points and the mechanics being a nightmare in the end it will be something is better than nothing. foreign travel has to open up. I have rescheduled my trip to cdg for hopefully the last time
I’ve known several people, including myself, who were NOT required to show any identification when vaccinated. And even if identification was required, what id’s are acceptable? The USA can’t even seem to agree on what id’s should or should not be required to vote, much less get a shot.
How many Americans are capable to to create the fake vaccination card? Not too many. And most of those who can, they will be vaccinated. Other have no idea how to use softwear required for that project.
You do know that the current yellow fever vaccination certificates that are required in some places are paper?
@Kurt M Fainman – I think you have too much faith in state databases. Here locally Austin Public Health has had issues scheduling second doses because they never entered first doses into *their own* system. I’ve also seen where cards had the wrong date of birth written on them, folks administering vaccines ripped them up and replaced cards but didn’t update systems. This isn’t Singapore on the blockchain, people!
Bill Gates has a dream of creating another business around digital health passports. Remember electronic medical records and how this would streamline the healthcare? And, by the way,
right now one can download Covid-19 vaccination form as a PDF from CDC website.
HIPAA….
Publix wanted our insurance info before giving a covid vaccine because the law lets them bill the insurer something like a $14 administrative fee that way. (There is a waiver for that for the uninsured) So I figure that’s a good thing for me because I end up with an additional paper/electronic chain of vaccine proof beyond the paper CDC card that would be very easy to forge.
Gary, you have said it before – right now we have a supply shortage, with lots more people wanting a vaccine than can get it right away. Within a couple of months that will flip. Anyone in the U.S. who wants one will at least be eligible to get their first dose, and there will be a need to convince the reluctant to get theirs too. Return to real life depends on enough people getting vaccinated. So I support anything that creates incentives.
I really think we need to stop just sending out stimulus checks to everyone, but make it contingent on getting vaccinated. A lot more complicated, sure, but that is the best stimulus possible. A lot of people would overcome their fears and conspiracy theories if a worthwhile amount of cash was on the line. A vaccine passport too. If we can spend $1.9 trillion on stimulus, we can figure out a way to use some of it to implement a blockchain system like Singapore’s. I’m tired of the “We all want this pandemic to be over, but we can’t do this, we can’t do that, too bad, we can’t figure it out” thinking. We did a great job of developing the vaccines; we’ve stepped it up after a miserable start in getting the administration going; now we need to complete the job.
My travel dollars will go to the countries that do not make travel difficult. This is why we have avoided China for years.
I live in Colorado and obtained a printout of my state immunization record. It was a pain in the neck to obtain- I had to submit a notarized request. However I received it within hours. Also interestingly it showed I have received three doses of the Pfizer vaccine. One of the entries was from an appointment which I had canceled.
No way that the US will issue vaccine passports. There is no central registry, and no way of proving that you’ve been vaccinated.
Also, since its main use will be international travel – it will be hard to justify spending millions of dollars on a vaccine passport system that will only benefit those travel internationally – and neither Democrats or Republicans will be willing to spend millions to benefit “elites.”
Alex_77W says:
Bill Gates has a dream of creating another business around digital health passports. Remember electronic medical records and how this would streamline the healthcare? And, by the way,
right now one can download Covid-19 vaccination form as a PDF from CDC website.
Let’s be honest here. Just because the U.S. cannot figure out how to do electronic medical records, does not mean it is impossible or unworkable. I know, I now live in Malta. We have electronic records. My wife is from Finland. Finns have not had paper records for years. In fact, when your doctor gives you a prescription there, you can go into any pharmacy in Finland, and have them enter your ID, and they can issue you your prescription.
Expect some combination of negative COVID test and/or vaccination certificate at least for some countries outside of the US. Will it be foolproof? No, but counterfeit options and so forth will be the exception. It’s all about reducing risk to the extent that the global community can.
I just finished getting my #2 Pfizer shot yesterday at our local health department. Knowing the issues around the CDC cards I asked about forms that could be used to validate vaccination. They offered me a vaccination report from the Wyoming state registry. I was amazed what was on it, some of the shots I didn’t even remember. I think the reports are a lot more credible than the cards. It may be a good idea to ask for one any time you get any kind of vaccination.
Yellow fever vaccines are paper cards. I understand you want to rush people back into international travel, but the reality is other countries aren’t going to give a crap if people are claiming they are vaccinated if they are coming from a country where the virus continues to rage. If there are enough of them the anti-masker/anti-vaxxer covidiots could keep the US as outcasts for international travel by now letting us get control of this virus. We need to reduce the virus here to levels low enough that we are not deemed a high risk. Really all this vaccine passport stuff should have been in place way before they started vaccinations. Unfortunately, the prior administration did little to nothing to prepare and it is much much more difficult to rectify the issue now. Such a missed opportunity.
Also, how would they deal with people that cannot get the vaccine because of auto immune issues? There are a lot of things that are out there that I am sure they don’t even know how to deal with right now. I am one of those people and would like to resume my travels, but just wonder how that is going to work!
Gary Leff says:
March 13, 2021 at 11:16 am
@Kurt M Fainman – I think you have too much faith in state databases. Here locally Austin Public Health has had issues scheduling second doses because they never entered first doses into *their own* system. I’ve also seen where cards had the wrong date of birth written on them, folks administering vaccines ripped them up and replaced cards but didn’t update systems. This isn’t Singapore on the blockchain, people!
Hi Gary,
Its not about faith, its about working with what we have. after your gov and AG are finished suing your city for wearing masks you guys can better target the issues at hand. as they say, garbage in/garbage out. the big question is do you think there will be travel from the us-> eu without some form of proof. I say no. do I hope I am dead wrong. yes. that is my .02
Kurt
I tend to agree with this. No one besides Singapore will ever get this right. The bottom line is a continuation of banning or restricting certain countries that are above the appointed thresholds of infections. There is no other way around it and why it’s important everyone get vaccinated when they can so as to allow each nation to have all its citizens travel overseas.
Gary – just as a term of reference, the U.S. military says you are vaccinated after the first shot and immunized after the second. I realize that is not universal, but it does make a good distinction in terms on where you are with the process.
It is ironic that Asia/Pacific is being as cautious about covid given that the region has had multiple disease outbreaks, many of Chinese origin, over the past 20 years.
It doesn’t matter what system any country uses if they don’t accelerate vaccinations of their own people and then develop reasonable systems to accept vaccinated people – if they have any desire to rejoin the global travel community.
Given that there are many high quality airlines in E. Asia that have had financial advantages because of labor costs and high quality, losing 6-9 months or more of revenue compared to other countries could have significant implications for the future of the global airline industry.
The US, UK and Israel will set the defacto standards for travel by being the first to reach vaccination levels that bring covid deaths and cases down.
I suspect that just like in the US and EU, people in E. Asia will push back if reopening moves too slow. And don’t forget that Japan’s vaccination rate is very low for a country that is going to host a global event in less than six months. They have to ramp vaccinations up and, by doing so, will probably lead to increased jabs in E. Asia, even if the summer travel season will be smaller than other global regions.
International travel will continue to be the unpleasant practice of Covid-19 testing < 72 hours before flights unless this gets sorted out. There will be too much disparity between countries for the next 24 months (Africa is unlikely to get herd immunity anytime in 2021) for governments to let their guard down.
So, I expect there will be a solution for proving that you've been vaccinated. All of Gary's concerns are valid, but challenges like that never stopped governments from setting arbitrary rules. I expect that items 2-5 on his list will be unique to whatever country you're heading to, meaning item 1 will pay the price. 😉
Geebus Gary. You sound desperate. Travel should be the last thing to come back, period. Less of a thing than you make it out to be.
Poverty kills many more people than COVID ever did or will in many countries. Hundreds of millions of people have been plunged into abject poverty by the global catastrophe.. But fortunately, for a combination of reasons, a lot of places do not have high COVID numbers..For those who are concerned to get their people working again in the tourism industry, the lifeblood of many countries, welcoming safe travelers – those who are vaccinated – will be a life saver.and a priority.
We carry our yellow International Certificate of Vaccinations whenever we travel. I’m taking that and my COVID-19 vaccination card to my next physician appointment, where I will ask him to make and sign the appropriate entries.
I’m puzzled the existing yellow international vaccination certificates aren’t used as the standard of proof?? If it’s good enuf for yellow fever, it’s good enuf for COVID, and all immigration officers and many travelers know the document! I brought to my vaccination my most recent yellow fever document and asked that an entry be added for the C19 vaccine (besides giving me the little white CDC card that can be duped on a home printer and for which no stamp was used).The nurse did, but didn’t have the stamp used by every nurse, doc and pharmacist, for other vaccinations recorded in the document, so the document isn’t much good. Now in this day and age any paper document is a bit dated, and there should be an app that can be used in place of the international vacc cert, but that’s a different issue.
For those who travel internationally, carrying your yellow-colored WHO Internation Certificate of Vaccination booklet (printed by US DHHS and the Public Health Service) is second nature.
When I received my COVID vax, I brought my booklet and made sure that the nurse vaccinator filled out the COVID vax info in the booklet. So now I have the COVID vax card and the signed/dated COVID vax entries in my yellow vaccination booklet.
Guess what? When I presented my booklet for the nurse to fill out with the COVID shot record, he said that it was the first one that anyone had brought for him to sign.
Gary, your crystal ball failed. There will be some type of “proof of vaccination”, period. Accept it, and work with it. Accept that there will be issues.
The differences of vaccines is not really important. Do you have a choice of which vaccine you are receiving? I don’t. Do you? Because, if you do, you are a very privileged person!
As @Andrew states, there will still be pre-travel testing. There has to be, because there will be billions of people not vaccinated!
Hopefully, we get to a workable situation that allows travel to be somewhat normalized. Otherwise the status quo will continue.
There is little doubt that vaccine proof is going to be required for international travel at some point. Once it is, the USA will find a way to make it happen. Now we have paper cards but the records are in the state database. I checked mine online and it shows I have received both shots. Further, even if it was paper, my international vaccine booklet in paper shows my yellow fever vaccine and countries that require that accept it as definitive. For now, I have stapled my vaccine card to my international vaccination booklet. And for those of you who say travel is not important—some jobs require it. There is only so much that can be accomplished via Zoom.
@JohnB – “The differences of vaccines is not really important. ” tell that to China which is first with a vaccine certification for travel who disagrees.
I don’t understand why in the US did not provide a process to stamp the CDC version of the WHO international certificate of Vaccination or Prophylaxis yellow card when you get your covid vaccine. I used it for countries that require the yellow fever vaccine and have never had an issue.
There’s no need to create something new. We already have something that works. I will need a booster shot for yellow fever before I return to Africa. I plan on taking the Covid white card to my doctor and see if they will add it to the yellow card.
Well all of this is fine for those of you that can get the vaccination but I am allergic to an ingredient in all of them and refuse to go into anaphylactic shock to get it. There are others that have reasons as well that disqualify them from getting it. Those of you insisting that everyone MUST get a vaccination haven’t got all the facts. There had better be exceptions made because there are valid reasons not to get it. Taking my rights away isn’t one of them.
@KarenS – if you were actually allergic to the lipid nanoparticles used in the Pfizer-BioNTech and Moderna vaccines, what’s the concern with Johnson & Johnson, and why not wait for Novovax or AstraZeneca?
Gary Leff – While China is really going it alone there, after there is proper 3-phase testing, it’s possible we will recognize CoronaVac as a clinically-effective vaccine. Or not, depending on the outcome. There will eventually be consensus on the topic, but as I said before, the road there won’t be perfect.
I still don’t see why that means “the US won’t have vaccine passports.” If every solution in the world had to be perfect, nothing would ever happen.
KarenS: I am just like you. I have an autoimmune disorder and cannot get the vaccine. We love to travel and I’m just wondering what is going to happen.
Gary: You are telling KarenS to wait for the Johnson & Johnson vaccine or others, but I’m pretty sure they are ALL going to be the same, meaning they are all going to be bad for people like her and myself that are allergic to vaccines.
@Ampy – I don’t think you have any idea what issues KarenS may have that causes her to have an allergic reaction, the reference to anaphylactic shock seems to suggest the lipid nanoparticles of the mRNA vaccines may be a concern. Other vaccines using completely different approaches may not have these issues.
We have great electronic health records in the US. Epic does an excellent job. The problem is that our medical system is decentralized with many payers. EHRs with some exceptions do not really communicate with each other. And that will not change until you have some form of a single payer system.
Interesting topic.
1) Trust Bill Gates
Same guy who made his money off of (Microsoft) someone else’s idea
2) Trust Government Data
See New York Gov. Cuomo on if he took care of elderly with the virus???
I could add to this list of concerns but why especially when the “poll” that Reuters did of a grand total of 1,005 Americans should be enough to convince us that all Americans should fall in line. I will add I have received the vaccine but I don’t believe others should be forced to get it for travel or any other reason.
As long as HIPAA exists, using state databases to publish an OK to fly list may be illegal.
There are already websites where you can buy a fake CDC card…
@Eric A few things on HIPAA as a challenge to requiring proof of vaccination:
1) Any health information can be disclosed with the consent of the patient. It should be possible to set up a consent authorization as part of the process of verifying immunization through an app or website. The simplest solution would be if 1 or 2 entities established a private clearinghouse of sorts to verify the original state records once and then provide that verification to other entities upon request and consent from the patient.
Not a likely scenario for them specifically, but an example could be the American Red Cross establishing a site for people to consent to record pulls from state IIS and then allowing Delta Airlines to connect to the Red Cross system (with an additional consent, of course). That would save Delta the trouble of figuring out how to get records from 50 different states.
2) HIPAA can easily be amended by federal statute if necessary for these purposes. It has already been amended to allow for schools to obtain immunization records directly from state IIS, without consent, if required by state law. Most states do still require consent, but many have at least established specific processes for schools to get the records directly. No reason it couldn’t be amended to allow other entities to pull the records also. I could imagine at least transportation carriers being allowed by a specific statute, again with a simple consent from the patient. This seems like a good opportunity to update the entire process for proving immunization within the US. A single system, instead of the 50+ separate state systems would make more sense–or at least a single system that pulls data from the state/district/territory system and allows one pull for schools, transportation, etc.–but being logical means it will probably never happen! LOL
@Eric from Chicago
HIPAA affects healthcare providers releasing personal health information. There is an exception for public health: “public health activities and purposes.” This includes disclosure to “a public health authority that is authorized by law to collect or receive such information for the purpose of preventing or controlling disease, injury, or disability, including but not limited to, the reporting of disease, injury, vital events…, and the conduct of public health surveillance,… investigations, and… interventions.” (45 CFR § 164.512(b)(i))
There have been 5 waivers from HIPAA for Covid related healthcare. These are: first responders, telehealth use, business associates, community-based testing sites and web-based scheduling applications. Making a special database for Covid vaccination status is probably next.
The only people who would care about their vaccination status are ones that refuse to be vaccinated. Because even “special exemptions” would have to be documented. People under the age of 16 are not currently being vaccinated. So that’s another list.
Everybody screams HIPAA. But try re-entering the USA, right now. Do you think these foreign countries honor HIPPA?
I think HIPAA already has a public health exception….this would qualify. And yes, I was appalled at the cheesy CDC verification card – but the yellow yellow-fever booklet that I was required to present in Africa and Southeast Asia was no different. Worrying about the flimsiness and fakeability of the CDC card is making the perfect the enemy of the good (and I have never found a way of working that phrase into conversation before)
But there really isn’t a plausible HIPAA issue, though lots of people will try it (and the First Amendment and the Second Amendment too [the freedom to bare arms??])
FWIW, I don’t think HIPAA is a problem because people will consent to release of their health information. However, I do not think the “public health” exception in the statute is sufficient. That exemption can only be used for the release of information TO a “public health authority.” It does not allow the release of information BY a public health authority without meeting one of the exemptions itself. That means a public health authority could theoretically collect all of this data that would be needed to have a single database of vaccinated or special circumstances (can’t get vaccinated, but maybe has a negative test history), but they couldn’t share it with an airline, hotel, concert venue, etc. At least not without consent.
But again, who will have been vaccinated but refuse consent to share proof of the vaccination with the airline or whomever if it’s required to fly, go to a concert, or whatever?!