Halt! Show Me Your Virus Papers

A new controversy over "immunity passports" is coming soon to a screen near you.  With vaccinations ramping up, we are entering a partially-immune world, and will remain there for at least several more months.  What should happen to people who have achieved immunity either through infection or vaccination?

The idea behind immunity passports is that

These documents would certify that the passport-holder had mounted a positive immune response to the virus and was presumed to be resistant to further infection. Passport-holders might safely be released from public health restrictions and allowed to return to work or study, and to live a more normal everyday existence.

At first glance, it looks like a reasonable idea. Give people a "get out of quarantine free" card and they can help re-energize businesses that have been hit hard by the pandemic and begin the process of economic recovery. The measure is under discussion in several jurisdictions around the world, including Ontario.

But the idea is making people in the public health community nervous. Someone I know that community said, "they're always put in place for good reasons," but added, "and they always wind up being used for discrimination."  

This is because the passports divide society into two groups of people, those who can freely participate in social and economic activity, and those who can't. Those divisions aren't random but coincide with other groupings in society.

For example, the earlier stages of the vaccination program target older people because they are more at risk of complications or death from the COVID-19.  In the early going, then, most people over 65 would have passports but most young people wouldn't. People living in wealthier and more urban areas will likely have better access to vaccinations and than people in poorer and more rural ones.  So many people in cities will have passports and many people in the country will not.  And so on.

Business might start requiring people to have passports before they are hired.  Airlines might require them before allowing people to fly. We would have one group of people who could eat in restaurants, go to bars, and attend public events, and another group that can't. Over the summer Chile abandoned a plan to issue immunity passports for just these reasons. 

The problems just described are not new:

For most of the nineteenth century, immunity to yellow fever divided people in New Orleans, Louisiana, between the ‘acclimated’ who had survived yellow fever and the ‘unacclimated’, who had not had the disease. Lack of immunity dictated whom people could marry, where they could work, and, for those forced into slavery, how much they were worth. Presumed immunity concentrated political and economic power in the hands of the wealthy elite, and was weaponized to justify white supremacy.

Immunity passports might also create what economists call perverse incentives.  If people can't or won't get vaccinated, they may have an incentive to become infected as a means of getting their passport.  A market for fake passports will inevitably spring up, just as it has for so-called mask exemption cards.  You can buy those on Amazon.  

And of course, these days no controversy is complete without accompanying conspiracy theories. Anti-vaxxers will view this as another attempt to coerce or punish members of their movement.  Some Christian groups see immunity passports a "mark of the beast" and a sign of the end times. Libertarians like Ron Paul say it's just another way for government to achieve greater power over free individuals, and fret about what other personal information might be stored on this "passport."

Some people argue that the idea is worth considering, and that there are ways to mitigate the negative effects. But this is a minority opinion. The public health community seems to be in agreement that immunity passports are only likely to further divide us and risk amplifying problems in society.

And we have enough problems as it is.

Update 1/24

Today's New York Times has a story about how the kinds of divisions mentioned above may be occurring even without passports.  For example a luxury travel agency is offering travel to the United Arab Emirates to be inoculated with "privately obtained" vaccine, with travel adventures for the newly immune after that.

Image:  Base image by cytis from Pixabay and modified by the blogger.