As the first doses of a much-anticipated vaccine are being injected into the arms of elders in Quebec long-term care homes, we can start dreaming of a world where the coronavirus has been tamed.
Getting there is going to be a long and bumpy ride rife with challenges. Given limited supplies and a rollout that will proceed slowly over months, deciding who gets inoculated first is one such challenge.
Canada has got that right so far, starting with vulnerable residents in institutional care and front-line health workers. Then it gets more complicated.
Even more difficult will be figuring out what benefits immunization confers. Is getting a vaccine a free pass to head back out into the world unencumbered? And how will we distinguish between the vaccinated and unvaccinated, the immune and the still-at-risk?
To that end, there is much talk about creating an “immunity passport,” a document (paper or digital) that would offer proof someone has been vaccinated.
“That’s going to be really important for people to have for travel purposes, perhaps for work purposes, for going to theatres or cinemas or any other places where people will be in closer physical contact,” Christine Elliott, Ontario’s Health Minister, said recently. Her comments set off a bit of a firestorm.
“Your Vax Papers Please!” screamed the headline in the Toronto Sun. The hackles of civil libertarians were also raised, with legitimate concerns about privacy and discrimination.
Before discussion of the pros and cons of an immunity passport, however, we should be clear about some basic science.
The clinical trials were promising, but we still can’t say that vaccination guarantees immunity and, if it does, how long that immunity will last. Even more important, we don’t know whether people who are inoculated can still spread the virus.
That is true too of those who have been infected and recovered – almost 500,000 Canadians to date.
Even those who have been vaccinated – two shots, three or four weeks apart – and those who have been sick and recovered need to keep wearing a mask and practising physical distancing. It’s not a get-out-of-jail-free card. Not yet.
Should people who are vaccinated be able to travel, return to the office, go to the movies and indulge in other verboten activities, as Ms. Elliott has suggested?
Airlines are keen on this approach. They have already embraced apps such as “CommonPass” and the “IATA Travel Pass.” (IATA is the International Air Transport Association, a grouping of 290 airlines worldwide.)
Demanding proof of vaccination is a common and longstanding practice in international travel.
So, too, is demanding vaccination in workplaces such as hospitals and long-term care homes. Personal support workers, nurses, physicians and others in these settings can be required to get immunized against hepatitis B, varicella (chicken pox), influenza and other infectious diseases in various institutions and jurisdictions.
But what about the general public? Can we say, “You can’t go to work, or a restaurant or the movies anymore without proof of vaccination”?
Legally, it can probably be done. Requiring proof of vaccination is not the same as mandatory vaccination.
But we have to be wary of this approach.
Our desire to get back to “normal,” and our over-eagerness to fire up the economy again, has been problematic. It shouldn’t now be used as an excuse to discriminate. Some people, because of their socio-economic circumstances, will have trouble accessing vaccination promptly, or won’t be able to afford fancy phones with immunity apps. Patients with some health conditions will not be able to be vaccinated. Some people will be scared. Some will have religious and moral objections. (Anti-vaccine conspiracy theorists are a matter for another day.)
Our end goal should not be to create various classes of citizens, vaccinated and unvaccinated, but to create herd immunity, a large percentage of the population with immunity. We need to crush the virus so we don’t need passports and apps and such.
Still, there will still be circumstances where demonstrating that a person is vaccinated and/or immune to coronavirus will be important.
That’s as a good a reason as any to get our act together on vaccine registries and digital health records more broadly.
While this is a good ethical debate in principle, it’s almost laughable that we’re discussing the idea of immunity passports in a country where most of us still have yellow paper vaccination booklets – or, for the keeners, the voluntary CANImmunize app.
We don’t need technology to create coronavirus vaccine haves and have-nots. We need to make getting vaccines into people’s arms the focus.
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André Picard