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Zackary Berger is a primary care physician and bioethicist at Johns Hopkins School of Medicine and the Esperanza Center, both in Baltimore. Andray Domise is a Toronto-based writer.

Recently, New York City became the first American city to declare that workers and customers alike will require proof of having received at least one vaccine dose, before being allowed to partake in routine activities such as dining at restaurants and exercising at gyms. Since then, Québec, British Columbia, and now Ontario have chosen to implement “vaccine passports” – digital or physical proof of full immunization – to categorize which residents should and should not be able to conduct nonessential activities.

Canadians are understandably anxious to see as many of their neighbors vaccinated as possible. COVID-19 cases are spiking in Canada, driven by the Delta variant, with most – but not all – occurring among the unvaccinated. But current initiatives to require vaccine passports ignore the reality of vaccine segregation, and how they could reinforce inequities in society – and how they might not actually encourage vaccination nor stop the spread of the disease.

One of Dr. Berger’s patients in his Baltimore clinic – a 35-year-old – was recently asked whether he’d been vaccinated against COVID-19. “I do food prep at a restaurant, 14 hour days, six days a week,” he replied. “I’m not sure when I’m supposed to get time off.” He cracked a tired smile. “And then I worry about going out, these days.” He explained that was because of COVID-19, but also because of the U.S. Immigration and Customs Enforcement agency, which has not stopped its efforts to deport the undocumented even during a global pandemic.

In Canada, fear of compromising privacy has already fueled vaccine hesitancy among the undocumented, and digital vaccine passports (which require users to download an app to their phone, and to scan a QR code provided by the venue which they are visiting) has only added to their fears.

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Additionally, in British Columbia, the vaccine passport requirement has been applied so stringently that even people who cannot be vaccinated for medical reasons will have their freedom of movement restricted. Gabrielle Peters, a disability rights advocate in British Columbia, is among them. “[People with disabilities] were completely ignored and now we’re completely thrown under the bus because of concerns about other people,” she said in a recent interview. “How is it that you can make an age-based exemption, but you can’t make a medical exemption?”

These people are not ideologically opposed to vaccination; they are constrained by circumstances and undermined by lack of support. How should we best respond, to support public health while also relieving the desperate circumstances of Dr. Berger’s patients and those like them?

Beyond medical and legal reasons, there are widespread barriers to getting vaccinated. If you can’t get off work because you lack protections or just need the money, say. Or if you have to take care of kids, the bus isn’t running, you’re not feeling well, or you simply can’t find the time to figure out how or where to get the vaccine, given everything else life has thrown at you.

Then, there’s also the matter of understandable mistrust in governments. A person thinking about getting vaccinated also has to trust that those organizing vaccinations have their best interest at heart. But many governments have victimized various people at various times, both in the past and to this very day. How can Black Americans place full trust in vaccinations when they’re being promoted by a government with a profoundly cruel history of medical experimentation on Black communities throughout the country’s history? Which Puerto Rican would not think twice about the shot, given the memory of forced sterilizations on that part of the U.S.? Who among the Indigenous people in Canada would uncritically accept any announcement from a federal government with its own history of forced sterilization and residential school programs?

Technical barriers also underlie the failures that have plagued vaccine passport rollouts in Europe, as well as New York and California. In particular, the U.S. has seen technical hiccups that could have been predicted and avoided. Additionally, IBM – the developers of New York’s Excelsior passport app – have already been musing about adding even more private information to the passport, including health insurance and driver’s licenses. Yet, there has been no parallel effort by legislators to safeguard users’ privacy with legal protections against information-sharing among third parties, or penalties for misuse.

If we must have COVID-19 passports, we must also make them supportive, not punitive. They need to open doors to all the social supports that make life during a pandemic possible, and which so many have been denied: reliable, humane work; food; housing; shelter; childcare; and healthcare. The state needs to provide, not punish – and that would actually help hasten the end of COVID-19.

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