The Coronavirus Vaccine Could Be the Ultimate Gateway Drug

It’s mid-2021, and people arrive at the airport, or line up to attend a concert or a baseball game. They pull out their phones and tap an app that shows whether they’ve had a coronavirus vaccine, or perhaps a test, and breeze through the gates.

That’s the brave new world businesses are contemplating as humanity embarks on the biggest mass-vaccination program in history. On Dec. 2 the U.K. became the first country to approve the Pfizer Inc. and BioNTech SE vaccine, followed by the U.S., Canada, and others. Yet even with the end of the pandemic in sight, governments and corporations will have to negotiate some unprecedented logistical, technological, and legal challenges in the months ahead.

Until late spring, doses will be in short supply, which means the immediate future will be defined by the haves and the have-nots: people emboldened to leave home with their vaccine- or disease-induced immunity and those who are still waiting in line for a shot in the arm. There’s increasing talk about using so-called immunity passports to get economies moving again. With no time to waste, governments in the U.S. and the U.K. are moving ahead with decidedly low-tech solutions such as paper vaccination cards.

Nadhim Zahawi, the U.K.’s minister for vaccine deployment, sparked an outcry in late November when he said that restaurants, bars, cinemas, and sports venues could ask people to demonstrate proof of vaccination before entering. That raised the specter of a two-tiered society, forcing Zahawi to walk back the idea.

Alan Joyce, the chief executive officer of Qantas Airways Ltd., ignited a global debate about immunity passports last month when he said proof of vaccination would be a condition for travelers entering or leaving Australia on its planes. He’s discussed the idea with other airlines, and it’s likely to become a pre-boarding requirement around the world, he said during a TV appearance.

The Coronavirus Vaccine Could Be the Ultimate Gateway Drug

For now, there’s no international system for verifying that someone has had a jab. The World Health Organization is working on an e-vaccination certificate. But this will take time, because there are myriad issues to sort out. Here’s one: If countries require vaccination for entry—the likely scenario for any future travel—what happens when a Russian citizen lands in London claiming to have been inoculated with the Sputnik V vaccine, which hasn’t been approved in the U.K.?

There are further reasons to proceed with caution. Scientists still don’t know how long the leading vaccines provide protection, or if they stop transmission of the virus. The frontrunners are highly effective in preventing disease, but it’s unclear whether vaccinated individuals might still be infectious. “Vaccination may protect the individual but not their contacts,” says Emily Hyle, an infectious disease physician at Massachusetts General Hospital in Boston. “We need more information before using vaccination status to change guidance about masking and social distancing.”

The yellow fever vaccine is the only immunization required for travel to certain countries under the WHO’s International Health Regulations, a rule familiar to hardened travelers who end up accumulating a collection of the tattered yellow vaccination booklets. WHO would have to modify its rules for a Covid-19 vaccine—a long, fraught process that would involve all 194 members.

Governments are banking on enough people being eager to get a shot so they can confidently resume their daily lives, enabling them to sidestep the need for mandates. “All of us who work in public health would rather avoid mandatory vaccination,” Mike Ryan, head of the WHO’s emergencies program, said at a briefing in Geneva in December. “We’re much better served to present people with the data, with the benefits, and let people make up their own minds.”

Tom Frieden, the former head of the U.S. Centers for Disease Control, has argued that immunity certificates will inevitably be developed despite the hurdles. While there’s a precedent for schools to require certain vaccinations, there could be legal challenges if states or businesses do so, says Allison Hoffman, a law professor and expert on health policy at the University of Pennsylvania. Mandatory vaccination could be challenged in court as a violation of religious liberty and anti-discrimination protections.

“It’s really uncharted territory,” she says. “Private businesses can put restrictions generally on participation. Dress code for entering a gym or a restaurant, for instance: no shirt, no shoes, no service. There’s an even more compelling justification if there’s a public-health reason for their limits.”

In the absence of government guidelines, businesses decimated by the pandemic are exploring how to use vaccines and testing to restore consumer confidence. The global airline industry, facing $157 billion in losses through next year, is leading the way with trials of competing digital apps that display test results and, soon, vaccination records.

Most work the same way: A certified medical clinic or laboratory uploads test results or inoculation records to an app that generates a QR code to present at check-in or immigration without revealing private information. Some of the apps employ blockchain technology to enable users to maintain privacy while sharing data, while in others the data may be stored in a central repository or on people’s phones.

The International Air Transport Association (IATA), the global airline lobby, is working on its own mobile app called Travel Pass, which it’s trialing with British Airways parent IAG SA this year before it arrives on Apple Inc. and Android devices in the first quarter of 2021, says Nick Careen, the organization’s senior vice president of airport passenger cargo and security. It’s based on the existing IATA Timatic system used by airlines and airports, including Heathrow, to verify documents such as passports, which may give it an edge over competitors.

IATA is not intent on acquiring a monopoly. “Our system isn’t meant to be the only game in town,” Careen says. “It will be messy before things are interoperable and harmonized.”

That seems certain, judging from the number of apps already vying for a piece of the market. International SOS, a French travel security company, developed AOKpass with two Singaporean startups to display verified test records. Backed by the International Chamber of Commerce, the AOKpass is being used by Etihad Airways on flights between Abu Dhabi and Karachi and Islamabad in Pakistan, routes the emirate wanted reestablished to safely return workers who left when immigration rules were tightened as part of a government effort to contain the spread of Covid. Rome’s airport is also using it for flights to Atlanta and New York.

International SOS co-founder Arnaud Vaissie says he expects systems to be built corridor by corridor, with many governments requiring proof of vaccination when crossing borders. Companies are also using the app to track workers at remote sites such as oil platforms and mines. Digital immunity passports would help combat the forgery of medical records. “The point of going digital is so the whole thing can be traceable and secure,” he says.

Perhaps the most surprising entrant into the field is a Swiss nonprofit backed by the World Economic Forum that’s developed a digital health app called CommonPass. It’s being deployed by some of the world’s biggest airlines, including JetBlue, Lufthansa, Swiss International, United, and Virgin Atlantic on flights to New York, Boston, London, and Hong Kong.

The Swiss nonprofit Commons Project Foundation got involved in March when it began work on a plan to ease traffic chaos jamming critical Kenyan border crossings. The technology allows truck drivers delivering essential goods to show certified test results on their mobile phones to gain entry to neighboring countries. CEO Paul Meyer sees CommonPass being used in shipping, schools, hotels, and concert venues. He’s even had talks with the Japanese government about using it for the Olympics in summer 2021. “Vaccination records aren’t something people might need just to get onto an airplane, but also to enroll in a school,” he says. “There’s a real need for a global model.”

Ticketmaster, the world’s largest seller of tickets to concerts and sporting events, is exploring using third-party digital tools that would include testing and vaccine information if event organizers want to carry out health verifications on fans. “We’re already seeing many third-party health-care providers prepare to handle the vetting—whether that is getting a vaccine, taking a test, or other methods of review and approval—which could then be linked via a digital ticket so everyone entering the event is verified,” Ticketmaster President Mark Yovich told Billboard last month.

Large events aren’t likely to resume for months, but Ticketmaster is in discussions with International Business Machines Corp. about using its digital health pass, says Eric Piscini, vice president of IBM Watson Health. More than a dozen clients now use the technology, which was originally developed as part of the drive to digitize health records, but the pipeline includes hundreds of companies, he says.

As testing became cheaper and vaccines looked likely to get approved, inquiries surged. “The last few months have been very intense for us,” Piscini says. “We haven’t slept much.”

He says his team has been in discussions with CommonPass, IATA, and others to make sure the different platforms recognize each other. In many cases, the IBM pass will be integrated into existing apps offered by sports teams or airlines to display green or red cards that can be attached to tickets indicating whether someone is good to go. Testing, he believes, will remain common even as vaccines get rolled out. Multiple apps will be inevitable. “It would be awesome to have one platform,” Piscini says. “But it’s unrealistic.”

With the pandemic accelerating our embrace of technology, the use of digital medical records will probably become as routine as Zoom calls. If you think you have too many apps on your phone now, just wait until next year. —With Corinne Gretler and Angus Whitley
 
Read next: Biometric Tracking Can Ensure Billions Have Immunity Against Covid-19

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