In Tuesday’s post on “Incentivizing COVID Vaccination,” I pointed to Israel’s Green Pass, a government-issued certification that allows fully-vaccinated citizens to prove their status at restaurants and other public venues to resume pre-pandemic normalcy. While I support such a program here, I am leery of the obvious inequities that it would create.
POLITICO reports that President Biden is under pressure to emulate the Israeli model but is resisting, seeing the equity issues as outweighing the rather obvious benefits.
States, airlines and tech companies are pressuring the Biden administration to develop a federal standard for vaccine passports — a policy that could speed the economic recovery but might also discriminate against disadvantaged groups and jeopardize privacy.
Digital credentials showing proof of a person’s Covid-19 test results and vaccination status are rapidly being embraced as a tool to redesign workplaces and jump start travel and tourism. New York State is trying out an ”Excelsior Pass” to fast track reopening theaters and venues like Madison Square Garden. Hawai’i is developing a version that would let visitors skip the state’s mandatory 10-day quarantine.
But without White House involvement, industry leaders say they’ll be left with a confusing patchwork of unregulated and unreliable tracking tools that could invite fraud and raise troubling questions about risk and fairness.
Absolutely. Some states won’t enact programs at all. And residents traveling out-of-state will have difficulty getting their credentials recognized. Not to mention the much-increased risk of counterfeiting with multiple credentials out there.
The White House says the government shouldn’t issue the credentials or store the data. But it’s held discussions with tech firms on how a passport system might work, asking for details about whether pharmacies and other establishments might provide the necessary data. The Department of Health and Human Services has also sought input from 25 federal agencies on the passports, including if they’d encourage their own employees to use them, sources familiar with the conversations say. HHS’ national health technology office declined comment.
It’s awfully late in the game to still be figuring this out but, alas, we’re not quite two months into the Biden administration and its predecessor was, at best, incompetent in managing the crisis and, at worst, actively sabotaging efforts to respond. Still, you’d think career professionals at HHS and elsewhere would have been thinking through this problem.
“The right way is that it should be private, the data should be secure, the access to it should be free, it should be available digitally and in paper, and in multiple languages, and it should be open source,” White House Covid-19 adviser Andy Slavitt said on Monday.
In principle, I agree with all of that. But this seems to be a case of satisfying political constituencies at the cost of efficiency. Maybe get it available in English, our de facto national language for centuries, now and worry about other languages later? Hell, make it mostly pictorial for all I care—just get the damn thing out. And, frankly, if Microsoft or Apple or someone can make it happen fast, we should prioritize speed over fealty to open source.
The passports have been discussed since early in the pandemic, when antibody tests and accompanying apps to were being touted as a tool for reopening the economy. But businesses are reviving the pitch with vaccinations on the rise and travel picking up: A coalition of aviation and travel groups this month called for a federal standard, saying passports would not only accelerate a recovery but expand testing and vaccinations while limiting disease spread.
“There’s a role for the U.S. government to set standards,” particularly to ensure the credentials are “interoperable,” or talk with other systems efficiently across borders, said Tori Barnes, executive vice president of public affairs and policy at the U.S. Travel Association.
While I support devolution of many aspects of government to state and local jurisdictions, this would seem to be an obvious case for centralization. (I’d be happy for everyone to get free federal passport-passports that could be embedded with things like drivers licensing permissions and restrictions as well as vaccination status.)
The other concerns are much more salient to me:
Public health experts and bioethicists say digital credentialing could discriminate against disadvantaged populations. The Electronic Frontier Foundation, a digital rights group, argues that using smartphone-based verification to access public places would create a two-tiered system that bars people who can’t work, shop or attend school because they don’t have a cell phone or access to testing.
Granting that just about everyone I encounter in life, including laborers, has a smartphone, I’m sure there are plenty of folks who still can’t afford them. And goodness knows our patchwork healthcare system leaves too many people behind. But we can surely issue some sort of ID card that people can carry in addition to making the certification available digitally.
Beyond the ethical considerations is the separate question of whether the fragile U.S. health tech infrastructure can withstand a barrage of new apps tapping vaccine data.
Data troves containing immunization records vary in quality from state to state and may not be able to handle a surge of real-time queries about vaccination status, said Deanne Kasim, executive director at Change Healthcare, which is part of a consortium including Microsoft and Salesforce working on standards and technology for passports. Her company argues for a “lighter lift” and teaming up with pharmacies, which have more robust record-keeping systems.
I’ll have to defer to those who study the issue that this is big lift. But that would seem all the more reason to have this centralized in some fashion.
There also are privacy considerations. Requiring people to store test and vaccination results in digital format could expose them to the kind of data breaches that have proliferated during the pandemic. “We wanted data to reside on patients’ phone” as opposed to a database, where individuals can control the data, Kasim said.
Efforts to create passports could also run into legal barriers, said Rebecca Coyle, the executive director of the American Immunization Registry Association. Privacy laws restrict the kind of data some registries can share. Tech interests have asked the HHS national coordinator for health technology to issue national guidance so that “different solutions return the same information,” Coyle said.
I haven’t expended much effort thinking through this issue but, offhand, it seems trivial. There’s no reason for this passport to store more than a name, photograph, and vaccination status. I’m sure that information can be exploited by people more clever than me but it doesn’t strike me as that catastrophic compared to the massive benefits of being able to prove that one is vaccinated.
Some states are looking at getting ahead of the feds and regulating the still-nascent field, Kasim said. Several legislatures, for example, have introduced bills to prevent discrimination for people with religious objections or health conditions that might prevent them from getting immunized.
While I’m not religious, I try to bend over backward in respecting religious accommodations. And, certainly, we need to think through the implications for those who can’t get the vaccine. But the bottom line is that, if you’re not vaccinated, you’re a threat. The negative externalities—you could literally kill people—would seem to outweigh whatever liberty interests you have.
