From Immunity Passports to Vaccination Certificates for COVID-19: Scientific, Equitable and Legal Challenges

WASHINGTON (May 4, 2020) – As governments from countries including the U.S., Germany, Italy and the U.K., explore the possibility of issuing so-called “immunity passports,” a leading global health and legal scholar warns that such action poses significant practical, equitable, and legal issues. In contrast, if and when a vaccine is developed, vaccination certificates will likely play an important role in ending the pandemic and protecting global health.

Writing in The Lancet, Alexandra L. Phelan, SJD, LLM, LLB, an assistant professor at Georgetown University Medical Center and a faculty member of its Center for Global Health Science and Security, writes that immunity passports “create an artificial restriction on who can and cannot participate in social and economic activities,” warning that this creates “a perverse incentive for individuals to seek out infection.”

“Immunity passports would be ripe for both corruption and implicit bias” and would “exacerbate the harm inflicted by COVID-19 on already vulnerable populations,” Phelan argues. And she adds that the people “most incentivised to seek out infection might also be those unable or understandably hesitant to seek medical care due to cost and discriminatory access.”

Immunity passports would also face legal challenges, argues Phelan, who is also an adjunct professor at Georgetown Law and a member of its O’Neill Institute for National and Global Health Law. While the International Health Regulations prohibit health measures that are discriminatory and impede international travel, at present, she explains, countries may not have laws to expressly address discrimination experienced by those without “immunoprivilege.”

“Immunity passports would risk enshrining such discrimination in law and undermine the right to health of individuals and the population through the perverse incentives they create,” she writes.

In contrast, if and when a vaccine is developed, “vaccination certificates” may be an important tool to incentivize vaccination, evidence protection, and resume international trade and travel. Unlike immunity passports, vaccination certificates are expressly permissible under the International Health Regulations, which govern when countries can use them. Phelan sets out the legal steps required to be able to use vaccination certificates in the COVID-19 response. 

“Until a COVID-19 vaccine is available, and accessible, which is not guaranteed, the way out of this crisis will be built on established public health practices of testing, contact tracing, quarantine of contacts, and isolation of cases,” Phelan concludes. “The success of these practices is largely dependent on public trust, solidarity and addressing – not entrenching – the inequities and injustices that contributed to this outbreak becoming a pandemic.”

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Phelan’s work includes legal and policy issues related to infectious diseases, with a particular focus on emerging and reemerging infectious disease outbreaks and international law. She has worked as a consultant for the World Health Organization, the World Bank, and Gavi. Follow her on Twitter at @AlexandraPhelan. 

About Georgetown University Medical Center
As a top academic health and science center, Georgetown University Medical Center  provides, in a synergistic fashion, excellence in education — training physicians, nurses and other health care professionals, as well as biomedical scientists — and cutting-edge interdisciplinary research collaboration, enhancing our basic science and translational biomedical research capacity in order to improve human health. Patient care and clinical research is conducted with our clinical partner, MedStar Health. GUMC’s mission is carried out with a strong emphasis on social justice and a dedication to the Catholic, Jesuit principle of cura personalis — or “care of the whole person.” GUMC comprises the School of Medicine, the School of Nursing & Health Studies, Biomedical Graduate Education, and Georgetown Lombardi Comprehensive Cancer Center. Designated by the Carnegie Foundation as a “very high research activity university,” Georgetown is home to a Clinical and Translational Science Award from the National Institutes of Health, and a Comprehensive Cancer Center designation from the National Cancer Institute. Connect with GUMC on Facebook (Facebook.com/GUMCUpdate) and on Twitter (@gumedcenter).

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