Opinion | The Reality of Vaccine Passports

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Today on “The Argument,” the case for and against vaccine passports.

To a lot of people, a vaccine passport sounds great, a piece of paper or an app on your phone that proves you’ve got the Covid vaccine. Just flash it to a maitre d’ or a TSA official or the front desk of a hotel, and bam, you’re in. It’s like your own little ticket to post-pandemic freedom. But what about the billions of people who live in countries with less access to a vaccine? And who exactly has access to that information about your vaccine status? If you care about your data privacy — and you should — maybe you don’t want software companies, and correspondingly, a bunch of businesses you use every day, knowing if you’re vaccinated or not. I’m Jane Coaston. And as of yesterday, I’m fully vaccinated. And I’m as excited as anyone to get back to packed Michigan football games and busy restaurants. But should I need a proof of vaccine to do those things? And who gets to know that I’m vaccinated anyway? My guests today disagree about the risks of vaccine passports. Ramin Bastani is the founder and C.E.O. of Healthvana, a healthcare communications platform. Natalie Kofler is a molecular biologist and bioethicist at Harvard. Natalie, what is a vaccine passport? What does that mean?

I mean, I think, firstly, it’s confusing because there are several names that have been given to this sort of situation, right? So, vaccine passports, vaccine certificates, vaccine certification. And really, the idea is that someone who can show that they have proof of being vaccinated for Covid-19 is then able to move through society in different ways. And so we’re seeing this being thought about in the context, of course, of international travel. So, thinking about being able to enter certain nations on the premise of showing vaccination, but then also kind of merging more into issues of thinking about people who could be employed in certain situations and needing to show a proof of vaccine, and then more widely, sort of distribution of these ideas and thinking about it in its use in the private sector, right? So to be able to go to a concert, maybe go to a hockey game, these sorts of more voluntary, you could kind of call, leisure activities that are, of course, really important to people, but might not be essential things, like work or school or healthcare.

Ramin, can you tell me about the feature that your company has been working on to do this?

Yeah, sure. So we actually don’t think of it as a passport at all. We certainly don’t think of it as an immunity passport. We think of this as a medical record. And it’s your personal health record. Some background is helpful. We’ve delivered millions of HIV-related results. HIV is sensitive protected health information. So we have experience in doing this exact kind of work. And prior to the whole conversation around your vaccine record as a part of this, we delivered about 10 million Covid-19 test results to people across the United States. They had used those also to get back to school, to get on a plane, to go back to work, whatever it may be. So we have quite a bit of experience, and we have a very clear point of view that this is your health record. We want to empower you with your health information that, one, you have a right to a copy of it under HIPAA. Number two, and incredibly importantly, you can make sure it’s correct. We get so many records that have the wrong date of birth. Maybe it’s set on your phone to internationalization. Your day and month or flipped around. And so we think of this as more of a data problem than anything else. And yes, some people may want to see proof of this for school, for certain employers, perhaps for International travel. But we think this has different layers to it, meaning international travel may have a different subset of rules versus domestic travel, which we don’t think there will be any. Then you have different types of employers that might work in food processing that might require it, versus a law firm which won’t require it at all. They may want to know that you’ve been vaccinated or tested weekly. But it’s going to be about confidence. And so we very much want to empower patients with information at their fingertips. It’s what we’ve done as a company for a number of years.

Natalie, I want to hear some of your skepticisms because this sounds like the type of information that a lot of people either would want or, in many cases, already have. I got a vaccine card after I was given my first shot, along with arm pain. You use a driver’s license or state ID to cross state lines all the time. Why is this a different issue?

It’s different for several reasons. I mean, I do want to just kind of echo the importance of thinking about this around individual empowerment and being able to have power over your health data and how it’s used. And I think that’s incredibly important. But that comes with risks, right? So for example, HIPAA was put in place to protect the privacy of patients, right? And so, those sorts of privacy oversights don’t necessarily translate when people are carrying that information in their pocket or in their smartphone. So the excitement of this is clear. But it also establishes an entirely new platform of biological data that can be used in ways that people may not be consenting to or maybe used in actually nefarious ways. And I think that that’s something we have to be really cautious of when we’re building these new platforms, particularly in times of emergency like this pandemic of what they can become later on. So what stops this biological platform from people putting in their ancestry.com genetic sequencing data, having that then be able to be used whether they can get life insurance. I mean, there’s all sorts of ramifications that need to be considered and thoughtful. And I think the other thing, really looking at this from the other side of this, is, what private actors are implementing or thinking of implementing certain immunity or vaccine mandates, right, that would then be able to impact the movement of individuals? And this is where I get really concerned because I think everyone’s aware of inequitable access to vaccines, both domestically and very much so internationally, right? So if you start establishing these new sorts of gates for who can access certain things or not, it’s going to just sort of further entrench these inequities that we already see. And I think that’s a place that I get very, very concerned about and something that really needs to be sort of thoughtfully weighed out when we’re looking at risk to inequity and risk to public health and risk to economies, really thinking about this in a comprehensive way.

Ramin, how are you thinking about that? Because you talked about the work that your company has done on HIV. And HIV, in many ways, deals with very similar or worse inequities. So how is your company thinking about this equity issue? Because even just to use this requires you to have a smartphone, I’m assuming. How is your company thinking about that?

With regards to Covid, we’ve been delivering, again, 10 million plus test results across the country. It’s a similar situation where people do have access to go get tests in some cases and in most cases. What I can tell you with I think what you’re describing is the digital divide potentially, 97% of people who have used Healthvana are able to view the results in the first day. It doesn’t have to be a smartphone. But most people have text on their phone. So what we’ve made sure to do is to make sure that it doesn’t have to be a smartphone. You can use a desktop. We’re available in multiple languages. We’re working with very large testing sites in a way to help them manage their populations. And if you don’t have a smartphone, you can then get the email and then print it up at home. With regards to the vaccination card, we think this is better than a piece of paper. We’ve seen so many — I mean, we have emails about this, where people are like, it says I got Pfizer, but I actually got Moderna. It doesn’t have all my information. My name is misspelled. What if I have to use this thing? So we’re very much focused on that first order problem of getting information to patients in a digital way, so they don’t have to necessarily laminate it. And that becomes incredibly important because there’s going to be booster shots coming. And we can then remind hundreds of thousands, millions of people that there’s a booster available for Moderna. If you’re of this age, that might be relevant.

I am sure that you are a delightful human being and your company is full of delightful human beings. But tech companies are often run by delightful human beings with security lapses, which can happen to virtually any company. So that piece of paper I have that could have my weird misspelled name, I know exactly where it is. I am looking at the drawer that it is inside. I do not know where you or your company will keep this information. So for people who are older or paranoid, or old and paranoid, why should they trust a tech company, when literally having that piece of paper, I think, for many people, including me, is very reassuring?

They don’t have to. They can opt out of it. Or they’re opting into it. So when you’re registering, you’re opting in to receiving a digital version of this by email or by text. Now it’s not coming in the email or the body of the text. You click on the link, you enter your first name, last name, and your date of birth, and within 15 seconds, you have access to a digital record. You can then take a screenshot of it. There’s different ways to do this, but it’s an option that goes beyond a piece of paper. And with regards to security, we’ve been doing this for a while. And we’re securing at the same place hospitals keep their kinds of information in Amazon Web Services. So we take a lot of the different measures that are necessary for a company like us.

So I want to move on and talk to Natalie a little bit about what a vaccine passport hypothetically would look like in the United States. Because public health is both the federal level and the state level. What would this even look like for most Americans?

The way that this is sort of looking from a legal standpoint is that it does look like at this point, for private actors — companies, airlines, Ticketmaster, Delta, those sorts of folks, the NBA — if they wanted to implement sort of a requirement to use their services, there doesn’t seem to be any sort of oversight that would prevent that from happening, right? There’s a lot of impetus to think about providing a sense of security to your patrons or to your customers that say we can guarantee if you’re going to take this flight on American that every adult will be vaccinated, right? And so then you see that as being like, OK, then you have to use some sort of form of validating your vaccine status, which could likely include some sort of smartphone app or paper validation to then get on that American Airlines flight. This is where the privacy issue gets — I get concerned about because now American Airlines has access to information about your health, right? And what level of information are they being given? And not even to point it at airlines, I mean, it could be like literally your local Italian restaurant down the street, too.

So we know that other countries have already either begun to or are thinking about implementing vaccine passports. I think the most prominent example is Israel. What has worked there that might not work in the United States, Natalie?

Well, one thing was that they are basically deploying a single vaccine, which is the Pfizer vaccine, which we know is actually quite highly effective at this point. They deployed super quickly. And people might not understand how they got such high levels of vaccine so early. And that’s part because they made a deal with Pfizer to share the health information and data from that rollout with the company. They have a social healthcare system. So there’s just all these different caveats there that make it a really unique situation. What we saw in Israel is as soon as they reached about 40% vaccination within those who would be eligible, so those over 16, they began to implement these vaccine passport mandates, right? And it was called the Green Pass, and it meant you can go to the gym, you could go to a concert. You can do kind of all these more leisure activities that those couldn’t. At the same time, very few Palestinians living in the West Bank had been vaccinated, for example. And I think what was also interesting is you saw folks go to this outdoor concert, physically distance, all wearing masks, but all showing that they’ve been vaccinated. And in some ways, it’s like, where does this line get drawn? If you can maintain safety in other ways, is vaccination a requirement to attend those sorts of events? And I’m not sure if that’s the case.

That Israel example is particularly interesting because I was thinking that perhaps having a Covid passport would give you a false sense of security because you would have — presumably, for instance, I have the Pfizer shot. But there are additional Covid variants that are emerging. And as Ramin mentioned, you might need a booster shot. Is there a concern for you what people interpret the Covid passport as meaning might put them at risk?

I think that is a concern, and I think there’s already sort of reports coming out of Europe that there are starting to be concerns about activities of individuals based on their sense of security. I keep saying that this isn’t your yellow fever card.

I think that’s incredibly important because I’ve been thinking about the difference in that if you go somewhere where that yellow fever or malaria exists, it is so you do not get it, not to prove that you do not have it necessarily.

It’s so that you don’t get it, and it’s so that you don’t bring it to another place that also has those mosquitoes that could then make it endemic in a new area, too, right?

Yes.

This is a totally different scenario. And the other difference here — and this is super important — there is only a single commercially available yellow fever vaccine. It’s been around since 1938. It is nearly 100% effective. And it’s thought to give — it’s pretty clear that it gives lifelong immunity to yellow fever. We are now in a situation that there have been different vaccines in different various levels of sort of approval process of the W.H.O. They have varying levels of efficacy. They have varying levels of efficacy against the new variants that are emerging in this global pandemic where anyone anywhere in the world can get Covid-19. And so it is just a completely different scenario in many ways. And I think we have to be really careful at not oversimplifying it and kind of say, well, we’ve already got the yellow fever vaccine cards. Like, why is this any different? And I do think it’s actually quite different.

Ramin, I want to put that question to you. Because if there are a number of variants — this isn’t yellow fever — this is something where there are many different vaccines — how does your platform or how does your company deal with the fact that there is not just one great vaccine to rule them all?

Yeah, we think of this domestically more than anything else. There is a couple of vaccines that are pretty effective. And hopefully, people do want to get the vaccination. But a lot of people won’t for all sorts of reasons. And that’s their right. So I guess a lot of the times, we think of it as three different ways that you can get back to whatever that normal may be for you. And again, that’s really important that it’s up to that person or if their employer requires it if that’s a part of their job, but one is showing some proof of your vaccination. Second is going to be a negative PCR test. And third will be showing an antibody test to show that maybe you’ve had a recent infection or that you have some level of antibodies or immunity through the vaccination. I think my guess is about a fifth of the country won’t get vaccinated. You look at different numbers. There’s already people saying there’s all sorts of reasons why they don’t want to do it. And it’s become a political issue, in some ways. And as things change, to your question, we’ll iterate along with it. We act as that last mile. We’re able to deliver that information to people in a way that they can have at their fingertips that enables them, empowers them to go about their life in the way they want.

So there is obviously a ethical concern with vaccine passports here. Because I think that there is obviously the, what if the government demands I show this to do something or to cross state lines. But we’re very quickly going to see private companies saying, you can’t come to this restaurant or kind of making it the no shirt, no shoes, no service argument.

I’d say that’s my largest concern, is implementation in the private sector. It’s concerning from the privacy standpoint, but actually, the bigger concern is what I’ve talked about from the beginning, is just issues of entrenching inequity. And we know historically within the U.S., separation of society based on immunity has caused severe inequity. You can go back to Antebellum New Orleans with yellow fever. And basically, immunity to yellow fever allowed white privileged men to be able to concentrate power economically and politically against those that had not been acclimated to the disease. At the same time, it allowed those same folks to justify enslavement and slave labor of those of African descent. And so I think we have to just be so careful about not repackaging these ideas of immunoprivilege, as you could call it, and being able to structure our societies. And I think that’s where my heart hurts when I think about that. And that’s what really, really keeps me working in this space. Because it’s incredibly concerning to me to kind of create these new divisions between have and have nots when they’re already those divisions of have and have nots are built on who’s privileged enough to access a vaccine, who’s privileged enough to have a smartphone to show that vaccine, and then deciding how they can then move through society. It’s really concerning.

Ramin, you have mentioned that your company works a lot on HIV. And what did you learn from that experience of working on HIV? And how are you applying that to Covid and thinking about privacy in that way?

It’s because of our work in HIV that formed the way we think about this. And it’s the almost identical thing in that you have a right to your information. It has to be a correct amount of information. And that information can be used by you to maybe get a second opinion, another doctor. Even in the work that we do within HIV, which includes your sexual health and STIs and then also hepatitis, a lot of people use Healthvana to actually screenshot their results, whether HIV positive and showing they take their medication. And so people actually put them on dating sites. It’s up to them to share what they want. And that happens a lot. People are doing the exact same thing with Covid where we put it in a way they could screenshot it and share it, if they wanted, with family. Especially if they test positive, they can tell other people to actually get tested right away. In the HIV world, it’s called partner notification, if you test positive and you have disease, investigation specialists that come to you and do contact tracing. So it’s also why we’ve been able to jump so quickly into doing a lot of work with Covid and have had such a good impact so quickly in our view. [MUSIC PLAYING]

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We have recently seen the governor of Florida, Ron DeSantis, push back massively against the concept of vaccine passports. Ramin, how are you working to convince people that these passports are both useful and safe and that their privacy will be respected?

Right, so on the useful on the privacy and the security, look at our background as a company. We didn’t pop up three or four months ago, saying, hey, this is a thing we’re trying to do. We’re not focused on creating any kind of framework that everyone uses us. And when it comes to stadiums, we’re talking to a lot of the big event planning companies in the country. We’ve talked to a lot of massive restaurants, chains, hotel chains. And so I think we have a slightly different view, is, I don’t think you’re going to see hotels and restaurants ask you for your vaccination proof. I don’t think people are asking for your test result. Now hopefully that doesn’t happen, to Natalie’s point. In some places, it might. But more of what you’re seeing across the country is people saying, no, we are open for business. You know, we’re close to bankruptcy, is what we’re hearing from the business community in a lot of ways. And then if you’re someone who doesn’t feel comfortable going to a place that doesn’t require that, then you don’t go. Or if you feel more comfortable of a place that has all of that, you go. I think as much as you can put it up to the individual to make better choices about them with regards to going to businesses, that’s one thing. The place that we think it’s going to get more challenging is around employers. If you’re required to do something in order to work to make money to make a living, that’s a bigger issue that we see. We think it just has multi-levels to the conversation. And the ones that people are focusing on are kind of scattershot again about all of this. We see this a lot more nuanced. It’s not either you have a vaccination proof or nothing. It’s, you have vaccination proof potentially, and they’ll decide what that actually is. It could just be your little card, right, that you have, or it’s a negative PCR test amongst a certain amount of time or an antibody test. So it’s definitely not black and white. And we can help with the nuance of that, given that we’ve already delivered all this kind of information in the past.

You don’t think businesses will be pushed by consumers? Because I can easily imagine hotels doing the same thing that they’ve done with mandatory masking or asking people to socially distance. You provide us with verification that you’ve been vaccinated. And that business can make the argument that that’s protecting their staff. It’s protecting other guests. It’s protecting everyone involved.

Generally, no. That’s our sense of the conversations we’ve had. I think the focus is to make sure customers feel more comfortable. And that might mean their employees get vaccinated or show negative test results if there’s a place where they interact a lot. But I don’t think you’re going to have large hotel chains — again, this is so far from our opinion in some of the conversations we’ve had, saying you can’t stay at our hotel unless. Now that has a flip side to it, where then you have employees, right, who may be coming in contact with people. And so there’s a lot of different pieces to this that are confusing, especially because it’s a piece of paper that you have, right, if you don’t want it digital. Even if it’s digital, that piece of paper is very easy to falsify.

Right, there have been a couple of already cases. I was just reading about something about someone who essentially stole those cards and was filling them out. So I think that that is a concern.

It’s going to happen. We know it. And it was happening with the test results as well. So, this is something that’s going to be a part of it. But all in all, I think continuing to wear masks when you feel comfortable, it makes sense for you, socially distancing still, and making decisions that you think are best for you if you are to go somewhere as a patron makes a lot of sense. And it’s going to vary by city, by county, by state. So it’s not going to be a one-size-fits-all.

Natalie, what ethical alternatives could or do we have?

Yeah, I would say, in many ways, it seems like it’s going forward. And I do agree with Ramin in the idea that if you are going to implement this, it should be a variety of methods to reduce risk, which would mean showing vaccination perhaps, showing that you have a negative test result if you can’t be vaccinated or you don’t want to be vaccinated. And I do think those options are important, but I actually have to disagree with you a bit where I actually do think we will see pretty strong rollout in the private sector from a variety of different actors. And I think tourism is a really big place there. But what’s going to be really interesting, particularly in the United States, is what differences we’ll see from state to state.

Right. I live in Washington, D.C., which is not yet a state. But I can imagine that D.C. has been more cautious. And then there are going to be states like Florida that will be whatever the opposite of more cautious is. And I can easily imagine that difference, but especially if you are a multinational hotel chain or something like that, having different rules for different hotels, that could be a potential challenge.

And it might end up being that way. The reason I think it’s so likely to be implemented, though, is that if you are trying to guarantee safety to your consumers, then you want to show that you have vaccine or negative test requirements. I mean, that’s how you demonstrate safety so consumers can feel more safe. I think from an ethical standpoint, I mean, I do think we still have to be very careful not to skip past the question of, should we do this? That’s where I get concerned because I see so quickly we get to the conversation of, OK, how we do this ethically, without actually maybe always continually thinking about, should we be doing this? And if we are going to do this, in what context do we do this? If you are doing this to secure public health and to protect the health of those most vulnerable, then you can make arguments for vaccine mandates in places of high risk, right? So that would be front line healthcare employees or employees at long-term care residences, folks working in penitentiaries, for example. Those could be places where mandates would be really necessary and required. This becomes a really different question if you need to have vaccine mandates to go to a concert. What this quickly slips into, people put the argument that if you’re vaccinated, you shouldn’t be restricted anymore. Like, you should be able to move through society completely freely. And why can’t I go to a concert or why can’t I go to a restaurant if I am vaccinated? And so I think we just have to be careful that the individual needs aren’t put in front of the community health needs. And that’s where we’ve seen huge issues in the United States. And success in trying to fight this pandemic is when individual liberties are put over community health.

Right, I actually reached out to former representative Justin Amash on this question. And he said when the term vaccine passport is used in the genuine sense, it doesn’t mean simply a vaccine record for travel or schooling. It’s a unified centralized system to give or deny access to everyday life. I think there are massive equality and civil liberties issues that will arise. Ramin, I want to go back to you because, clearly, you run a company that does this. Was there a point where you’re asking, should we do this?

I keep coming back to this. What we think about it is giving patients their information. It’s what we’ve done for years, tens of millions of times. We actually even advocate for variants to be a part of your personal health record. Because people in the country right now, up to nine months later, have symptoms still from Covid. And we have no idea what long Covid really looks like. And that may be tied to which variant you have, whether it’s the South African variant, the Brazilian variant, the U.K. variant, the New York variant. We think that will have an impact. So everything we’re about is pro-information, pro-power to the person in a secure way.

In some ways, it’s perhaps inappropriate to ask Ramin the should question. I think you’ve skipped past that, and you’re trying to provide a tool, right, to help consumers or help communities with this issue. I think the should question lies at the feet of the private actors with governments that might be promoting this. Like, the New York state government is now implementing a trial with vaccine passports for Madison Square Garden. Those are where the should question should lie at. And I don’t see the should questions being answered.

I was just thinking to myself. Like, I know that there’s a part of me that, now having been vaccinated, wants to just run around in giant circles near people. But there’s also a lot of hesitancy and also a lot of concern about what that means. And so I really appreciate you two for having a really interesting and nuanced conversation about what this could look like. Ramin Bastani is the founder and C.E.O. of Healthvana, a healthcare communications platform. Natalie Kofler is a molecular biologist and bioethicist at Harvard. Thank you both so much for having this conversation with me.

Thank you.

Thank you. [MUSIC PLAYING]

If you want to learn more about vaccine passports, I recommend the piece, “Vaccine passports won’t get us out of the pandemic,” from The New York Times Opinion section published in March. You can read more about how vaccine passports work in Israel in the article, “Vaccinated workers are getting benefits and those without Covid shots won’t,” published in Bloomberg last month. And listen to WBUR’s “On Point” episode, Vaccine Passports, Public Health Tool or Invasion of Civil Liberties? You can find links to all these in our episode notes. Finally, vaccine passports are just one of the many debates happening around how our societies adapt under Covid. We asked you to send us the arguments you’re having about one of the other huge debates, going back to in-person learning.

“The Argument” is a production of New York Times Opinion. It’s produced by Phoebe Lett, Elisa Gutierrez, and Vishakha Darbha; edited by Alison Bruzek and Paula Szuchman; with original music and sound design by Isaac Jones; and fact-checking by Kate Sinclair. Special thanks this week to Shannon Busta. [MUSIC PLAYING]