In recent days there is much talk about the vaccination passport that the European Commission plans to propose for summer mobility. This certificate would allow, in theory, that people vaccinated against COVID-19 could make their movements more easily. The proposal, however, raises many ethical and health concerns.
In the first place, because there is still a lot of information about the type of immunity conferred by currently approved vaccines, as Matilde Cañelles, a scientist at the Institute of Philosophy of the CSIC and with a long career behind her in basic research in immunology reminds us: ” At the level of the immune system there is a great variation between people, and also it is not yet guaranteed that a vaccinated person will not transmit the virus ”. That is, we know that vaccines protect us from developing a serious infection, but it is not clear if a vaccinated person could function as asymptomatic and transmit the disease.
“Until now, phase III clinical trials have been carried out, which take place in fairly controlled conditions and from which information is obtained to know if a drug works and is safe,” the expert explains. “But the data that interest us for this matter are those that are obtained once the vaccine is being administered in a massive way and data is collected at street level that compares vaccinated and unvaccinated people . And, obviously, it is still too early to have that analysis ”. In addition, and as Cañelles reminds us, we have several approved vaccines on the market, as well as others in the regulation phase, which could have different effectiveness. “A publication will soon be out in The Lancet with very promising results for the Pfizer vaccine based on data collected in the UK comparing vaccinated and unvaccinated healthcare workers. But there are other vaccines on the market , it is possible that some do prevent the transmission of the virus and others do not, and there is still a long time to collect all that information.
Ethical doubts
In a scenario in which mass vaccination campaigns against COVID-19 have only just begun, the implementation of the vaccination passport raises, in addition to doubts about its usefulness to control the pandemic, numerous ethical conflicts.
On the one hand, possibly this summer there will be a very large group of people who have not yet been vaccinated, not because they did not want to, but because they have not yet touched the calendar of population groups. “The vaccination passport should be made, at least, when people have free access to vaccination , because otherwise you are marking citizens as first and second for something that they cannot choose today”, reflects Oriol Yuguero, collaborating professor of the Health Sciences Studies at the Open University of Catalonia and president of the Healthcare Ethics Committee of the Lérida Health Region. “On the one hand, we are giving importance to vaccines that we still do not know if they are capable of preventing the transmission of the virus. And on the other, there will be people who, due to their pathologies, will not be able to be vaccinated, in addition to those who will be vaccinated last because they are not risk groups ”, says the expert. “I think that the reflection that needs to be made about the passport is what purpose it has and what exceptions are allowed so that people who cannot receive the vaccine have the possibility of traveling . Imagine, for example, that a relative is dying in a neighboring country, and since you have not received the vaccine you cannot go, instead another vaccinated person could … this causes inequality at the level of justice in the distribution of some resources currently they are finite ”.
In addition, as we mentioned at the beginning, we still do not know if all the approved vaccines prevent the transmission of the virus. “If differences were observed between some vaccines and others, the COVID passport would also be discriminating within the same group of vaccinated, who are currently not choosing which vaccine to receive,” recalls Cañelles.
The passport could fuel corruption
Increased corruption is another risk of implementing such a passport when the supply of vaccines is very scarce. “We have already seen how, even without a vaccination passport, there are people with access to positions of power who have been vaccinated, skipping the order of priority , well imagine if that gives you access to travel freely,” Yuguero indicates. Another of the associated phenomena is what is being called ‘vaccine tourism’: trips organized by agencies to certain countries that include the long-awaited puncture due to astronomical prices. “All this raises numerous ethical and economic problems, because we are back to the same thing: we are in a scenario of vaccine shortage and this type of practice is depriving people at risk of the drug who should receive it as soon as possible,” explains the expert.
Vaccination passport, an option for the future?
As we have already seen, the implementation of the vaccination passport in the short term raises numerous health and ethical conflicts, but it could be an option to consider for the future. “This is the time to open the debate to see how society reacts to this type of measure, think about how it would be implemented and what problems and ethical conflicts may arise, ” explains Cañelles. “I think it is positive that a person, if they are vaccinated and it is shown that they are not transmitting the virus either, can travel and we can recover a certain normality. But I think it is premature to do it this summer, we still lack a lot of information ”.
Yuguero agrees in this analysis: “I understand that at an economic level it is important to allow mobility, but you have to see based on what criteria it is done. In my opinion, it is too early to propose the obligatory nature of a vaccination card, especially since we do this to prevent the spread of the virus, and at the moment there are no guarantees that the vaccine will do so . Maybe in a year or two, when we have more information, but right now there is still a lot of virus and a lot of variant circulating. We have already seen that, despite the restrictions, the British variant has turned our system upside down… imagine if we allow the mobility of people who think they are protected but can be transmitters, that can be a time bomb ”, he reflects.
In the future, if vaccines are shown to prevent transmission, and once universal access to them is assured , the picture will change a lot: “There are certain countries to which you cannot travel without being vaccinated against yellow fever. , but this vaccine can be obtained without problem, there is no limitation in the supply. And if you cannot get vaccinated because you have a certain pathology that advises against it, you must present a medical certificate that proves it. Perhaps in the coming years this may also be possible for COVID-19, but today the situation is completely different ”, he concludes.
