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- Thanh Le T
- Andreadakis Z
- Kumar A
- et al.
a proposal that some governments have suggested, including Chile, Germany, Italy, the United Kingdom and the United States,
it is the use of immunity passports, that is, digital or physical documents that certify that an individual has been infected and is supposedly immune to SARS-CoV-2. People in possession of an immunity passport may be exempt from physical restrictions and may return to work, school, and daily life. However, immunity passports pose considerable scientific, practical, fair and legal challenges.
“Immunity passports” in the context of the scientific report COVID-19.
In a follow-up tweet, the WHO clarified that infection with SARS-CoV-2 is expected to produce some form of immunity. Caution should be exercised in how population-level serological studies and individual tests are used. It has not yet been established whether the presence of detectable antibodies against SARS-CoV-2 confers immunity to additional infection in humans and, if so, how much antibody is needed for protection or how long that immunity lasts.
“Immunity passports” in the context of the scientific report COVID-19.
Sufficiently representative serological data will be important in understanding the proportion of a population that has been infected with SARS-CoV-2. These data can inform decisions to alleviate physical distance restrictions at the community level, provided they are used in combination with other public health approaches.
Considerations for adjusting social and public health measures in the context of COVID-19. Provisional guidance.
The use of seroprevalence data to inform policy making will depend on the precision and reliability of the tests, particularly the number of false positive and false negative results, and requires additional validation.
Develop a national strategy for serology (antibody testing) in the United States.
At the individual level, this reliability could have public health ramifications: a false positive result could lead an individual to change his behavior despite being susceptible to infection, potentially becoming infected, and unknowingly transmitting the virus to others. Policies directed at individuals based on antibody tests, such as immunity passports, are not only impractical given these current gaps in knowledge and technical limitations, but also raise considerable legal and fair concerns, even if those limitations are rectified .
- Wadhera RK
- Wadhera P
- Gaba P
- et al.
Such behavior would represent a health risk not only for these people but also for the people with whom they come into contact. In countries without universal access to health care, the most incentivized to search for infections may also be those who cannot or understandably hesitate to seek medical care due to cost and discriminatory access.
Such incentives must be understood in the context of the pressure governments may face from companies seeking to adopt policies that return employees to the workforce, with corporate entities being the beneficiaries of workers’ immunocapital.
Furthermore, immunity passports risk alleviating the duty of governments to adopt policies that protect economic, housing and health rights throughout society by providing an apparent quick fix.
Like all of those government-administered privileges, immunity passports would be ripe for both corruption and implicit bias. Existing socio-economic, racial and ethnic inequalities can be reflected in the administration of such certification, governing who can access antibody testing, who is in the queue for certification, and the burden of the application process. By replicating existing inequalities, the use of immunity passports would exacerbate the damage inflicted by COVID-19 in already vulnerable populations.
Depending on the jurisdiction, anti-discrimination laws may cover overall health status as a protected class, as well as those for whom infection presents a disproportionate risk, for example, the elderly, pregnant people, people with disabilities, or people with disabilities. comorbidities. This inequity is not a consequence that can be legislated out of existence: the adoption of laws that avoid discrimination on the basis of the immune state is inconsistent with a process expressly destined to privilege socio-economic participation according to that state. Under international human rights law, states have an obligation to prevent discrimination, while taking steps to progressively achieve the full realization of social and economic rights.
UN General Assembly. International Covenant on Economic, Social and Cultural Rights, December 16, 1966. 993 UNTS 3.
Immunity passports would risk enshrining such discrimination in law and undermining the right to health of individuals and the population through the perverse incentives they create.
International Health Regulations (2005), WHA 58.3.
Given the current uncertainties about the accuracy and interpretation of individual serological tests, immunity passports are unlikely to satisfy this burden of health reasons
and they are inconsistent with the WHO recommendations against interference with international travel that were issued when the WHO Director-General declared COVID-19 a Public Health Emergency of International Concern (PHEIC).
Statement on the second meeting of the International Health Regulations Emergency Committee (2005) on the outbreak of new coronaviruses (2019-nCoV).
Given the discriminatory impact of immunity passports, any changes to the WHO recommendations should be considered in the context of the IHR human rights protections.
However, there are significant differences between the two types of documents, which cause fundamentally different burdens on the risk to people’s health and bodily integrity, the risk to public health, and an individual’s ability to consent and control. The main distinction between the two is the nature of the incentive. Vaccination certificates encourage people to get vaccinated against the virus, which is a social good. In contrast, immunity passports incentivize infection. Under the RSI, states may require travelers to provide vaccination certificates, but this is limited to specific diseases expressly listed in Annex 7, which currently only includes yellow fever, and if included in WHO recommendations, such as those issued after the declaration of a PHEIC, such as polio.
International Health Regulations (2005), WHA 58.3.
Once, and if a vaccine is developed, COVID-19 vaccination certificates could be included in the WHO revised recommendations for the PHEIC COVID-19, while member states might consider requesting permanent recommendations or revising Annex 7 of the IHR long-term.
Until a COVID-19 vaccine is available and accessible, which is not guaranteed, the way out of this crisis will be based on established public health practices of testing, contact tracing, contact quarantine, and case isolation. The success of these practices depends to a large extent on public trust, solidarity and the approach, not securing, the inequities and injustices that contributed to this outbreak becoming a pandemic.
I declare that there are no competing interests.
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DOI: https://doi.org/10.1016/S0140-6736(20)31034-5
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