“[A vaccine passport] keeps people safe. It encourages everyone to do the right thing. It keeps our businesses open and it keeps our economy rebuilding.”

Justin Trudeau
Prime Minister of Canada

INTRODUCTION

In the wake of the COVID-19 pandemic’s Delta-driven fourth wave, governments around the world, including many Canadian provincial and local jurisdictions, are turning to so-called “immunity” or “vaccine passports” to safely re-open their economies and give vaccinated citizens a renewed sense of freedom following months of isolation and quarantine measures.

The decision has proved incredibly controversial. While many welcomed the new policy, others labeled the initiative as discriminatory and haphazard. Demonstrations erupted around the world, with some even protesting the new rules outside of hospitals and schools.

The issue of immunity passports has proved divisive, however the concept is not novel and several iterations have been considered since the onset of the pandemic. From early discussions of infection-based immunity passports to more recent vaccine-based policies, the initiative has undergone considerable changes in Canada and around the world.

In this blog post, we’ll be tracking the development of immunity passports over the course of the COVID-19 pandemic, highlighting:

• What is an immunity passport?
• Immunity passports and COVID-19
• A shifting debate: Canada’s stance

What is an immunity passport?

An immunity passport is a physical or digital document that demonstrates that a person is immune to a particular disease (Phelan, 2020). This immunity may be acquired through natural infection or through inoculation, depending on the nature of the illness (Brown et al., 2021). Depending on implementation, the passport could be used to gain access to certain high-risk activities such as travelling, going to a concert, and attending school. 

The idea of an immunity passport is nothing new. Many countries require international travellers to be vaccinated against certain infectious diseases in order to gain entry. The famous International Certificate of Vaccination or Prophylaxis was developed by the World Health Organization (WHO) as an internationally recognized vaccination record against yellow fever, and is required to travel to countries where the disease is prevalent (Government of Canada, 2015). Several Canadian provinces also require children to be vaccinated against a range of diseases to attend primary and secondary school. The province of Ontario, for instance, requires its students to provide proof of vaccination against diseases like measles, mumps, rubella, polio, and pertussis, among others (Eastern Ontario Health Unit, 2021).

Immunity passports and COVID-19

The debate over immunity passports in the context of the COVID-19 pandemic has evolved considerably since the onset of the crisis.

The policy’s earliest iterations proposed offering immunity certifications based on prior infection and recovery. The idea was based on the assumption that those who had been infected with COVID-19 were protected from re-infection, thus making it safe for them to resume normal activities like attending work and school (Phelan, 2020). Several countries floated this idea, including Chile, Germany, the UK, and the US (Phelan, 2020).

As global vaccination programs picked up steam in early 2021, the focus shifted towards vaccination-based immunity passports. Many countries made full vaccination against COVID-19 a pre-condition for international travel, including Canada (Government of Canada, 2021) and the EU (Schengenvisinfo, 2021). 

More recently, countries have mandated vaccine passports to access certain domestic activities deemed high-risk or non-essential, a strategy that is highly unprecedented. Depending on the country, these activities may include indoor dining, attending a concert, and going to a gym, among others. Israel became the first country to implement such a policy in February 2021, issuing fully vaccinated citizens a “green pass” that could be used to access non-essential services (Holmes, 2021). Many other countries followed suit, including several Canadian provinces (Durrani, 2021). 

A shifting debate: Canada’s stance

Immunity passports in all their iterations have been controversial, to say the least. Many experts and politicians have flip-flopped on their stance towards the initiative in the face of changing epidemiology and evolving scientific evidence. 

The case against

The WHO has consistently cautioned against immunity and vaccine passports due to the possibility of discrimination. It took a hard-line stance against issuing immunity passports based on natural infection in April 2020, stating there was little evidence to suggest previously infected individuals could not be re-infected with the virus (Graham-Harrison, 2020). The organization also cautioned against the use of vaccine passports for international travel, citing equity concerns due to the widespread unavailability of vaccines in most low- and middle-income countries (Smith-Schoenwalder, 2021). 

At the domestic level, opponents have pointed out that vaccine passports have a huge potential for discrimination and could lead to the creation of a “two-tiered” society. Many have noted that vaccination is a personal choice and barring an individual from certain activities and lines of employment based on vaccination status may compromise civil liberties (Kirkey, 2021). Vaccine passports could also unfairly discriminate against those who are unable to be vaccinated on medical grounds – for instance, due to a known allergy or a previous adverse reaction to a dose of the vaccine (Brunoro, 2021). 

For these reasons, many politicians and policymakers expressed hesitancy early on. Canadian Prime Minister Justin Trudeau stated in March 2021 that, while he supported proof-of-vaccination initiatives for international travel, he wasn’t sure a domestic vaccination passport would be ethical (Travel Pulse Canada, 2021). John Horgan, the Premier of British Columbia, was also hesitant to the idea, stating in March that vaccination requirements for domestic activities “strikes [him] as counterproductive at this point.” (Meissner, 2021). 

The case for

As the COVID-19 situation evolved – particularly as the significantly more contagious Delta variant became the dominant strain worldwide – domestic vaccine passports gained more traction among key public figures. In August 2021, Trudeau pledged $1 billion to help provinces pay for domestic vaccine passport programs (Tasker, 2021), and a host of public health experts and business organizations expressed support for the initiative (Blancher, 2021). 

Supporters of vaccine passports have asserted that vaccination requirements allow non-essential activities to resume safely while the world still works to bring the COVID-19 pandemic under control (Child, 2021). This would help kick-start the economy and bring much needed financial relief to some of the sectors hit hardest by rolling lockdowns such as tourism and entertainment. 

Immunity passports would also allow fully vaccinated individuals to regain a sense of autonomy. Lockdowns and quarantine measures, while powerful in the fight against COVID-19, have also limited peoples’ individual freedoms, particularly freedom of movement. Immunity passports would limit this burden by allowing fully vaccinated individuals to bypass these invasive measures – indeed, some have argued that it might be unethical to continuously impose lockdowns on people who pose a minimal risk to public health (Brown et al., 2020). 

While they’re still in their infancy, domestic vaccine passport programs in Canada appear to be faring well and are supported by a large majority of Canadians. According to recent polling by Leger, 80% of Canadians surveyed support vaccine passports for the time being (Leger, 2021). 

Key takeaways

The debate surrounding immunity passports has evolved and shifted considerably over the course of the COVID-19 pandemic. While fraught with controversy, vaccination-based passports have emerged as the preferred strategy to weather the tail end of the pandemic in Canada. In this blog, we’ve considered:

• The definition of an immunity passport and its historical usage
• The evolution from infection-based immunity certificates to vaccine passports over the course of the COVID-19 pandemic
• The pros and cons of implementing vaccine passports, including the shifting nature of the debate over time

Written by: Claire Borgaonkar BPAPM (c)