The Medical, Ethical And Practical Challenges Of Immunity Passports
As the global fight against the coronavirus pandemic continues, some countries are considering issuing immunity passports — a document certifying that a person recovered from COVID-19 and now has immunity.
While countries including Chile, the U.K., Germany, Italy and the U.S. consider immunity passports, the World Health Organization and other critics are raising questions about issuing this type of certification.
Immunity is a complex concept, even with diseases scientists are familiar with, says Dr. Alexandra Phelan, a researcher with the Center for Global Health Science and Security at Georgetown University Medical Center.
With some infections such as chickenpox or measles, an infection generally confers lifelong immunity. But with others, like the seasonal flu or colds caused by other coronaviruses, it does not.
“With coronaviruses, whether you have lasting, lifelong or long-term immunity is a little bit more challenging,” she says.
Detecting indicators in the blood and bodily fluids that show whether someone is immune is a complex process — and that’s exacerbated with COVID-19 because it’s an emerging disease, she says.
Scientists are looking into whether having an infection leads the immune system to create antibodies or certain molecules that correlate with immunity, she says. But a recent study from China published in the journal Nature Medicine suggests that recovered COVID-19 patients get only about two to three months of immunity before it fades.
“It’s likely that infection will result in immunity,” she says, “but we still have a lot more to find out about how strong a reaction you require and how long that immunity lasts.”
The next question scientists need to answer is whether or not current testing methods accurately reflect whether a person has antibodies or not. This is a big challenge with immunity passports because certification would rely on these tests.
If a person receives a false-positive antibody test that inaccurately indicates immunity, they could become certified but later get sick and transmit the disease to others, she says.
The idea of immunity passports also raises ethical questions. In a recent article in the journal The Lancet, Phelan writes that the move could compound the existing gender and race inequities — and also serve as an incentive for people to get sick.
Immunity passports create an “artificial restriction” on who can and can’t participate in social and economic activities, she says.
People want to work, reconnect with their loved ones and participate in civil activities such as voting. An immunity passport would determine who can access certain parts of society, she says, which creates a perverse incentive to get sick so they qualify for certification.
Lawmakers need to avoid “silver bullet solutions” that create an incentive to fall ill, she says, considering that COVID-19 can result in long-term consequences such as lung damage and potential interaction with other chronic illnesses.
“We are still learning so much about this virus and how this disease affects people and the long-term impacts of this disease are not insignificant,” she says. “ It’s not just a matter of getting the common cold and moving on with your life.”
The economic pressure to reenter society is higher for vulnerable populations that have been disproportionately affected by both the health and socioeconomic impacts of COVID-19, she says.
Black and Brown communities are seeing more deadly outcomes as a result of systemic injustices in accessing health care. Introducing immunity passports could also further racial inequities in terms of access to antibody tests and the certification process, and result in long-term health damage for marginalized groups, she says.
“Like all privileges administered by governments, immunity passports are at real risk for corruption and further implicit bias,” she says. “Because just having an immunity passport doesn’t mean that there isn’t going to be further systemic injustice in how that is viewed and interpreted.”
Immunity passports inherently create indirect discrimination against those who can’t put their health at risk such as the elderly, people with chronic illness or disabilities and pregnant women.
As historian Kathryn Olivarius writes, immunoprivileged people in 19th century New Orleans contracted yellow fever so they could continue to work. This practice fell along racial and socioeconomic lines, Phelan says.
“Immunoprivilege … compounds existing discrimination,” she says. “The law does currently attempt to cover certain individuals and their health status, but it’s not appropriately defined to be able to cope with this idea of immunoprivilege.”
Unlike immunity passports, Phelan says vaccination certificates create an incentive to do something healthy. The key difference is that people who get vaccinated can’t infect others.
“Vaccination certificates incentivize individuals to go and obtain vaccination against the virus, and that’s a social good for everyone,” she says. “In contrast, immunity passports are incentivizing going and getting that infection, which is actually a threat to others and also a potential long-term burden for the individual.”
This article was originally published on WBUR.org.
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