Vaccine Passports Done Equitably

Around the world, governments and other organizations are developing COVID-19 vaccine passports-documentation to allow vaccinated people greater mobility and access to other services-to speed society's reopening and a return to ordinary life.But vaccine passports are controversial: sources of opposition include scientific questions-for example, whether vaccinated people can still transmit the virus-and concerns about privacy, especially in connection with digital passports.Each of these are likely to be solvable problems.Evidence of vaccine effectiveness continues to accumulate 1 and will eventually answer questions about lasting immunity and transmission.Privacy concerns could be mostly addressed by adopting passport alternatives that satisfactorily protect individual's information, and such efforts could be advanced by government attention and regulation.A deeper and more intractable concern is that any system of vaccine passports risks being discriminatory and inequitable.Consider the inequities we see already 2 in the distribution of COVID-19 vaccines: supplies and distribution have predictably favored richer countries.Historically and socially marginalized groups are less likely to be vaccinated, often because of worse access, but also because of vaccine hesitancy based on intelligible mistrust of government and historical experiences of medical abuse.For people who are unable to be vaccinated because of their health status or religion, a vaccine passport regime could unfairly frustrate their return to normal life.In general, the problem is that existing inequities threaten the future equitability of any vaccine passport scheme.However, achieving perfect equitability may be impossible.It would require going beyond improving access to vaccines and making sure people who cannot be vaccinated are not "damned for their disability"; it would also require us to resolve substantial social, economic, and health inequalities among nations and individuals.These may not be solvable problems, at least not in the short term.Fortunately, good policy need not be flawless, and there are many ways for policy makers to promote equity in the context of vaccination and vaccine passports.For example, a community-led approach to promoting vaccine uptake executed by trusted community leaders, organizations, and local health care institutions could address the issue of mistrust.3 Such an approach is being used by some Indigenous health leaders in their work with Indigenous individuals who may be vaccine hesitant.In support of accessibility, mobile vaccination units and vaccination clinics in smaller communities should be deployed.It would also be advisable to implement systems to monitor the outcomes of vaccine passports themselves: monitoring brings accountability and transparency and provides information to guide future policy making.To the extent that vaccine passports are useful, regulating against them makes sense only when they would create worse problems than they would solve.Disallowing vaccine passports will not fix our inequities, and there are obvious situations in which requiring proof of vaccination is appropriate and well advised.For example, there is a clear public health interest in tightly controlling international travel during a pandemic, and many governments, airlines, and others have been motivated to implement proof of vaccination as a condition for air travel.Vaccination requirements for travel are not new 4 and can be implemented equitably as long as they respect human rights and are not too restrictive.5 With respect to people who cannot be vaccinated for health reasons, there is middle ground here: it is unnecessary to completely bar unvaccinated people from activities like air travel.Vaccine passports could facilitate a fast lane for travel without the extra testing, quarantines,