It's been almost a year since a Luzon-wide lockdown was first announced, and the Philippines finally started vaccinating people against the virus this week. It might seem like a long time, but in the context of producing an antiviral agent, one year is basically lightning-fast.
Getting vaccinated is, of course, a good thing. That means diminished chances of developing life-threatening symptoms from the coronavirus, and, consequently, that allows for more freedom of movement, and, eventually, access to things like travel, concerts, bars, and other things we did pre-COVID that we all likely took for granted.
A divided population
Once enough people are inoculated, the population will be divided between those who have been vaccinated and those who haven’t. It won’t be long before those in the former group will need to present some sort of evidence to prove their vaccination status.
Which is what a vaccine pass or passport is. Bearing this document—digital or otherwise—is the logical next step in navigating life in a post-COVID world.
But creating another division between a populace already fractured by multiple societal barriers is as complicated as it sounds. Vaccinating people might seem like the final step in getting rid of the virus once and for all, but in reality, it’s only the beginning of perhaps an even lengthier battle.
The benefits of an actual defense against the virus are incalculable, but it does come at a price. While vaccinations are completely voluntary, based on current government policies, how long before the unvaccinated begin to feel shortchanged? What happens when vaccine passports become mandatory for things like job applications or entrance to shopping malls or sporting events?
And we haven’t even touched on the fact that vaccines are predominantly being distributed first to wealthier countries, creating a lopsided imbalance between the haves (vaccine passport-carriers) and have-nots?
A complicated system
For a bioethicist, the question is less about the necessity of a vaccine passport and more on its effectivity in stopping the transmission of the virus.
“In the context of the current pandemic, the necessity of vaccine passports depends on various factors,” says Dr. Yves SJ Aquino, a physician and philosopher with a medical degree from the University of the Philippines College of Medicine and a Ph.D. in bioethics from Macquarie University in Sydney, Australia. “First is to clarify the goal of vaccine passports, which, at the moment, is to restrict movements of individuals to prevent further transmission of COVID-19. Second is to clarify whether the passport is effective in achieving that goal. Both these factors depend on what we know about COVID-19 and the available vaccines.”
“So far, we know that vaccines can prevent individuals who get infected with COVID-19 from developing severe complications that lead to hospitalization, intensive care, or death,” he adds. “That means the vaccine does not prevent infection, and there is no clear evidence that vaccines substantially prevent transmission of the disease.”
According to Dr. Aquino, who also currently teaches bioethics and public health ethics at Macquarie University and is a research fellow at the Australian Centre For Health Engagement, Evidence and Values at the University of Wollongong, the nature of COVID-19 itself complicates how vaccines work.
“The coronavirus continues to mutate, and it is not very clear how long the vaccine protection lasts or whether the available vaccines are effective against new strains of the virus.”
And as he points out, the idea of vaccine passports isn’t even new. Several countries already restrict the entry of individuals with infectious diseases, such as HIV and tuberculosis, with some requiring a “yellow card” that proves they have been vaccinated against diseases like yellow fever and rubella.
“But just because it’s nothing new, it doesn’t mean it’s not ethically problematic,” Dr. Aquino says.
Ethical issues of vaccine passports
“There are numerous ethical issues arising from vaccine passports,” he says. “First ethical issue is the tension between individual freedom (movement) and public good (fighting the pandemic), which is a common issue in public health. We have seen this issue arise in socially restrictive measures such as lockdowns and border closures. It is a difficult and ongoing task to find a middle ground: If you restrict too much, you may lose public support and the health measure will fail. And if you don’t restrict enough, then the health measure will also fail.”
“Second, a number of ethical issues can be understood as ‘unintended consequences.’ Public policies are based on good intentions, but we need to play devil’s advocate and try to identify potential harms arising from such policies. One possible public harm is complacency, where vaccinated individuals (or largely vaccinated communities) become complacent and forego other types of preventive health practices such as handwashing, social distancing, and travel quarantines. Without these types of preventive practices, transmission may continue and lead to further mutations—at which point current vaccines may no longer work.”
Dr. Aquino also identifies another potential public harm—that of vaccine passports spilling over from travel to other aspects of life, including the opportunity for employment, access to public spaces such as restaurants, and participation in social activities such as sports.
“Vaccine passports can also exacerbate existing inequalities and marginalization of disadvantaged groups,” Dr. Aquino adds. “In many countries, vaccination programs are not equitable, with individuals from lower socio-economic brackets unable to access vaccines that they cannot afford. Some minority groups who have historically experienced neglect, highlighted by the lack of social and financial support during the pandemic, may have lost trust in the government and may be less willing to participate in vaccination programs.”
As the New York Times pointed out in its piece about vaccine passports, there’s a very real possibility of this document becoming yet another reason for segments of the population to be left behind or become discriminated against.
No easy way forward
Clearly, there is a lot to ponder as the country and the world slowly moves forward and away from the scourge of the virus. Government officials and those tasked to lead and protect our countrymen need to examine all sides of this issue before deciding on the correct path. And as Dr. Aquino himself acknowledges, there are no easy answers.
“I think currently, there is no one answer to how countries should employ vaccine passports for the COVID-19 pandemic because of differences in cultural, legal, and ethical norms,” he says. “In public health ethics, we tend to raise specific principles or questions when it comes to health policies. Is the proposed response proportionate to the problem? Is the proposed response violating some human rights, and is the violation justified? Is there an alternative? Does the response unfairly exclude individuals or groups?”
“Even if we do not have clear answers, I think asking these questions is an important starting point.”
