Immunity passport

Immunity certificates are a legal document granted by a testing authority following a serology test demonstrating that the bearer has antibodies making them immune to a disease. These antibodies can either be produced naturally by recovering from the disease, or triggered through vaccination. Such certificates are practical only if all of the following conditions can be satisfied:[10][11]

• Recovered patients have protective immunity that prevents them from being reinfected
• The protective immunity is long-lasting
• The pathogen mutates sufficiently slowly for immunity to work against most strains
• Immunity tests have low false-positive rates

If reliable immunity certificates were available, they could be used to exempt holders from quarantine and social distancing restrictions, permitting them to work (including high-risk occupations such as medical care) and travel.

An Italian health pass (fede di sanità) for travel during times of plague, 1722

Sample of a certificate, which should inter alia demonstrate immunity to yellow fever caused by illness. It was used for immigration to the United States in the late 19th century.[16]

Quarantine has been used since ancient times as a method of limiting the spread of infectious disease. Consequently, there has also been a need for documents attesting that a person has completed quarantine or is otherwise known not to be infectious. Since the 1700s, various Italian states issued fedi di sanità to exempt their bearers from quarantine.[17]

In 1959, the WHO created the International Certificate of Vaccination (Carte Jaune) as a certificate of vaccination, particularly for yellow fever.[18] However, these are certificates of vaccination, not immunity.

An early advocate of immunity passports during the COVID-19 pandemic was Sam Rainsy, the Cambodian opposition leader. In exile and under confinement in Paris, he proposed immunity passports as a way to help restart the economy in a series of articles which he began in March 2020 and published in The Geopolitics and The Brussels Times.[19] [20] [21] The proposals were also published in French.[22] The idea became increasingly relevant as evidence of lasting acquired immunity became clear. [23]

In May 2020, Chile started issuing "release certificates" to patients who have recovered from COVID-19, but "the documents will not yet certify immunity".[24] Many governments including Finland,[25] Germany,[26] the United Kingdom,[27] and the United States[28] have expressed interest in the concept.

Ethical concerns about immunity certificates have been raised by organizations including Human Rights Watch (HRW).[29] According to HRW, requiring immunity certificates for work or travel could force people into taking tests or risk losing their jobs,[29] create a perverse incentive for people to intentionally infect themselves to acquire immunity certificates,[29] and risk of creating a black market of forged or otherwise falsified immunity certificates.[29] By restricting social, civic, and economic activities, immunity passports may "compound existing gender, race, ethnicity, and nationality inequities."[30]

On the other side, it is argued that it would be disproportionate to deprive immune persons – who can neither infect themselves nor others – of their basic freedoms. This general prevention would only justified as ultima ratio.[31] Accordingly, Govind Persad and Ezekiel J. Emanuel stress that an immunity passport would follow the “principle of the ‘least restrictive alternative’“ and could even benefit society:[32]

“Just as the work of licensed truckers benefits those unable to drive, the increased safety and economic activity enabled by immunity licenses would benefit the unlicensed. For instance, preferentially hiring immune individuals in nursing homes or as home health workers could reduce the spread of the virus in those facilities and better protect the people most vulnerable to COVID-19. Friends, relatives, and clergy who are immune could visit patients in hospitals and nursing homes.”

In contrast to immunity certificates, so-called Covid-free certificates assert a person's Covid test result for a short period of time (typically in the range of a few days). In this context, Covid-free certificates link a person's identity to the Covid test result.

• Electronic health record
• Patient record access
• Vaccination requirements for international travel