IMMUNITY PASSPORTS?
Several countries mulling the idea
Some see them as get out of jail free cards to help economies stagger back to life. To others, the idea of “immunity passports” is madness. As countries around the globe begin emerging from pandemic lockdown, several are mulling the idea of immunity certificates — passes that would permit those who have tested positive for antibodies to COVID-19 to return to work, shop, board airplanes and otherwise circulate freely in public, while the non-immune would remain mostly sheltered in place until vaccines become available.
This week, Chile said it was proceeding with plans to issue “immunity passports” that would liberate holders from quarantines and other restrictions. Germany, Italy and the U.K. have also floated the idea, while Anthony Fauci, a key member of the White House COVID-19 task force, told CNN last week the idea “might actually have some merit, under certain circumstances.”
The idea of a hall pass out of lockdown hinges on the mass availability of antibody tests — also known as serological tests — that can identify who has been infected and developed antibodies thought to give them some protection from future infection. About half of those infected never develop symptoms, meaning there could be tens of thousands of Canadians who never knew they had the illness.
A dozen companies are seeking Health Canada approval for serological tests, including Halifax-based MedMira Inc., whose rapid antibody test takes three minutes, using a drop of blood specimen. In the U.S., more than 70 developers have notified the Food and Drug Administration they have tests ready to launch.
The science, however, is still murky: There are concerns about sensitivity — how good are the tests at identifying people who have had the disease — and specificity, meaning, are they cross-reacting with other coronaviruses that cause the common cold? A positive test may only indicate the person has been exposed, no more, no less. There’s no known understanding of how long immunity lasts — three months? three years? — or the level of antibodies necessary to presume a person is now “noncontagious.”
Do the immune wear lanyards and badges? Would it trigger a black market of fake immunity passes? How would it be implemented and patrolled? Is a world of immunes and non-immunes a future we want?
“For years, decades, we’ve been writing about stigma in infectious disease and how it’s problematic and now people are thinking of actually employing something that is by definition stigmatizing as a way out,” said University of Toronto bioethicist Dr. Ross Upshur, of the Dalla Lana School of Public Health.
“Play this out in your mind in several different scenarios,” said Upshur, an internationally recognized public health and bioethics expert. “You have to have an immunity pass. Do you get a jacket? Do you get a hat? How is it that people identify the fact they have an immunity pass or not? What happens if somebody who doesn’t have an immunity pass is found in a group of people who do? Do they get beaten up? We know humans can behave very savagely to each other under these types of circumstances.”
Immunity passports could also present a perverse motivation to get deliberately infected, like misguided mothers who bundled their children off to chickenpox parties. Others have argued that it would be entirely ethical for grocery stories, restaurants and other businesses to require immunity passports of customers — that the price of coming out is to surrender some civil liberties.
The tests measure the amount of antibodies, or proteins present in blood when the body responds to an infection caused by the virus. However, it’s not clear which particular antibodies are actually providing immunity after the person recovers, or for how long.
The plan would also be premised on the idea that the non-immune would remain largely sheltered until vaccines become available. But Upshur, who has been in meetings with top scientific minds on World Health Organization teleconferences, says the probability that there will be a vaccine in the near future with over 90 per cent efficacy and available in seven billion doses “is almost non-existent.”
It’s likely that people exposed to the virus would have some reasonable degree of immunity. “One hundred per cent immunity? Probably not. One hundred per cent of the time? Definitely not.
But better than nothing,” said Amir Attaran, a professor of law and medicine at the University of Ottawa who has a PhD in immunology.
However, in our shelterin-place isolation, we didn’t magically develop immunity, Attaran noted. “We cannot all march forward out our doors,” said Attaran. We are going to have to divide it up into batches, into cohorts of people. Young people are just as likely as older ones to get infected, but they’re much less likely to die. Later batches could include older people and the immune-suppressed.
“All the Boomers get to take a little longer time out. This is the time of Gen X and Gen Y,” said Attaran, who added it is reasonable to consider immune passporting.
But what level of immunity makes someone passport-worthy? How would it work? There are currently no validated serology tests in Canada “and thus there is no mechanism to implement such an initiative,” a spokeswoman for the Ontario health ministry said in an email. The province is working with the Public Health Agency of Canada “to understand the evolving technology and its applications,” she said.
While we wait for the testing, everyone wants to know how soon can we come out? “Unfortunately, there is no clear answer,” Dr. Barbara Yaffe, Ontario’s associate chief medical officer of health said this week. It won’t be like a light switch, she said, “you know, on-off.”
It will be gradual, and the impact of each change will have to be monitored carefully. But once the genie is out of the bottle it will hard to put back in.