Does the World Need Global Vax Passport?

Governments around the world are exploring the potential benefits of using ‘vaccine passports’ as a way to reopening the economy by identifying and permitting only those who are protected against COVID-19. While the world awaits herd immunity, millions of vaccinated individuals across the world are eagerly anticipating trade and operational plans at the vaccination horizons. Border checkpoints are reviving vigilance around the globe and countries are exploring novel methodologies to revive international travel, an essential social and business component at present.

As the aftermath of the pandemic continues to pummel international trade and businesses across sectors, a concerted attempt is on to develop and deploy potential technologies such as digital and biometric passports. From the second quarter of 2021, travel corridors were opened for vaccinated individuals with the prospect of the ‘digital vaccine certificate/passport’ as an integral part of international travel. Digital vaccine tracking system, the “vaccine passport” is a form of e-certificate that provides proof of vaccination and COVID-19 test results. Yet, they require international or national coordination on the best practices to implement cross-border vaccine passes.

Vaccine passports are not new to the countries who have already used the Yellow card around

1959, a certificate (a physical paper) to identify individuals vaccinated for Yellow fever. Yellow card was mandatory for those arriving from 42 African and South American countries. Nations around the world implemented Yellow Card vaccine passports specifically to complement various border control measures and not just travel. For decades, ‘yellow cards’ were used as a proof of vaccination against diseases like cholera, yellow fever, rubella, and polio as a mandatory pass. However, COVID-19 vaccine passport marks the first electronic alternative. Hence, extending the system to COVID-19 might face hurdles due to application of digital format and duration of immunity gained by several vaccines administered around the world still under observation.

Tech initiatives

While the COVID-19 vaccines are being rolled out around the world and testing is becoming customary for international travel, many tech firms and healthcare organizations are collaborating to ensure access to a secure, digital record of their COVID-19 vaccination status. Several companies and technology groups have developed smartphone apps or systems for individuals to upload details of their COVID-19 tests and vaccinations and thereby

create digital credentials permitting entry to a venue, university, workplace, hotels, public transport, tourist destinations or traveling across borders.

Health passport, or health pass, are physical or digital documents to certify that the holder is unlikely to either catch or spread a disease. Thus, attesting that the holder has been vaccinated, or has tested negative for the virus or has recovered from previous COVID infection. These passports are validated by digital apps or smartphone tools recognised by authoritative governments.

The systematic COVID-19 testing for all international travellers can be effective through ‘secured information flow infrastructure’ allowing governments to verify the authenticity of tests and vaccine certificates. Regional airlines can further fine tune the test as per local travel guidelines. Government recognised labs can also issue recognised digital certificates to passengers.

International Airlines Group (IAG) in association with International Air Transport Association (IATA)

has developed ‘IATA Travel Pass’, a digital health pass that will support the safe reopening of many borders. IATA represents around 290 airlines in 120 countries, carrying 82 per cent of the world’s air traffic. IATA is a globally-recognised trade organisation and advocate for airlines. Thus, its health pass intends to manage and verify the secure flow of necessary testing or vaccine information among governments, airlines, laboratories and travellers.

IATA Travel Pass proposes a global information infrastructure to securely manage, share and verify test data matched with traveller identities in compliance with border control requirements. IATA Travel Pass has been developed on block chain technology concept where de-centralised data storing protects data from hackers. This pass is also built using a modular approach based on open source standards to facilitate interoperability.

Further, the IATA app provides travellers with easy access to COVID-19 entry requirements and accredited laboratory testing centres at their point

of departure. The IATA app enables passengers to link their COVID-19 test results to a digital profile through a secure, encrypted channel. The airport registered services directly send the COVID-19 test result to the traveller’s mobile device.

IATA Travel Pass and IAG can generate various travel bubbles and public health corridors for an active operation of safe cross border transactions. IATA Travel Pass assist in complex travel requirements like, ‘IATA’s Timatic’ (a global registry and verification of health requirements used by most airlines to manage compliance) and IATA’s ‘One ID’, (a secured contactless Travel App facilitating travel processes with a single identity token for test and vaccination certificates). The pass is also designed for airlines to embed it into their own apps or can be used in combination with other service providers.

The World Health Organisation (WHO) is also working on a Smart Vaccination Certificate, which will provide guidelines and standards for every digital vaccine passport. The Smart Vaccination Certificate Working Group brings together experts to focus on defining specifications and standards for a digital vaccination certificate that would serve current and future requirements. A number of agencies including United Nations Children’s Fund (UNICEF), International Telecommunication Union ITU), a specialized agency of the United Nations responsible for all matters related to information and communication technologies and the European Commission are contributing along with WHO to this initiative. The finalised specifications and standards for digital vaccination certificates will be architected for link to national and cross-border digital systems. The Task Force is working closely with a range of partners, including governments, public health agencies, institutions, health organizations, research teams, other task forces, communities, and stakeholders.

The WHO, in its 2021 bulletin states that implementation of immunity certification/ passport at present may not be advisable because of uncertainty about whether long-term immunity truly exists in COVID-19 recovered patients and individuals vaccinated with different vaccine brands. It also highlights concerns over the reliability of the proposed serological test method for determining immunity. The report states, immunity certification can only be considered if scientific thresholds for assuring immunity are met. However, even if immunity certification became well supported by science, it has many ethical issues in terms of different restrictions on individual liberties and its implementation process.

Asia-Pacific efforts in vaccine passport

Currently there is no international or national coordination on the best practices for implementing vaccine passes. Hence, the airline industry is trying to frame widely acceptable essential credentials in collaboration with technology companies, health giants and travel trade groups. Different trial health passes have been deployed by governments and firms around the world in recent months.

In early March 2021, China rolled out its vaccine passport (digital and paper form) in association with TenCent, a technology conglomerate holding company. The app-based health code system uses travel and medical data to give people a red, yellow or green rating, indicating whether they are unwitting hosts to the virus. The digital health certificate tracks users’ vaccination and coronavirus test history and runs on TenCent’s WeChat messaging app and currently works only for Chinese citizens. China’s health code app was among the first to deploy the tool to provide access to subway, hotel services and international travel for symptom-free individuals.

But then, there remains a challenge - China is very particular about considering vaccination by Sinovac (which is in the emergency use phase) to grant the pass to citizens and even foreigners.

Singapore Airlines (SIA) is the world’s first airline to test (IATA) Travel Pass earlier in March 2021 in association with Singapore’s Civil Aviation Authority of Singapore (CAAS). The trial began with passengers travelling from Singapore to London between March 15 and March 28, and is now accepted by Singapore as the mode for routine procedure. Passengers create a digital ID on the IATA app that will display their COVID-19 testing results and vaccination status. However, they still need to bring a physical copy of their vaccination certificate to the airport. With the pass, passengers can open up the possibility of travel without the quarantine and stay-home

notice. On May 27, Singapore made the vaccination pass mandatory for locals who are departing from Singapore’s airport. Accredify, a document accreditation firm in Singapore is also widely used and is based on blockchain technology for pre-travel COVID-19 health screenings.

Japan’s Nippon Airways also carried out a trial of a ‘digital health’ passport, around March 2021. Japan Airlines has also implemented the ‘Common Pass’ App platform on selected flights from Japan to Honolulu and Singapore. Similarly, South Korea has also moved towards smartphone app vaccine passports using blockchain technology.

Malaysia launched first Health Passport, Immunitee in first week of March 2021. In collaboration with Affinidi. Malaysia’s Immunitee Health Passport functions on blockchain system. Hong Kong Airlines digital health passport developed by IATA, Travel Pass and is exploring its Lab App, a key module in Travel Pass.

On April 19, Australian & New Zealand too have initiated travel bubble and Hong Kong, Singapore travel bubble postponed in observation of recent strict measures to curtail new wave of infection. India too is issuing QR code-based electronic certificates to all vaccine beneficiaries as proof of their COVID-19 immunisation. Indian health ministry has also made the contact-tracing mobile app ‘Aarogya Setu’ mandatory for users of public transport and flight travel.

Efforts are ongoing to integrate data into a common global data system. Asia-Pacific is slowly entering into bilateral agreements for ‘travel bubbles’ with some select neighbours for initial safe opening of borders.

In order for vaccine passports to be an internationally practical tool, there will need to be a standardised platform that crosses all boundaries. The WHO is working with agencies including the IATA and the International Civil Aviation Organisation (ICAO) to develop standards for digital vaccination cards.

Similarly, the ‘World Economic Forum’ and a non-profit public trust ‘The Commons Project’, have collaborated with various international airlines to create the CommonPass app. It uses testing and vaccination data to generate a health certificate in the form of a QR code that can be scanned at borders.

With so many similar but separate initiatives cropping up at once, open-source tech organisation and non-profit technology consortium, ‘The Linux Foundation’ and the ‘COVID-19 Credentials Initiative’ in the United States are working on developing a set of universal standards for such apps.

Most countries in the midst of the vaccination process are still exploring factors to be involved in certifications that could be accepted across borders. It is important for a synergistically complementary authentication process of the vaccine passport platform across multiple countries. Development of centralised digital certificates broadly accepted around the world is the immediate requirement.

Tamper-proof Blockchain tech

Companies are prioritising countering serious privacy issues tagged to health data collection for COVID passports. Blockchain, otherwise known as Distributed Ledger Technology (DLT) records any event or transaction (as blocks) in an encrypted way, making the information immutable, safe and verifiable. Blockchain technology is tamper-proof and therefore unable to be falsified.

Block chain technology lends decentralisation, transparency and anonymisation to data management endeavours. Blockchain is a distributed system for transactions recording and storage. Owing to the absence of central authority in governing the process, access to data is restricted and relies on wellestablished peer-reviewed cryptographic techniques, called ‘hash key’, in ensuring that any third parties’ claims are verifiable. This method does not require pre-existing trust between parties while keeping individuals’ confidentiality intact.

Blockchain technology Digital Health Passport (DHP) creates a ‘hash’ or fingerprint of the data that is captured on the blockchain thus becoming immutable. The verification process takes place against that hash instead of the medical information fed by the user. Once a vaccine is administered to an individual, the individual is issued a verifiable health credential that is only included in that individual’s encrypted digital wallet on their smartphone.

With blockchain, there is no need to have a central database of healthcare information that could be a target for hackers.

For instance, IBM has built a Digital Health Pass, on similar blockchain technology which allows users to share only encrypted data of their vaccination and health status through an encrypted digital wallet. Through this, the IBM blockchain system assists authorities to access and verify health credentials (test results, vaccination records and temperature checks) without revealing users’ personal information. As the user controls the data they share, checkpoint authorities won’t have access to other personal health data. Submission and verification of COVID test result or vaccination record is confirmed through a ‘green light’ or ‘red light’ indicator.

Scepticism in data sharing and communication should be overcome to improve data provenance, security, integrity, access control, and importantly interoperability. In this way, health information exchanges among institutions and governments could be encouraged.

Potential Benefits and Risks

Experts argue that vaccine passports, in any form, might make travel inequitable. Adoption of these digital passports can perpetuate discrimination and inequality, increasing the divide between socioeconomic groups. Vaccine certificates raise social, ethical and political concerns too. Potential issues could arise around discrimination, privilege and exclusion of certain groups who are not eligible for vaccination.

For instance, many COVID-19 vaccines are not recommended for pregnant women (esp mRNAbased), immunocompromised persons, patients under chemotherapy, patients with particular health conditions like allergies and immune system issues. Underaged children whose vaccination regimen is yet to be determined are also deemed unsuitable to be vaccinated.

Further, vaccination passports may give people an inaccurate level of risk perception. Among the

7.8 billion global population, as of May 29, only 1.87 billion doses have been administered (Source: Our World in Data). It is also unclear how long immunity will last and the extent to which virus transmission is limited in a vaccinated individual. Public health authorities’ advice mandatory COVID precautionary measures in vaccinated individuals, especially if interacting with unvaccinated people. Hence, even after vaccination, people may still spread the virus through a false sense of security.

Due to these concerns, the WHO is currently not in favour of making the vaccination passport mandatory. The WHO has previously noted that it’s still unknown how long immunity lasts from the numerous licensed COVID-19 vaccines and that particular data is still being collected.

Tussling with pandemic impact, businesses across have suffered since early 2020, and thus vaccine passports could be the means to enable recovery by opening economies. The capabilities of flourishing digital health technology can also be leveraged to be better prepared for any future pandemic. A truly global implementation of the vaccine passport could open-up economies across the world, giving the citizens around the world a fair chance to rebuild their lives and nations anew.