Vaccine passports are engendering a wide range of emotions and opinions. Gov. Cuomo has embraced them in New York. Gov. DeSantis has banned them in Florida. Gov. Charlie Baker has dismissed them, saying, “No, no, no, I want to vaccinate people.” And critics are charging that vaccine passports are illegal, invasive, or divisive.
“HIPAA” has been trending on Twitter because of a misguided concern that vaccine passports violate the Health Insurance Portability and Accountability Act of 1996. The HIPAA privacy rule protects sensitive patient health information from being disclosed without a patient’s consent or knowledge. It does not prohibit people from voluntarily revealing any aspect of their health status in any manner they choose.
Much has been written about a perceived conflict between requirements for Covid-19 vaccination and personal liberties. Usually missing in the discourse is an acknowledgment that such tradeoffs are a part of daily life. To benefit from the services society offers, we sometimes must submit to a limited invasion of privacy. To get a driver’s license, we voluntarily disclose information about our eyesight by taking an eye exam. People who are unwilling to divulge that information may be denied the privilege of driving. The choice is ours.
Proof of vaccination has long been required for international travel. The World Health Organization provides a standardized “International Certificate of Vaccination or Prophylaxis” — often called the “Yellow Card.” People wishing to travel to a county requiring proof of vaccination must relinquish their freedom to refuse vaccination. The choice is theirs.
The travel industry is committed to using health passports to provide proof of a recent negative test or a vaccination against Covid-19, required by many countries. Airlines require travelers to produce such proof before boarding flights to those destinations. Smartphone apps enable passengers to document their Covid-19 status electronically to expedite the boarding process.
Using a digital health passport is voluntary. Travelers can provide printed documentation of Covid-19 status. The requirement for such documentation, however, is not optional. Entry into another country is a privilege, not a right. The host country is entitled to impose any public health requirement it feels necessary to keep its citizens safe.
Vaccine passports are being used for domestic purposes unrelated to travel. The Biden administration has ceded the development of digital health records to the private sector to avoid the political fallout that would inevitably accompany the federal government’s becoming a repository for health-related data on U.S. citizens.
Other jurisdictions, however, have accepted the challenge. New York state has launched its Excelsior Pass, heralded as providing secure, digital proof of Covid-19 vaccination or a negative test. Its website reveals that a major purpose of the initiative is to facilitate reopening the state’s economy: “Easily present your Pass at participating businesses and become part of New York’s safe reopening.” New York requires proof of vaccination or a negative Covid test to enter events attended by more than 100 people, which the state began permitting on April 2. Madison Square Garden was the first large arena to use the Excelsior Pass.
In February, Israel released its “Green Pass,” documenting that residents are fully vaccinated or have presumed immunity after contracting Covid. Holders of the pass are granted exclusive access to gyms, hotels, theaters, and concerts. Some people lament that this policy creates a two-tier system of haves and have-nots, but everyone will soon have the choice between the two options. More than 50 percent of Israeli citizens have been fully vaccinated. When all those choosing to be vaccinated are accommodated, membership in the “have-not” community will be entirely voluntary.
A distinction should be made between the fairness of documenting that people have been vaccinated against Covid-19 and the fairness of having access to vaccination in the first place. Because economic, geographic, racial, and ethnic issues are known to disadvantage certain segments of our population, authorities responsible for vaccine passports as well as for vaccination should do everything in their power to ensure equitable availability for everyone.
Many of us, even though not planning international travel, will probably obtain a vaccine passport to help restore normalcy to our lives. Safe participation in some entertainment and cultural activities may require showing proof of vaccination or a negative Covid test. That requirement will involve an implicit agreement between restaurants, theaters, and sporting venues and their patrons that the arrangement is mutually beneficial. That choice will be ours.
Ronald A. Gabel, M.D. of Yarmouth Port is a retired anesthesiologist.