The scientific and ethical feasibility of immunity passports

Abstract

There is much debate about the use of immunity passports in the response to the COVID-19 pandemic. Some have argued that immunity passports are unethical and impractical, pointing to uncertainties relating to COVID-19 immunity, issues with testing, perverse incentives, doubtful economic benefits, privacy concerns, and the risk of discriminatory effects. We first review the scientific feasibility of immunity passports. Considerable hurdles remain, but increasing understanding of the neutralising antibody response to COVID-19 might make identifying members of the community at low risk of contracting and transmitting COVID-19 possible. We respond to the ethical arguments against immunity passports and give the positive ethical arguments. First, a strong presumption should be in favour of preserving people's free movement if at all feasible. Second, failing to recognise the reduced infection threat immune individuals pose risks punishing people for low-risk behaviour. Finally, further individual and social benefits are likely to accrue from allowing people to engage in free movement. Challenges relating to the implementation of immunity passports ought to be met with targeted solutions so as to maximise their benefit. Context of the debateAt this point in the COVID-19 pandemic, how or when our lives might return to normality is unclear. One strategy proposed to help this resumption is the identification and documentation of immunity: so-called immunity passports. These passports are a potential tool for recording and sharing the immune status of an individual. The introduction of immunity passports is being considered by several countries, including the UK, Estonia, Italy, and Chile; although as yet, there is no information on the effects of their use. [1][2][3] Health certification for public health purposes is already used in other contextseg, in the management of yellow fever. 4 Passports could take different forms, such as a wristband, smartphone application, or certificate, and be used to confirm to others that a particular individual is at a low risk of acquiring or transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). During periods of lockdown, immunity passports could allow immune individuals to follow less stringent requirements around physical distancing and travel, perhaps permitting them to return to work, care for those at risk, visit friends and relatives, or undertake other activities that expose them to the virus. Whether this strategy should be pursued depends on both scientific evidence and ethical reasoning.

Detection of SARS-CoV-2-specific Antibodies via Rapid Diagnostic Immunoassays in COVID-19 Patients with Positive SARS-CoV-2 RNA Real-time Reverse Transcriptase PCR Results

“…With regard to disease prognosis and epidemic control, early detection, diagnosis, and isolation are highly advantageous. Although there remains considerable uncertainty regarding the duration of immunity to SAS-CoV-2, the intense knowledge focus on this infection will potentially useful answers in a practicable timeframe of "immunity passport" [15]. Serological assays are important tools for understanding the extent of COVID-19 in the community and identifying individuals who are potentially immune [16].…”

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“…52 As a consequence, at this point in the COVID-19 pandemic, the use of immunity passports (risk-free certificate), which is digital or physical, documents that certify an individual at low risk of acquiring or transmitting SARS-CoV-2 have suggested. 53 But, an individual might nevertheless carry the virus at similar levels, and for a similar duration, to those previously uninfected, with an unchanged potential for transmission. 54,55 As with seasonal coronaviruses, COVID-19 patients who have recovered from infection have been found to develop antibodies between 6 and 15 days post disease.…”

“…33,50 Despite limited information on the effect, some governments, including the UK, Estonia, Italy, and Chile have considered immunity passport. 53 Why Not Immunity Guarantee?…”

“…One of the debating issues with immunity passport has been uncertainties relating to COVID-19 immunity, issues with testing (lack of timely access to laboratory test or vaccination), perverse incentives (to seek out infection), doubtful economic benefits, privacy concerns, and discriminatory access. 53 Challenges relating to the implementation of immunity passports ought to be met with targeted solutions to maximize their benefit. However, individual-targeted policies predicated on antibody testing, such as immunity passports, are not only impractical given these current gaps in knowledge and technical limitations but also pose considerable equitable and legal concerns, even if such limitations are rectified.…”

A public health ethic should inform policies on COVID-19 immunity passports

“…In their Personal View, Rebecca Brown and colleagues 1 argue for the implementation of so-called COVID-19 immunity passports to allow individuals presumed immune to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to move through society under reduced social distancing and other restrictions. Brown and colleagues contend that constraining these individuals’ freedom of movement is a serious breach of personal liberty.…”