The Ethics of COVID-19 Vaccine Passports
Artist Unknown. “Drawing up the Liquid” from Gustav Preiswerk, Lehrbuch und Atlas der konservierenden Zahnheilkunde, (J. F. Lehmann's Verlag, Munich, Germany: 1912)
As president of The National Catholic Bioethics Center (NCBC) and a longtime international pro-life advocate, I have some considerations regarding serious ethical problems related to proposed COVID-19 vaccine passports and how such certificates of immunity could be misused. Clearly, immunizations should be documented in one’s confidential medical records. For my pro-life trips to many less developed tropical countries, I needed the International Certificate of Vaccination or Prophylaxis, or Yellow Card, with my vaccinations listed. Currently, the International Health Regulations created by the World Health Organization (WHO) and legally binding for 196 state parties allow certain countries to mandate that visitors provide proof of vaccination for only one disease: yellow fever.
Israel is the country with the highest percentage of its population vaccinated against COVID-19. Approximately 80 percent of adults are fully vaccinated. The Israeli Ministry of Health created an electronic document it calls a Green Pass, certifying immunization by vaccination or previous infection. Those with this document are allowed to socialize at events like plays or concerts and go to public restaurants. Those without a Green Pass are barred from travel to certain vacation destinations and many social and work activities, creating the specter of a society divided into a favored class of people and an underclass suffering discrimination based on immunization status.
The most obvious practical objection to plans for a required COVID-19 vaccine passport is that the vast majority of the world’s population has no access to the newly created vaccines. Putting such a measure in place now would be grossly discriminatory against the poor and those with least access in the United States and globally. The WHO has come out against proof of COVID-19 vaccination for international travel for these and other reasons. This means that nations attempting to require travelers to give proof of vaccination for anything except yellow fever will be in breach of binding international public health regulations.
Lack of scientific data on the efficacy of COVID-19 vaccines in preventing transmission of SARS-CoV-2 and its newer variants is a big problem. Also, determining how long before travelling these vaccines should be taken is a key concern. Before any WHO-sanctioned COVID-19 immunization document requirement for international travel can even be considered, we need more information on the duration of protection provided by the various vaccines, further analysis of specific contraindications, and processes for exempting people who already have antibodies against the virus thanks to catching the disease.
I am pleased to note that the Biden administration has come out against a federally created or mandated vaccine credential because of concerns about how it could be used to violate privacy rights and to treat people unfairly. The American Civil Liberties Union is also quite concerned about the risks posed by these proposed digital COVID-19 immunization documents. The ACLU points out the danger of becoming a “checkpoint society” where people’s private medical information could be coercively required. This could extend beyond COVID-19 vaccination status to other sensitive data. Finally, conservative Republican governors in Texas, Florida, and elsewhere have expressed strong opposition to these new vaccine passports. Governor Ron DeSantis of Florida was among the first to sign an executive order prohibiting the use of such documents in his state. That is a remarkable level of ethical consensus in our ideologically divided society.
The Catholic perspective on the problems with requiring a COVID-19 vaccine passport looks first at the fundamental liberties of persons. The Church is calling people to make a careful discernment in conscience regarding taking a COVID-19 vaccine or not. See our updated NCBC guidance on this issue. This means that individuals have a strong right to be free of coercion to take a COVID-19 vaccine. They should also not be prevented from getting vaccinated if they qualify for ethically distributed vaccines and have made a well-considered decision to go forward with it. The proposals for the use of new vaccine passports that would involve discrimination against persons who choose not to accept the COVID-19 vaccines must be opposed by Catholics.
A more difficult ethical question is the problem of requiring the holders of certain jobs to be vaccinated. There are certain frontline occupations where COVID-19 vaccination could have a disproportionately strong positive effect on the common good. It remains true, however, that other effective means of preventing viral infection and transmission exist. Health workers were able to remain safe and protect their patients before the availability of these new vaccines thanks to personal protective equipment and safety protocols. I do not see how one can ethically justify coercive measures regarding a question where people have no moral obligation one way or the other. Accommodating individual conscientious and prudential judgments is possible here without undue difficulties or increased danger.
The authors of a New England Journal of Medicine article on COVID-19 passports point out that history is full of examples where social privileges or restrictions based on “fitness” of one kind or another led to terrible injustices. The Excelsior Pass in New York and the Green Pass in Israel raise many red flags. Public safety measures aimed at mitigating the COVID-19 pandemic have already placed large and internationally unprecedented burdens on societies and individuals for long periods of time. We should be very leery of going further in the bad direction of invading the privacy of medical decisions and adopting coercive tactics. Free and informed consent is a pillar of medical ethics. We erode that fundamental human right at our peril.
