Vaccine passports and digital vaccination records, explained - Vox

As Covid-19 vaccine eligibility opens up across the country, the United States is now confronting the question of what to do about vaccine passports. These could be digital certificates or scannable documents that can be used to verify a person’s vaccination status so they can travel more freely or go to large events. Some think a coordinated, nationwide vaccine passport system could help us get back to a semblance of normal life and speed up economic recovery. But this seems unlikely.

On Monday, White House press secretary Jen Psaki told reporters that “there will be no centralized universal federal vaccinations database, and no federal mandate requiring everyone to obtain a single vaccination credential.” Instead, the Biden administration has decided to leave it to the states and the private sector to figure this out, with the federal government setting some baseline guidance. As Andy Slavitt, a senior adviser to the White House’s Covid-19 response, told CNBC earlier in March, “The public will be more reluctant to get vaccinated if they feel like the government, the federal government is playing too much of a role in that.” Meanwhile, at least one governor, Florida’s Ron DeSantis, has pledged to ban businesses and venues in his state from using any vaccine passport system.

A growing number of companies, health care providers, and state governments are launching their own efforts. New York released the first state-backed vaccine passport, called the Excelsior Pass, just last week. This digital health certificate, which IBM built using blockchain technology, allows people in the state who have been vaccinated or recently tested negative for Covid-19 to download their health records onto a smartphone app that displays a QR code, which can be scanned by participating venues to verify their status. That New York has spent months developing the Excelsior Pass shows how some states didn’t expect the federal government to take the lead on key aspects of the country’s pandemic response.

Meanwhile, corporations including Walmart and the airport security company Clear are racing to build their own digital vaccinations databases. Some are already releasing vaccine passports, such as the CommonPass, an app from the World Economic Forum and the Commons Project that’s being trialed by a number of airlines. Carbon Health, which partnered with the city of Los Angeles for its vaccination rollout, is offering a HIPAA-compliant vaccine passport of its own, which it named Health Pass.

The idea behind all of these initiatives is simple: By putting their health data on a device like a smartphone or in a printed-out QR code, people should be able to confirm their vaccination status and more safely resume activities such as going to concerts or even traveling to other countries.

Again, the federal government has no plans to build a national clearinghouse for vaccination or Covid-19 statuses. People vaccinated in the US currently receive printed paper cards from the Centers for Disease Control and Prevention (CDC) that include their name, birth date, and patient number (if applicable), as well as the type of vaccine they received, when and where they received their doses, and the batch number their vaccine came from. While health care facilities keep their own vaccination records, the CDC cards aren’t really set up to be double-checked or verified by venues or other institutions. Forgeries started popping up for sale online not long after vaccines became available in the US, too.

Vaccine passport systems are designed to provide a more private and secure way to check who’s been vaccinated and make it easier for vaccinated individuals to provide proof of their status. The verification process generally works in two steps. First, a vaccination site, such as a pharmacy, provides a digital record or certificate with the details of someone’s Covid-19 vaccination. That verified record goes into that person’s account and would be accessible by an app or a website. The vaccinated person can then present either a scannable or physical copy of the code, allowing a venue or airline to securely verify their vaccination status without seeing their entire medical record. Different apps might work in different ways based on the public and private partnerships behind them, and again, so far there are no national standards to govern how any of this works.

So the slew of different initiatives has caused massive confusion. There are at least 17 vaccine passport efforts currently in development, according to a Department of Health and Human Services (HHS) document obtained by the Washington Post. The federal government has been racing to set national recommendations surrounding the privacy, security, and availability of these systems, all while not maintaining its own database of vaccination data. The White House has so far declined to share a timeline for when those guidelines will be complete.

Without federal guidance, the companies and organizations behind these efforts are developing their own standards for digital vaccination records and vaccine passport apps. At the same time, there are concerns about equity, particularly the potential for a digital vaccine passport system to exclude people who don’t use smartphones or cannot get the vaccine, whether due to issues of access or health status. Public health experts have also warned that vaccine passports raise a wide range of legal, privacy, and ethical concerns — and that they could exacerbate inequality in other ways.

“Ideally, everything should have been coordinated at a national level,” Bruce Y. Lee, a professor at the CUNY Graduate School of Public Health and Health Policy, told Recode. “One of the concerns about the passport is that people will still move forward to try and do this, but then you might have all these different businesses or organizations trying to do things, and you can’t really [make] heads or tails [of] how reliable they are.”

Without proper coordination, all of those problems could be much worse. The HHS document published by the Post warned in early March that the “[vaccine credentials] landscape could become littered with a confusing array of incompatible, proprietary solutions of varying quality and trustworthiness.” It went on to say that such a situation could impede the nation’s pandemic response “by undercutting health safety measures, slowing economic recovery, and undermining public trust and confidence.”

But despite the absence of federal guidance on the issuance of vaccine passports, all of the myriad state and private sector efforts are forging ahead, trying to figure things out on their own.

Vaccine passports, explained

When people talk about vaccine passports, they’re generally referring to a two-part system: a digital record that a person got vaccinated, and an app that can access that record to confirm the person has met the requirements to visit a particular place or attend an event. For the system to function on a large scale, those designing vaccine passports need a way to access records from a wide variety of providers and form partnerships with venues willing to trust their apps.

Walmart announced in early March that it would offer digital vaccination records that could be used with vaccine passports. The company said its digital vaccination record was built to meet the standards set by the Vaccination Credential Initiative, a coalition of health records management and tech companies that is co-chaired by the Commons Project, maker of the CommonPass. Walmart will also allow people to access paper versions of their health records at their local pharmacies.

Walmart’s digital vaccination record can be uploaded to one of three apps that function as vaccine passports. One is the Health Pass by Clear; the others are the CommonPass and CommonHealth apps, both of which are made by the Commons Project. Ultimately, proponents of these apps say they make it quick and easy for venues and airlines to verify someone’s vaccination or Covid-19 status while also maintaining that person’s privacy.

“The airline doesn’t necessarily want to have your vaccination record,” explains J.P. Pollak, a co-founder of the Commons Project. “They would work with CommonPass to get a checkmark that, ‘Yes, in fact, J.P. has been vaccinated by a trusted source,’ without having to convey all of that sort of underlying health information to them.”

Pollak said his organization hopes to do a full rollout of the CommonPass system in May, when vaccines are expected to be widely available to the general public in the US. He added that the Vaccine Credential Initiative requires partners to build out the ability to provide printable versions of the QR codes that verify someone’s status. Ultimately, Pollak said, the project’s goal is to work with as many vaccine providers as possible — from hospital systems to government-run vaccination outfits — to produce their own secure digital vaccination records that apps like CommonPass can process.

While the Commons Project is attracting a growing number of partners, it isn’t the only vaccine passport maker out there. Beyond its work on New York’s Excelsior Pass, which was tested at Madison Square Garden and the Barclay’s Center, IBM is working with Germany to produce digital versions of its paper vaccine certificates. The International Air Transport Association (IATA) is also developing its own “Travel Pass” for airlines, which is now being tested by Virgin Atlantic, Emirates, and other carriers. Carbon Health plans to expand the functionality of its Health Pass to work with Apple Wallet and Google Pay. Even Mastercard has joined the fray; it’s working with the International Chamber of Commerce on a protocol for a “global, interoperable health pass system.”

As more vaccines get delivered, more vaccine providers seem eager to come up with their own ways to manage vaccination records databases. Walgreens, for instance, is exploring “a digital dose card and tracker,” and the company expects to announce more on the effort later this month, spokesperson Erin Loverher told Recode.

But with an increase in vaccinated people, the sheer number and variety of digital vaccine records and passport options will surely be confusing, adding more disarray to recovery efforts. The flurry of options may also hinder efforts to ensure any new digital vaccine record systems are trustworthy, in terms of privacy and security.

The US government has no vaccine passport plan yet

While the US’s approach to vaccine passports is unclear, some other countries have already charged ahead in rolling them out. Israel is using a system called the Green Pass to allow people who have either had Covid-19 or been fully vaccinated to return to some venues, such as hotels and theaters. People who meet the requirements can show a paper certificate or code in an app developed by the country’s health ministry. Greece, in an attempt to aid its suffering tourism industry, has said it will recognize the Green Pass system and allow thousands of Israelis to travel there every week.

Similarly, the European Commission is proposing a Digital Green Certificate that would track whether people have been vaccinated, recently tested for Covid-19 (with a negative result), or are fully recovered from a previous infection in order to travel within the European Union.

Earlier in March, the World Health Organization released interim guidance for how digital vaccine certificates should work globally, opening the door for even more countries to create their own passports. WHO’s working group encompasses experts from 25 governments, including representatives from the CDC and the US’s Office of the National Coordinator for Health Information Technology, which is part of HHS.

It’s currently analyzing the data, ethical guidance, and verification systems needed to make digital vaccine records actually work, said Bernardo Mariano Jr., the WHO’s chief information officer and digital health and innovation director. Final recommendations are expected at the end of June. Out of concerns that more information on how well the vaccines prevent transmission is needed — and that requiring vaccination will incentivize people from wealthier countries to scoop up still-limited vaccine doses — the WHO is currently urging governments to not mandate vaccination for travel.

In the US, there’s been less action and enthusiasm for a system. While the US vaccine rollout began months ago, recent statements from the Biden administration suggest there will be limited coordination of vaccine passports on a federal level. The president did direct several government departments to look at the feasibility of “electronic versions” of international vaccination certificates in a January executive order, and a Biden administration official told Recode that there is still an ongoing interagency effort led by the White House analyzing the possibility of verified vaccine records.

Still, the lack of coordination is a reminder of other ways that the US has struggled to coordinate and come up with a national plan throughout the pandemic. Rapid and at-home testing — along with contact tracing — hasn’t been mobilized to the scale that would allow large venues to reopen properly. And while vaccines have been rolled out, the process has been bumpy and confusing. The same challenge and lack of planning now seem to have shown up for vaccine credentials.

“One of the challenges that has occurred throughout much of the pandemic — and this really was started back in 2020 — there’s been a lack of coordination among the different virus control approaches,” explained CUNY’s Lee.

Officials working on the interagency effort to study digital vaccine credentials have identified the lack of coordination as a significant barrier to recovering from the pandemic. Earlier this month, the Office of the National Coordinator for Health Information Technology said that proving vaccination was likely to become the way people confirm their health status, and that a “chaotic” approach to vaccine credentials could undermine public trust and confidence.

How you can get a vaccine passport

While there are many projects in the works, not many actual vaccine passports are widely available yet. If you’ve already been vaccinated and want a digital record of your vaccine, it’s worth calling the health care provider who gave you the shot to see if and when electronic records of your jab might become available. If you haven’t gotten inoculated yet, ask about such a record when you get the shot.

Some of these apps — including New York’s Excelsior Pass, the CommonPass, and Clear apps — are already available for download. Even if you don’t have a digital vaccine record, you might be able to use the apps to show the results of a negative Covid-19 tests.

If you’ve been vaccinated at Walmart, it’s worth regularly checking in on your online Walmart pharmacy account to see when your vaccination record becomes available (again, Walgreens said it may provide something similar soon). If you were vaccinated at Carbon Health, you should receive a text directing you to a downloadable online record of your vaccination.

And if there’s no electronic record of your vaccination yet, there’s no harm in asking your appointment provider to print out any records of your appointment so you have something beyond your vaccine card in your back pocket. If you don’t like the idea of downloading these apps, you can at least add a little extra protection to your CDC card and laminate it, a service Office Depot and Staples have said they’ll offer people for free.

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