Covid-19 health pass apps could help reopen businesses and restore the economy. They could also unfairly exclude people from travel and workplaces.Peter Vlitas, a travel industry executive, holding up the health passport app CommonPass. United and other airlines are preparing to use the app to confirm that passengers have negative coronavirus results. Credit... The Commons Project Foundation
Among all the tools that health agencies have developed over the years to fight epidemics, at least one has remained a constant for more than a century: paper vaccination certificates.
In the 1880s, in response to smallpox outbreaks, some public schools began requiring students and teachers to show vaccination cards. In the 1960s, amid yellow fever epidemics, the World Health Organization introduced an international travel document, known informally as the yellow card. Even now, travelers from certain regions are required to show a version of the card at airports.
But now, just as the United States is preparing to distribute the first vaccines for the virus, the entry ticket to the nation’s reopening is set to come largely in the form of a digital health credential.
In the coming weeks, major airlines including United, JetBlue and Lufthansa plan to introduce a health passport app, called CommonPass, that aims to verify passengers’ virus test results — and soon, vaccinations. The app will then issue confirmation codes enabling passengers to board certain international flights. It is just the start of a push for digital Covid-19 credentials that could soon be embraced by employers, schools, summer camps and entertainment venues.
“This is likely to be a new normal need that we’re going to have to deal with to control and contain this pandemic,” said Dr. Brad Perkins, the chief medical officer at the Commons Project Foundation, a nonprofit in Geneva that developed the CommonPass app.
The advent of electronic vaccination credentials could have a profound effect on efforts to control the coronavirus and restore the economy. They could prompt more employers and college campuses to reopen. They may also give some consumers peace of mind, developers say, by creating an easy way for movie theaters, cruise ships and sports arenas to admit only those with documented coronavirus vaccinations.
But the digital passes also raise the specter of a society split into health pass haves and have-nots, particularly if venues begin requiring the apps as entry tickets. The apps could make it difficult for people with limited access to vaccines or online verification tools to work or visit popular destinations. Civil liberties experts also warn that the technology could create an invasive system of social control, akin to the heightened surveillance that China adopted during the pandemic — only instead of federal or state governments, private actors like employers and restaurants would determine who can and cannot access services.
“Protecting public health has historically been used as a proxy for discrimination,” said Professor Michele Goodwin, a law professor who directs the Center for Biotechnology and Global Health Policy at the University of California, Irvine. “That is the real concern — the potential to use these apps as proxies for keeping certain people away and out.”
She added that tech developers often rush to deploy and scale innovations before governments have the chance to test and regulate them.Image People in the United States who are vaccinated against the coronavirus will receive personal record cards noting the medical provider, vaccine maker, batch number and date of their inoculations. Credit... EJ Hersom/DOD
In the U.S., for instance, the federal government plans to give out personal record cards to people receiving coronavirus vaccinations to remind them of their medical provider, vaccine manufacturer, batch number and date of inoculation. But federal health agencies have not yet issued guidance on third-party digital vaccination credentials, leaving it open for companies and nonprofits to introduce Covid-19 health pass apps. Neither the Department of Health and Human Services nor the Centers for Disease Control and Prevention responded to requests for comment.
Nonprofits and tech companies developing Covid-19 health pass apps say their aim is to create credentials as trustworthy as the W.H.O.’s paper yellow card. And they argue that the smartphone apps — which people may use to retrieve their virus test results and immunizations directly from their heath providers — are more reliable than paper health documents, which may be forged.
“To restart the economy, to save certain industries, I think you need a solution like this,” said Eric Piscini, a vice president at IBM who oversaw the development of the company’s new health passport app. IBM recently completed a pilot test of the app, called Digital Health Pass, with an employer, he said, and is in discussions with a major sports stadium. Without such apps, Mr. Piscini said, “people will limit their engagement in travel and entertainment because of lack of confidence.”
Clear, a security company that uses biometric technology to confirm people’s identities at airports and elsewhere, is already operating a Covid app. Called Health Pass, the app has been adopted by some professional sports teams and insurers, where employees may use it to confirm their coronavirus test results. Once vaccines become available, the company said, the app will be able to check users’ immunizations as well.
But no Covid-19 health pass has received as much fanfare as the CommonPass app, developed by the Commons Project, a nonprofit focused on building technology for public use. The group began developing software to help people retrieve and use their medical data well before the start of the pandemic. But spikes in virus cases around the world this spring accelerated its work.
First, the group helped build a health pass app for some East African nations that aims to verify truck drivers with negative coronavirus test results, enabling them to pick up food shipments at ports and deliver them across borders to landlocked countries. A few months later, the group partnered with the World Economic Forum to build a more global digital health pass system for Covid-19. Their first target: international air travel.
The resulting app, CommonPass, notifies users of local travel rules — like having to provide proof of a negative virus test — and then aims to verify that they have met those rules, enabling them to board international flights. In October, United Airlines tested the app on a flight from Heathrow Airport in London to Newark Liberty International Airport in New Jersey.
Peter Vlitas, an executive at Internova Travel Group, a travel services company based in Manhattan, signed up for the United flight. He said he first downloaded the app, which informed him that he needed to test negative for the coronavirus before traveling. Next, he said, the app directed him to a rapid-testing center at the airport. Soon after he took the test, the app displayed his negative test results and generated a confirmation code.
United and four other airlines plan to start using the CommonPass app in the coming weeks on some international flights. Passengers may be asked to show their confirmation codes at airline check-in counters or departure gates.
Dr. Perkins said the Commons Project designed the app’s credentialing system to work for a broad audience. If international air travelers who lack smartphones need to confirm their health status, he said, they could print their confirmation codes and show them at an airport much as they would a paper boarding pass.Image During smallpox outbreaks more than a century ago, some schools began requiring students to show vaccination certificates, as this article in the The New York Times reported on Nov. 26, 1887. Credit... The New York Times
But the great leap forward to 21st-century digital health credentials from 19th-century paper vaccination certificates represents much more than a technological shift. Some civil liberties experts say the vaccine passport apps signal a troubling privatization of public health practices and caution that the technology comes with privacy risks.
“The corporate part of it, the extent to which this is going to be privatized is quite new,” said Michael Willrich, a history professor at Brandeis University and the author of “Pox: An American History,” a book on health control during 20th-century smallpox epidemics. “It raises concerns about privacy, about the right to be free from everyday surveillance.”
App developers said they had seriously considered the privacy risks and designed their systems to help mitigate them.
The CommonPass, IBM and Clear apps, for instance, allow users to download their virus test results — and soon their vaccinations — to their smartphones. The apps can then check the medical data and generate unique confirmation codes that users can show at airports or other locations to confirm their health status.
But the health passes do not share specific details — like where and when a user was tested — with airlines or employers, developers said. The QR codes, they said, act merely as a kind of green light, clearing users for entry.
Even so, some tech executives are wary. Zac Cohen, the chief operating officer of Trulioo, an identity verification company, said society would be better off if app developers invested their considerable energy in pushing for the equitable distribution of coronavirus vaccines before pushing for apps to confirm that some people have been vaccinated.
“What we’re seeing today is a jump forward to try to create pockets of safe environments while ignoring the broader ethical concerns that that creates,” Mr. Cohen said.
He recently wrote an op-ed for an industry site warning that health passport apps could easily prevent people who cannot prove their identities or health status from accessing essential services.
“Until we figure out how to do that in a fair way,” Mr. Cohen said, “we really need to be cautious about deploying that technology.”