Leaders of the 27 European Union member states are moving closer to a consensus on an EU-wide system of vaccine certificates for travel between countries in the bloc. Within three months a system will be introduced, EU officials announced on Thursday, the first day of the two-day virtual summit of the European Council.

Several EU member states that rely heavily on tourism believe that a system of digital vaccine passports or certificates could revitalize air travel and ease the pressure on economies. Many, including Greece, Spain and Italy, are urging other countries to support a common European approach.

“Of course more work needs to be done on digitalization and on cooperation with the World Health Organization, but we felt tonight more and more convergence among us about this important topic,” said Charles Michel, President of the European Council, at a press conference on Thursday. “The European Council will resolve this matter.”

WHO has been reluctant to move forward on creating an international framework for vaccine passports so far, until it becomes clear that vaccination inhibits COVID-19 transmission and vaccines become more available globally – beyond the high-income countries that currently dominate in the number of doses administered. 

WHO officials have made clear, however, that requiring proof of vaccination could be a good idea in the future – and based on an existing clause allowing for countries to demand proof of yellow fever vaccination – embedded in the WHO International Health Regulations. 

Hesitancy From Some EU Leaders Won’t Stop Plans To Establish An EU-Wide System

The leaders of France, Germany, and Belgium have, however, expressed concerns that more evidence on vaccines inhibiting SARS-CoV2 transmission needs to be amassed before such a system is put in place. 

“First, it must actually be clearly resolved that vaccinated people are no longer infectious,” Angela Merkel, Chancellor of Germany, told the Frankfurter Allgemeine Zeitung. 

However, “we all agree that we need [a digital vaccination certificate],” Merkel said at a press conference Thursday following the virtual meeting. 

Despite concerns about the current low level of vaccinations, particularly in Germany where people have been hesitat about accepting the Oxford/AstraZeneca jab, Merkel announced that the EU member states will have developed digital vaccine certificates and the technical framework required for their introduction within three months.

“That will make travel within the European Union possible by having more information,” and could open up the opportunity for third-country nationals to enter the EU, said Merkel. 

COVID-19 tests could also be part of the new system, she added.

Both political and scientific questions remain to be answered, said Ursula von der Leyen, President of the European Commission, at a press conference on Thursday. The issue of what the certificates will be used for will ultimately be decided upon at the national level.

“But at the EU level, I believe we should use them to ensure the functioning of the single market,” Von der Leyen said. 

The content of the certificates will be uniform and will contain minimal medical information. Beyond providing proof of vaccination and specifying which vaccine was administered, the  system would also allow for the certification of immunity from a previous COVID-19 infection, or a negative PCR test.

The certificates will provide individuals with a unique identifier – similar to an IBAN code. 

Each country will need to integrate this into their health systems and the European Commission will provide a “gateway for interoperability” between nations, said Von der Leyen. 

“Member states will need to move fast with the implementation if we want such a green certificate to be in place by summer,” said Von der Leyen. “Beyond bringing on the principles and the technology, they will have to ensure a quick and complete rollout in their national health systems and in their border systems.”

Some European Countries and Others Already Moving Ahead with Systems 

Some EU countries already have created systems or have advanced plans for digital systems that document individuals’ vaccination status, both for the purposes of travel as well as to facilitate entrance to crowded venues or attendance of large in-person events. Many others are likely to move forward even without an EU-wide system – such as Denmark, Greece, Iceland, Hungary, and Poland.

The African Union, in partnership with the African Centers for Disease Control and Prevention (CDC), is developing a “My COVID Pass” tool to verify vaccine certificates, COVID test records and other documents, to facilitate travel across Africa. 

Thailand plans to ease restrictions for vaccinated individuals and shorten the mandatory quarantine from two weeks to three days. Lebanon is reportedly allowing those who have received the COVID-19 vaccine to be exempt from quarantine if they also take a PCR test upon arrival. 

Bahrain incorporated vaccine certificates into its “BeAware” contact tracing app, allowing authorities to scan a QR code linking to the national vaccine register.

Israel’s  “green pass” programme was launched last week –  and is intended to provide access to gyms, theatres, hotels, concerts and synagogues. Israel has also created bilateral agreements with Greece and Cyprus – and is in talks with Seychelles and Romania to establish a similar agreement – to permit the free flow of vaccinated travellers back and forth. 

However, at the country’s Ben Gurion Airport, current reality is almost the diametric opposite of any “green passport” vision. International flights have all but halted with thousands of Israelis left stranded overseas – and those wishing to return forced to submit requests to a “Exceptions” Committee – which critics say is politically stacked. The travel bottleneck has led to widespread allegations of corruption and bias in the issuing of the precious “exceptions” permits largely for ultra-Orthodox travelers and politically well-connected individvuals. And this is happening just week’s before a national election.  More fundamentally, COVID test forgeries and inconsistent quarantine enforcement also plague the system – with bureaucrats so far unable to come up with solutions for either.

Experts Raise Scientific & Technical Questions About Vaccine Passport Plans

The experiences illustrate just a few of the technical, scientific, and ethical dilemmas yet to be faced from a region-wide or international system of vaccine certifications. 

Others include questions such as: Will two doses of the vaccine be needed? For how long will immunity – and thus the passport – be recognized?   And which vaccines would qualify? For instance, would individuals who have been vaccinated by China’s Sinopharm and Sinovac vaccines or Russia’s Sputnik V vaccine –  that have not been approved by an internationally recognized regulatory agency or the WHO have problems travelling? 

Along with those issues, experts wonder about the ability of vaccines to actually halt the transmissibility of SARS-CoV2, and the effectiveness of vaccines against the virus variants that continue to evolve and mutate, are yet to be faced.  

“If we can still get infected but remain asymptomatic, a vaccine passport may make the situation worse if it is not supported by testing and social distancing, so it may not be a real way out,” Gian Luca Burci, Professor of International Law at the Graduate Institute of International and Development Studies, told Health Policy Watch. 

“The science doesn’t support COVID Passports b/c vaccines can’t guarantee immunity,” wrote Lawrence Gostin, Professor of Global Health Law at Georgetown University, on Twitter. “Vaccines are really good, but passports are premature.”

The science doesn't support COVID Passports b/c vaccines can't guarantee immunity. Which vaccines qualify? Do you need 2 doses? How long will immunity last? Do vaccines prevent transmission? Do they work against all variants? Vaccines are really good, but passports are premature

— Lawrence Gostin (@LawrenceGostin) February 25, 2021

Validation of Vaccine Status – Requires Cooperation Across Complex Systems

Beyond the scientific considerations, there are also worries about validating the certificates, preventing forgery and hacking, protecting medical privacy and assuring digital data security.

“The ability to identify an individual and validate vaccination status requires international cooperation, orchestration across complex systems and widespread adoption of open interoperability standards to support secure data access or exchange,” said a WHO statement released in early February. 

While a WHO standard does exist for providing proof of vaccination for international travellers, with the requirement of vaccination against yellow fever for entry into countries where yellow fever is endemic, implementing such a system for SARS-CoV2 would bring countless more considerations. 

“Disease passports have rarely been tried. The only parallel is @WHO’s Yellow Fever certificates. That program is small & doesn’t face near[ly] the same logistical, scientific, legal & ethical hurdles of #COVIDVaccine Passports,” Gostin tweeted. “COVID Passports are tempting, but too many hard problems.”

Others say that the bigger challenge may very well be how to use vaccine passports domestically – outside of the travel industry.

“Being certified for being vaccinated is not a new or recent issue. If you want to travel internationally, it is expected that you have been vaccinated against some of the major diseases,” Dr. Sridhar Venkatapuram, Senior Lecturer in Global Health and Philosophy at King’s College London, told Health Policy Watch. “This seems to be like that for international travel during this pandemic.” 

“The difficult and new thing is that vaccination is not just for travel, but to carry on with daily activities like work, socializing, sports et cetera,” said Venkatapuram. “You can’t create benefits to being vaccinated if you can’t assure everyone who wants a vaccine has access.” 

Human Rights and Ethical Questions

In line with those challenges, the prospects that a system of vaccine certificates could create new forms of discrimination, exacerbate existing inequality, and even amplifying vaccine hesitancy are another source of expert concern. 

The use of vaccine passports could “create a two-speed society with potential for marginalization and demonization of the non-vaccinated,” said Burci. 

“Another criticism is that it would make vaccination practically compulsory, which is an extremely sensitive point given the widespread vaccine hesitancy and [may] even generate pushback against vaccination programmes,” Burci added. 

COVID vaccine hesitancy is widespread in many European countries, with Italy (53.7%), Poland (56.3%), and France (58.9%) having among the lowest rates of vaccine acceptance, found a study reviewing the results from 31 peer-reviewed studies on COVID-19 vaccine acceptance. Ecuador, Malaysia, Indonesia and China had the highest rates of vaccine acceptance, among members of the public, the study found – while the lowest was in Kuwait, at only 23.6%. Meanwhile, in the Democratic Republic of Congo, another study found that less than 30% of health care workers would readily take up a COVID vaccine. 

Such low rates of vaccine acceptance also could pose a challenge for the widespread implementation of vaccine certificate programmes. 

“There is distrust of vaccines and pharma companies. So certifications will make people choose between their beliefs and distrust vs the benefits of getting vaccines,” said Venkatapuram.

In addition, vaccine certificates could lead to the gathering of “data that places marginalized and stigmatized people at risk, and could create a two-tier system that jeopardizes all our human right to work and to freedom of movement,” Dr. Sara Meg Davis, Senior Researcher at the Global Health Center at the Graduate Institute of International and Development Studies, told Health Policy Watch. 

National and Global Vaccine Equity

But one of the biggest barriers to the international rollout of a vaccine passport may be the small and disproportionate numbers of people to be vaccinated so far. Only about 8% of the adult population in Europe have received jabs: 

“Do we want to confer even more privilege on people who have so much privilege? Do we want to deny people a normal life if they can’t access vaccines?” Gostin tweeted. 

Beyond national equity, global equity is another concern, with vaccination campaigns in low- and middle-income countries only beginning recently and the first COVAX delivery of vaccines taking place on Wednesday. 

“Would we prevent travel & other joys of life primarily to rich country residents, when poorer nations can’t afford vaccines – especially when rich states hoard scarce vaccines,” Gostin tweeted. 

Equity within nations is a huge problem. But global equity is still a larger concern. Would we prevent travel & other joys of life primarily to rich country residents, when poorer nations can't afford vaccines– especially when rich states hoard scarce vaccines.

— Lawrence Gostin (@LawrenceGostin) February 25, 2021

“One can also imagine that given extremely limited quantities of vaccines, if you add further benefits to getting vaccines, then they become even more valuable and people may start to distribute them even more unfairly or unjustly,” Venkatapuram said. 

“Despite the problems, there are policy makers and others who are interested in the big picture…The suffering of disadvantages of the few will be seen as acceptable, or will be ironed out as time goes on,” said Venkatapuram. 

Under Pressure from Travel Industry 

Whatever the the issues may be, EU politicians are also under pressure to act from the airline and travel industry. Ahead of the European Council meeting, the International Air Transport Association (IATA), a trade association representing 290 airlines globally, had urged EU leaders to implement a standardised travel solution. 

The IATA has already issued its own proposal for  a digital travel pass to verify and store details of travellers’ vaccination status and COVID-19 tests, sharing the results with government authorities before entry into the country. 

According to Venkatapuram, it would be technically feasible for the EU to establish a vaccine certificate system within three months, as announced by EU officials on Thursday. 

“Policies can be made quite quickly…Different countries, or groups of countries may implement them. Like the EU,” said Venkatapuram. “The airline and travel industry is likely putting a lot of pressure on governments and summer is when people will want to travel. So yes, a policy could be put in place.” 

“The policy is easy to draft and enact. [Setting up] the actual infrastructure is a different story,” he added.

Image Credits: Twitter – EU Council Press, Press Office of the Federal Government, Deutsche Welle, Twitter, WHO, IATA.