Digital Health Passes: Useful, if Equitable, JAMA Authors Say

April 8, 2021
Mary Caffrey

Mary Caffrey is the Associate Editorial Director of AJMC/Managed Care for MJH Life Sciences. Her editorial responsibilities include Evidence-Based Oncology, Chief Healthcare Executive, and Managed Healthcare Executive.

Known by different names around the globe, from vaccine passports or green passes, various digital certificates confirm vaccination and negative SARS-CoV-2 test status through “confidential data transfers."

As more people get vaccinated, pent-up demand for travel and commerce has increased--and more governments are discussing the idea of asking workers or travelers to obtain a pass that would signal who is unlikely to spread COVID-19.

Known by different names around the globe—from vaccine passports, or green passes, to New York State’s “Excelsior Pass,” –or by commercial names such as VaccineCheck—the various digital certificates confirm vaccination and negative SARS-CoV-2 test status through “confidential data transfers,” according to an essay appearing today in JAMA that discussed the ethics and practicality of digital health passes.

“Digital health passes offer health and economic benefits until herd immunity is achieved,” write Lawrence Gostin, JD; Glenn Cohen, JD; and Jana Shaw, MD, MPH; who argue that besides offering benefits to the people who get them, the presence of a digital health pass can encourage people to get vaccinated if they otherwise would balk, whether they need the electronic document for work, travel, or both.

There are some practical challenges to such a system. It is unclear yet how long immunity lasts after getting vaccinated or contracting COVID-19, although the authors write this will become clear as the original participants from the clinical trials for the Pfizer-BioNTech, Janssen, and Moderna vaccines are followed, along with results seen in real-world studies.

Technical challenges must be overcome, including the need to ensure authentication; and in the United States, there are jurisdictional issues because state are the primary health regulators, although President Biden would regulate their use at international airports.

Constitutional questions may arise. “While the Supreme Court grants WPINT

public health agencies wide discretion, it is more protective of First Amendment freedoms, including religion, speech, and assembly,” the authors wrote, noting that the court has already struck down restrictions applied to houses of worship.

What About Employers?

The authors note that employers have the right to require COVID-19 vaccines to return to work to ensure that employees do “not pose a direct threat to health or safety,” and employers could use passes as proof of vaccination; this would not violate the Americans with Disabilities Act or the Genetic Information Nondiscrimination Act. Providing proof of vaccination would be unlikely to violation privacy laws, including HIPAA, as they do not share any other information.

However, civil rights laws must be followed, and reasonable accommodations would need to be made for those with health conditions or those who hold a “sincere religious

belief, practice, or observance.”

Equity Issues

Governments and employers, the authors say, must address the historic lack of trust among minority groups toward the health system that might prevent them from getting vaccinated. Also, richer countries signed advance agreements with vaccine manufacturers, and thus may have more early supplies than poor countries, which could contribute to global inequity.

High-income countries could help ameliorate inequities through funding and donating vaccine doses,” to central global distribution hubs, while building manufacturing capacity in low- and middle-income countries, they write.

Success of a global digital health pass program requires equitable administration, the authors say, “ensuring that everyone has a fair chance to return to a normal life.”