Rapid expert deliberation 17 February 2021

What place should COVID-19 passports have in society?

Findings from a rapid deliberation with multidisciplinary experts to consider the risks and benefits of the potential roll-out of digital vaccine certification schemes.

The views put forward below in these deliberation Introduction findings reflect a snapshot of our understanding of the evidence and the development In recent weeks, vaccine passports of technical tools. The urgency of the issue or COVID-19 status apps – which might give meant – by necessity – this was a limited some individuals greater access to travel, exercise. Nevertheless, some clear areas employment or entertainment – have attracted of concern emerged. attention as a route to move societies out of lockdown and open up parts of the economy. • The expert group came to the view that, at present, status does not offer With momentum building, the Ada Lovelace clear or conclusive evidence about any Institute convened an urgent expert deliberation individual’s risk to others via transmission. to consider how governments should act, chaired Without that, it cannot be a robust basis for by Professor Sir Jonathan Montgomery. A group risk-based decision making, and therefore of 17 experts from the fields of immunology, any roll out of a digital passport is not epidemiology, sociology, international currently justified. development, behavioural science, law, medical • However, given that evidence history, public health, ethics, digital identity and on transmission will emerge, and other technical system design came together across countries and companies are developing two weeks to discuss the evidence, deliberate such systems, the UK Government must act on use cases, explore opportunities and risks, urgently to address the public policy issues and identify areas of consensus to support that arise, and create clear and specific government decision makers around the world.1 guidelines and law around any appropriate uses, mechanisms for enforcement and methods of legal redress.

1 The deliberation forms part of a wider project, which also consists of an international call for evidence and a series of public events. The Ada Lovelace Institute will publish a longer report in March taking all of the evidence into consideration, and answering some of the questions raised by the expert deliberation. Ada Lovelace Institute COVID-19 vaccine passports and society 2

• While vaccine passports will be seen There are broad social benefits that flow from by some as a way to increase freedom, loosening restrictions on and for those without a passport they would many hope that passports might help do this constitute a denial of liberties that safely. In particular, arguments are made for: others are being granted. Therefore the justifications both for the relaxation • Public health – making the community of current restrictions for some and also safer. The effectiveness of this approach for their continuation for others should is based on the premise that only those who be clearly articulated. will not transmit the virus are able to take • The Government will need to take part in activities that would normally present a clear position outlining the specific a risk of transmission. But this aim is not purposes and use cases for which, if any, scientifically advisable at present, as it has vaccine passports can be legally and not been established that vaccination status legitimately used. reduces the risk of transmission to others • In allowing some uses or actively (as opposed to the risk of the vaccinated facilitating digital vaccine passports, person contracting COVID-19). governments must address the issues and • Personal liberty – enhancing the freedoms risks arising from such schemes or the of those who have a passport to do things creation of related digital infrastructure, that would otherwise be restricted due and whether and how these risks could to COVID-19 (always noting that granting be mitigated. permissions for some will, in relative terms, increase the loss of liberty experienced A vaccine passport as defined here consists by others). This could have a particularly of three things: health information (vaccine profound benefit for those facing extreme status through e.g. a certificate), verification harm and isolation due to the virus, for of identity (connecting the holder to that example those in care homes unable to see certificate) and authorisation for the purpose relatives. of allowing or blocking actions (a pass). • Economic benefits – supporting industries (and the wider economy) struggling Most passport models currently focus in lockdown by enabling phased opening, on displaying a vaccination status (rather than for example in entertainment, leisure and a more granular or ‘live’ assessment of risk, hospitality. which might incorporate other information) so this was the primary focus of our discussions. Technology companies across the world are However, many of the points below also relate developing tools and standards in expectation to other passport models, including those that vaccine passports and COVID-19 status based on negative COVID-19 antigen tests and apps could become instrumental to a move tests showing after infection. from national lockdowns to a more open and mobile society. There are intuitive attractions to the idea of a vaccine passport in relation to the hope that IBM has launched Digital Health Pass, a better balance could be found between integrated with Salesforce’s employee economic activity and community safety, management platform Work.com. by allowing a more fine-grained and targeted CommonPass, supported by the World set of restrictions than sweeping measures Economic Forum, and the International Air or national lockdowns. Transport Association (IATA)’s Travel Pass are both being trialled by airlines. Ada Lovelace Institute COVID-19 vaccine passports and society 3

The Linux Foundation Public Health’s In the UK, the Government has yet to take COVID-19 Credentials Initiative and the a clear position on whether to introduce Vaccination Credential Initiative, which vaccine passports, domestically or for includes Microsoft and Oracle, are pushing for international travel. The Government has open interoperable standards. A marketplace said there aren’t current plans to introduce of smaller, private actors has also emerged vaccine passports but some ministers have offering bespoke solutions and infrastructures. left the door open to digital passporting schemes when circumstances change. The Since the start of the pandemic, a number Government appears to be keeping its options of countries have demonstrated interest open by funding a number of startups piloting in some form of ‘ passport’ based similar technology and reportedly instructing on natural immunity and antibodies after officials to draw up draft options for vaccine infection with COVID-19 (including Germany certificates for international travel. and the UK, and a pilot in Estonia), but a lack of evidence about the protection acquired Given its comparatively high vaccination rate through natural immunity meant few schemes – and high infection rate – the UK may be one were used in real world scenarios. of the first countries to have vaccinated a sizeable proportion of the country (currently The World Health Organisation (WHO) put a fifth of their population has received at least out a clear statement saying there was ‘not one dose) while remaining in national lockdown enough evidence about the effectiveness with schools closed, many workers furloughed, of -mediated immunity to guarantee and international and most domestic travel the accuracy of an “immunity passport” banned. How the UK manages the challenge or “risk-free certificate”,’ and that ‘the use of a transition out of lockdown is therefore of such certificates may therefore increase the likely to be of international interest. risks of continued transmission’.

The approval and roll out of effective have re-energised the idea of restoring personal freedoms and societal mobility based on certification of COVID vaccination. A number of countries have made explicit calls for the development of such a tool. The WHO has shifted their stance by announcing plans to develop a digitally enhanced International Certificate of Vaccination and established the Smart Vaccination Certificate consortium with Estonia. Ada Lovelace Institute COVID-19 vaccine passports and society 4 Deliberation findings

1. Governments must act urgently At present, vaccination status does not to create clear and specific guidelines offer clear or conclusive evidence about any and law around any uses, mechanisms individual’s risk to others via transmission. for enforcement and methods of legal Vaccination status can never offer absolutely redress of vaccine passports. conclusive evidence of an individual’s risk to others (or their own risk), since no vaccine The evidence around transmission will will be 100% effective for 100% of recipients. develop, and that information must continue to inform future decision making. It seems 3. Passport systems would need likely that national requirements put in place to be flexible if they are to address by some countries will trigger the need for the development of mutations, such internationally accepted certification, and as the E484K mutation, found in South many systems are in development. While African, Brazilian and now UK variants some experts felt any form of digital vaccine of COVID-19, which is thought likely passport could not be justified due to the to reduce the efficacy of vaccines. risks they pose (below), the expectation from the group is that some form of vaccination These variations make it unlikely that certification will emerge, and therefore that a single COVID-19 vaccination ‘status’ would general prohibition is neither desirable nor be relevant to all countries or be of a standard achievable. Letting practice emerge via and fixed duration. private users and private markets will heighten a number of the risks outlined below. These mutations make understanding of vaccination effects on individual 2. Digital passports should not be rolled transmission a moving target, as vaccines out while so much is unknown about must be assessed against a changing COVID-19, particularly the effect background of dominant strains within the of different vaccines (and vaccination population. While booster against regimes) on transmission, the duration variants may manage the issue of strains of protection and the generalisability this will raise questions about the degree of those effects. of vaccination sufficient for passports and the duration of validity of the passport will The primary justification for sharing personal remain dynamic in response to developing information with a third party that would affect scientific understanding rather than a fixed rights and freedoms at an individual level date of issue. is that it would allow that third party to protect themselves from serious harm. In other words, the vaccine passport is premised on the assumption that my vaccine status tells you something about the risk I pose to you, not simply the risk I face from COVID-19. Ada Lovelace Institute COVID-19 vaccine passports and society 5

4. Governments should identify specific 5. If the Government allows or actively priority use cases for detailed facilitates the use of digital vaccine consideration of whether they justify passports, they must address the selective rights and freedoms based issues and risks arising from such on vaccination status, and if so, the best schemes or the creation of related digital mechanisms for those schemes. infrastructure, and whether and how these risks could be mitigated. Particularly urgent use cases to consider are international travel, key frontline workers Some of these issues and risks are near-term (especially in health and care, and education), concerns. Others are longer-term issues about and access to employment generally. how such systems might become embedded Secondary use cases include access and reshape society beyond the pandemic. to hospitality or leisure venues. Governments should actively shape their society’s choices Immediate risks around these use cases. 1. Undermining public health by treating At least some of these may be satisfactorily a collective problem as an individual one addressed by updating existing mechanisms, rather than building a new system of passports Digital vaccine passports could potentially and digital identity. For example, there are undermine other public health interventions already mechanisms in place to ensure that and suggest a binary certainty (passport individuals are properly protected at work. holders are safe; those without are risky) that One of the most prominent examples in health does not adequately reflect a more nuanced settings is the Green Book on immunisation, and collective understanding of risk posed and which covers requirements for vaccination faced during the pandemic. in high-risk environments. Further, existing safeguarding and ‘fit and proper person’ It may be counterproductive or harmful requirements allow employers to require to encourage risk scoring at an individual level employees to demonstrate that they can when risk is more contextual and collective be safely employed. In a non-health context – it will be national and international herd this might include confirming that they have immunity that will offer ultimate protection. not been convicted of relevant offences Passporting might foster a false sense through the issue of a Disclosure and Barring of security in either the passported person Service (DBS) certificate; if deemed legally or others, and increase rather than decrease permissible, a similar service could provide risky behaviours. one-off checks for vaccination status. Ada Lovelace Institute COVID-19 vaccine passports and society 6

2. The opportunity cost of focusing 4. Exacerbating inequalities within societies on vaccine passports Existing distrust of the state, identity There will be opportunity costs to focusing infrastructure and vaccines are also on vaccine passports rather than other expected to put some groups at a particular interventions. There may be a comparatively disadvantage. Access to digital technology, narrow window where there is scientific forms of identification, tests and vaccines confidence about the impact of vaccines is already unequal, and vaccine passports may on transmission and enough of a vaccinated unintentionally mirror and reinforce existing population that it is worth segregating rights inequalities without wider programmes for and freedoms. Once there is population- addressing health inequalities. level herd immunity it will not make sense to differentiate and passports would 5. Increasing inequalities between nations be unnecessary. International cooperation will be necessary, Passports may be a tempting distraction. particularly for schemes enabling international They bring political, financial and human travel. But scientific concerns could quickly capital costs that must be weighed against become geopolitical ones, with countries their benefits. They might crowd out more using recognition of (and access to) vaccines important policies to reopen society more as a form of political power and influence. quickly for everyone, such as by vaccine There is pressure on governments to acquire rollout and test, trace and isolate schemes, vaccine supplies, which in turn triggers and other public health measures. a form of ‘vaccine nationalism’ – where richer countries are able to buy up supplies 3. Exacerbating distrust by marginalised of vaccines where poorer ones can’t. groups and increasing vaccine hesitancy Tying movement to vaccine certification could It has been argued that one of the benefits supercharge protectionism and entrench of vaccine passports is to encourage existing global inequalities. International uptake of COVID-19 vaccines. In the UK, friction is unhelpful when vaccination is, which has already seen over 90% uptake ultimately, a global public good. Any individual of first doses in theover 75s and elderly country’s fate is tied to reaching international care home residents and where nearly herd immunity as we are seeing with emergent 90% of unvaccinated adults say they would new strains. be vaccinated if available, it is not clear there is much additional benefit to be gained by further incentivising vaccination.

However, there is a downside risk that it could reduce trust and increase vaccine hesitancy if the scheme is seen as introducing mandatory vaccination by the back door. This may be particularly acute amongst marginalised groups who may already have greater levels of mistrust, such as Black and Asian communities, who are already seeing lower rates of vaccine uptake. Ada Lovelace Institute COVID-19 vaccine passports and society 7

Future risks 7. Scope creep and information flows 6. Normalising health status surveillance by creating long-term infrastructure There were particular concerns in the expert in response to a time-bounded crisis group that digital identity systems could be introduced as part of an emergency It is likely that SARS-CoV-2 (the virus that infrastructure, but used for different causes COVID-19) will become endemic, like or expanded purposes. The wider merits seasonal flu and other infectious disease- of digital identity systems (for example) must causing pathogens (or even better contained, be disaggregated from the immediate health like measles, or even eliminated), at which context and considered in their own right. point it will no longer require the emergency and intrusive measures justified by its present Concerns were raised about how information transmissibility and fatality. Accepting this might be used more broadly than was as a reasonable scientific expectation for intended. Information might flow to third the near future, raises concerns about the parties, and personal data may be repurposed. longevity of emergency apparatus, and that Even with the most privacy-preserving such infrastructure – once built – will not technology, the expectation is that health be stripped back. data will be viewed by different actors, from healthcare settings, employers, clients, police Reference was made by the expert group and pubs to insurance companies, who to post-9/11 security infrastructure at airports, may have different levels of experience and and the once-limited but now essentially trustworthiness in handling personal data. mandatory Aadhaar identity system in India. There was pessimism about the likelihood of vaccine-passport technologies being ‘switched off’ once the crisis has passed. Building these roads could lead to path dependency: once an infrastructure exists, it will make certain future choices more favourable and block others. ‘Once a road is built, good luck not using it,’ as one participant put it. This might be a particular issue if the status of other health conditions were to be added.

The current uncertainty, ongoing social anxiety and economic cost of the pandemic makes the technical fix of a novel tool and emergency infrastructure seem attractive, but the starting point should be identifying specific problems and looking at whether and how these could be addressed through existing practices and laws. Ada Lovelace Institute COVID-19 vaccine passports and society 8 Next steps

Drawing on this expert deliberation, the They should evaluate the adaptation Ada Lovelace Institute has laid out some of existing mechanisms as well as a new recommendations for the UK Government. system of passports and digital identity. This will necessitate engaging Urgent domestic use cases are likely in wider conversations with other national to include the deployment of frontline workers governments, and we anticipate that many (particularly in health and care, and education) of these recommendations will be applicable and access to employment in general. in other national contexts. 3. Offer urgent clarification on the current 1. Set scientific pre-conditions legal status of the development and use of vaccine passports, in particular with To move forward, governments should have regard to data protection, equality and a better understanding of vaccine efficacy and discrimination, health and safety and transmission, durability and generalisability, employment law and evidence that use of vaccine passports would lead to: Developers of vaccine passports should not be in the position of also developing a. Reduced transmission risk the rules for where these systems should by vaccinated people – this is likely be implemented, nor are they taking to involve issues of risk appetite, as the responsibility for enforcing local law. risk of transmission may be reduced but will probably not be nil Currently, developers are operating under b. Low ‘side effects’ – that passporting the assumption that governments will provide won’t foster a false sense of security protections against unlawful or unethical use, in either the passported person and will enforce such restrictions. This does or others, which might lead not reflect reality. Governments must develop to an increase of risky behaviours clear guidelines, which will take time to do (not following required public health effectively. measures), with a net harmful effect. 4. Consult a wide group of experts and 2. Identify the urgent use cases so that perspectives the benefits and risks can be assessed if these pre-conditions are met As well as the experts from health, social sciences, law, ethics, technology and other Governments should consider a cost/ disciplines involved in our deliberation, benefit analysis of each specific use case. Government will need to understand the This includes assessing the likely impact perspectives of those involved in the on transmission risk, economic activity practical implementation of any use case, and social inequality if selective rights e.g. employers and industry bodies, unions, and freedoms were to be based public health experts and system leaders, on vaccination status. those working on vaccination programmes, software developers, groups working on open standards, local elected officials etc. Ada Lovelace Institute COVID-19 vaccine passports and society 9

This understanding is a necessary condition 6. Work through the World Health for both policy development and effective Organisation on international public engagement. travel use cases

5. Engage publics on any potential uses A key use case of vaccine passports is for to understand impacts, build trust and international travel. The UK has already played legitimacy, and understand what trade- an important role in championing global offs the public is willing to make vaccinations through early and significant contributions to GAVI and COVAX. It should The issues raised by vaccine passports should continue to seek international agreement be subject to proper public deliberation, on international travel passports, engaging engagement, co-production and evaluation with the World Health Organisation, who that goes beyond superficial opinion polling. are already coordinating efforts and will The deliberation should focus on issues have greater access to scientific evidence broader than passports, such as the public on developments globally. health response to COVID-19 in general and how people think vaccination data International standards will be vital for should be used. interoperability. Different countries leading different discussions outside the WHO’s This could be done in partnership with civil efforts will only heighten the difficulties society groups with relevant expertise. It will of international coordination and frustrate be essential to engage with those groups who attempts to define standards. The UK should are likely to face disadvantage, discrimination champion the WHO as the more appropriate or unique/particular risks through the roll and legitimate venue to make decisions about out of such technologies, including but not international travel passports and have expert limited to: input to wrestle with the scientific evidence (particularly on risk around mutations), and a. Those in insecure work or currently take a global view. unemployed b. Those with insecure or invalid 7. Identify and mitigate risks through citizenship status policy measures, technical design c. Those unable or unwilling to have and governance infrastructure prior the vaccine to proceeding with schemes d. Those who face historic or continuing over-surveillance.2 This will include careful consideration of the practicalities and security of any scheme and resources required – considering where responsibility and accountability for collecting, managing, securing and sharing data resides, and to what extent data minimisation is possible.

2 See current Ada Lovelace Institute project with the Health Foundation on public engagement about COVID-19 technologies and health inequalities Ada Lovelace Institute COVID-19 vaccine passports and society 10

Consider the costs and benefits of paper- based versus digital solutions, and novel infrastructure against existing structures that might be developed through existing health and safety procedures in high-risk occupations (see Chapter 12 of the Green Book); such as a one-off consultation akin to the DBS or Electronic System for Travel Authorisation.

Explore policy measures at a domestic and global scale that could adequately counteract and mitigate the risks and issues outlined above, for example: employment benefits for those unable to work; international requirements about vaccine coverage; defining clear and limited purposes of any vaccine passport with strong legal protection for data subjects; and socio-technical design principles. Ada Lovelace Institute COVID-19 vaccine passports and society 11

About this report • Sanjoy Bhattacharya is Professor This report is an interim summary of the in the History of Medicine, Director findings and recommendations from the Ada of the Centre for Global Health Histories Lovelace Institute expert deliberation, chaired and Director of the WHO Collaborating by Professor Sir Jonathan Montgomery. Centre for Global Health Histories at the A fuller report of the deliberation session will University of York. be available next month. • Sarah Chan is a Chancellor’s Fellow and Reader in Bioethics at the Usher We are indebted to the contributions of the Institute, University of Edinburgh. She experts who participated in this deliberation. is also Deputy Director of the Mason This report highlights conclusions from that Institute for Medicine, Life Sciences and collective conversation, acknowledging that Law, Associate Director of the Centre the group did not always arrive at a consensus, for Biomedicine, Self and Society and and the document reflects a majority view. a member of the Genomics England Ethics Individual findings have not been, and should Advisory Committee. not be, attributed to any specific individual. • Tracey Chantler is Assistant Professor of Public Health Evaluation & Medical Members of the expert group included: Anthropology at the London School of Hygiene and Tropical Medicine. She • Jonathan Montgomery (chair) is Professor is also a member of the Immunisation of Health Care Law at University College Health Protection Research Unit, London and Chair of Oxford University a collaborative research group involving Hospitals NHSFT. He was previously Chair Public Health England and LSHTM. of the Nuffield Council on Bioethics and • Robert Dingwall is Professor of Sociology Chair of the Health Research Authority. at Nottingham Trent University. He is • Danny Altmann is Professor also a Fellow of the Academy of Social of Immunology at Imperial College London, Sciences and a member of the Faculty where he heads a lab at the Hammersmith of Public Health. He sits on several Hospital Campus. He was previously government advisory committees, Editor-in-Chief of the British Society for including NERVTAG (New and Emerging Immunology’s ‘Immunology’ journal and Respiratory Virus Threats Advisory is an Associate Editor at ‘Vaccine’ and Group) and the JCVI (Joint Committee at ‘Frontiers in Immunology.’ on Vaccination and Immunisation) sub- • Dave Archard is Emeritus Professor committee on Covid-19. of Philosophy at Queen’s University Belfast. • Amy Fairchild is Dean and Professor He is also Chair of the Nuffield Council at the College of Public Health, Ohio State on Bioethics, a member of the Clinical University. She is also Co-Director of the Ethics Committee at Great Ormond Street World Health Organization Collaborating Hospital and Honorary Vice-President Center for Bioethics at Columbia’s Center of the Society for Applied Philosophy for the History and Ethics of Public Health. • Ana Beduschi is an Associate Professor • Matteo Galizzi is Associate Professor of Law at Exeter University. She currently of Behavioural Science at the London leads the UKRI ESRC-funded project School of Economics. He is also Co- on COVID-19: Human Rights Implications Director of LSE Behavioural Lab and of Digital Certificates for Health Status coordinates the Behavioural Experiments Verification. in Health Network and the Data Linking Initiative in Behavioural Science. Ada Lovelace Institute COVID-19 vaccine passports and society 12

About the Ada Lovelace Institute • Michael Parker is Director of the Wellcome Centre for Ethics and Humanities and The Ada Lovelace Institute was established Director of the Ethox Centre at the by the Nuffield Foundation in early 2018, University of Oxford. He is also a member in collaboration with the Alan Turing Institute, of the government’s Scientific Advisory the Royal Society, the British Academy, the Group for Emergencies, the Chair of the Royal Statistical Society, the Wellcome Trust, Genomics England Ethics Advisory Luminate, techUK and the Nuffield Council Committee and a non-executive director on Bioethics. of Genomics England. • Sobia Raza is a Senior Fellow at the Health The mission of the Ada Lovelace Institute Foundation within the Data Analytics team. is to ensure that data and AI work for people She is also an Associate and previous and society. We believe that a world where Head of Science at the PHG Foundation. data and AI work for people and society is a • Peter Taylor is Director of Research world in which the opportunities, benefits and at the Institute of Development Studies. privileges generated by data and AI are justly He was previously the Director of Strategic and equitably distributed and experienced. Development at the International Development Research Centre. We recognise the power asymmetries that • Carmela Troncoso is Assistant Professor, exist in ethical and legal debates around the Security and Privacy Engineering Lab development of data-driven technologies, and at the École Polytechnique Fédérale will represent people in those conversations. de Lausanne. She was a leading We focus not on the types of technologies researcher on DP-3T and is also a member we want to build, but on the types of societies of the Swiss National COVID-19 Science we want to build. Task Force’s expert group on Digital Epidemiology. Through research, policy and practice, • Edgar Whitley is Associate Professor we aim to ensure that the transformative of Information Systems at the London power of data and AI is used and harnessed School of Economics. He is co-chair in ways that maximise social wellbeing and put of the UK Cabinet Office Privacy and technology at the service of humanity. Consumer Advisory Group and was the research coordinator of the LSE Identity We are funded by the Nuffield Foundation, Project on the UK’s proposals to introduce an independent charitable trust with a mission biometric identity cards. to advance social well-being. The Foundation • James Wilson is Professor of Philosophy funds research that informs social policy, and Co-Director of the Health Humanities primarily in education, welfare and justice. Centre at University College London. He is It also provides opportunities for young also an Associate editor of Public Health people to develop skills and confidence Ethics and Member of the National Data in STEM and research. In addition to the Ada Guardian’s Panel and Steering Group. Lovelace Institute, the Foundation is also the founder and co-funder of the Nuffield Council on Bioethics and the Nuffield Family Justice Observatory.

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