Covid Immunity Passports: Legal? Ethical?

Absolutely fascinating debate taking place among bio-ethicists right now regarding ‘Immunity Passports.’ The premise is quite simple: if you’ve had Covid already and are not contagious or have had the vaccine, you can have a freedom of movement ‘immunity passport.’ These already exist in Hungary and Iceland, and other countries are starting to consider them as well.

One argument is that this would allow businesses to take a no muss, no fuss approach to who can and cannot work. This already exists to some degree in healthcare and education; no flu shot, no work for you. At the same time, there’s a high level of concern that those most in need of work would be less likely to have such a ‘passport,’ as it would require access, which most at risk populations don’t often have.

Lockdown restrictions are experienced unevenly by different people. While some are able to easily work from home, others will have lost their jobs or been furloughed. According to a survey conducted by the ONS, 29% of businesses reported laying off staff in the short term, with the accommodation and food services sector, the administrative and support services sector, and the arts, entertainment and recreation sector being the worst affected. In addition, people’s social interactions are likely to be significantly disrupted, with face-to-face interactions significantly reduced. Some individuals will be more or less able to relocate their social lives online; some will feel the loss of in-person socialising more acutely than others. Those living with domestic abuse may be at greater risk of violence, with some evidence that deaths from domestic abuse have increased during the lockdown period.

Immunity passports would create their own differential effects. If introduced, it is likely that immunity passport holders would be permitted freedoms such as increased travel outside the home, including travel to work. There is some concern that people are not seeking medical care for non-COVID-19 illnesses, for fear of contracting the virus in healthcare settings, or overburdening health services. Those tested and shown to be immune may be more willing to engage with healthcare and thus experience better health in the longer term. Since immunity passport holders would be assumed at low risk of contracting or spreading the disease, they may be permitted to visit others for socialising, or asked to support key services (such as volunteering in the health and social care sector) that are suffering from a loss of staff due to sickness and self-isolation. It is likely that possessing an immunity passport would be a significant benefit, advantaging holders relative to non-holders.

The disparity between the freedoms permitted to immunity passport holders versus non-holders could be deemed unfair. On a simple model of fairness, that requires all people to be treated the same in a strict sense, this would indeed be the case. We should, however, consider whether such a simplistic model of fairness is appropriate, and further, the extent to which we are willing to privilege fairness above other values (such as benefits to individual well-being and economic recovery).

https://jme.bmj.com/content/46/10/652