Global Vaccine Equity Is Much More Important Than ‘Vaccine Passports’

Editor’s Note (12/21/21): This article is being showcased in a special collection about equity in health care that was made possible by the support of Takeda. The article was published independently and without sponsorship.

As the U.S. and U.K. vaccinate their populations much faster than initially anticipated, two disparate concepts have been swirling online in English-language vaccine discourse: the moral need for global vaccine equity and the consumer-driven desire for vaccine passports.

I am a much bigger fan of creating global vaccine equity—by breaking intellectual property patents if necessary—to suppress the level of SARS-CoV-2, the virus that causes COVID-19, in as many humans as possible as quickly as possible across borders than I am a fan of creating vaccine passports that only allow those with the privilege of getting a vaccine to cross borders. Borders in some countries are currently being used to determine who does and doesn’t get a vaccine. It would be even more unethical to use those borders to bar the movement of people who have been denied vaccination.

As Stefan David Baral, Jean Olivier Twahirwa Rwema and Nancy Phaswana-Mafuya recently wrote in the BMJ, “being a citizen of certain countries grants people access to nearly the entire globe, whereas others face challenges just to legally leave the borders of the country they live in, even during times of conflict.” Not coincidentally, people in high-earning-income countries also have much greater access to vaccines than those in poorer countries with less mobility. But the idea that one “needs” to go on vacation or attend an academic conference abroad at this point in the pandemic is morally unjustifiable. This is especially true if you are traveling to or from a place where you know others do not have access to vaccines—and you want a special piece of paper proving that you do, which would allow you to cross the border.

While we should celebrate the fact that a half-billion doses of COVID vaccines have been administered globally, more than seven billion people have not received a shot (and may be months or years away from receiving one). As long as this remains the case, vaccinated Americans, Canadians and Europeans have no reason to want a passport to jet around the world for fun (or even for nonessential work). In February 2021 the governments of some rich countries opposed a plan at the World Trade Organization to waive intellectual property rights on COVID vaccines and medicines so that countries in the Global South could manufacture them as quickly as possible.

It is morally reprehensible (not to mention epidemiologically self-defeating) that countries can prevent vaccines from crossing their borders and want their own citizens to be able to cross those borders and travel to countries that are denied vaccines—and then use the threat of infection to keep the people of those unvaccinated countries inside them.

Vaccines are largely state administered and controlled. In addition to keeping vaccines within their borders, countries can control who receives vaccines and who doesn’t within those borders. Vulnerable populations are often denied vaccines this way. For instance, Israel has not distributed vaccines to Palestinians living in the West Bank and Gaza Strip—except for a small minority of workers—despite the fact that they live in conditions that put them at high risk. Meanwhile, after incarcerated people in New York State had been denied vaccines, a judge ruled in late March that Governor Andrew Cuomo’s COVID policies had “irrationally distinguished between incarcerated people and people living in every other type of adult congregate facility, at great risk to incarcerated people’s lives during this pandemic.”

Vaccine denial creates a viral divide, with the most privileged on one side and the most vulnerable on the other. Despised minority groups living in despotic regimes are not likely to get vaccines. Creating a passport that is granted to privileged groups and denied to vulnerable populations could exacerbate polarities with profound consequences—for example, for marginalized groups fleeing from war or conflict situations and for creating carceral infrastructure that is hard to predict but will be with us for decades. This would be true if such a passport were used to cross borders or were required domestically for public transit, shopping or other common spaces.

These competing ideas—whether we are rushing to get everyone across borders vaccinated as soon as possible or rushing to get passports so those on the upper side of the viral divide can “get back to normal” and cross borders for pleasure—are in conflict. The language we use is also important. A vaccine passport conflates the notions of biology, nationalism and surveillance; it builds on and passively accepts the ethics of passport privilege in general. This is the belief that those with citizenship in certain countries should be able to enjoy privileges within them (such as unemployment insurance) that people without citizenship should not and that the world should cater to our comfort in crossing borders even in matters of trivial fun. At the same time, passport privilege means the same borders some of us cross for leisure are used to deny entry to people in the countries we visit who may be fleeing from crises such as war, famine, climate catastrophe, political persecution, sexual violence or economic ruin. Creating a viral divide would lead to an increased biological surveillance (on everyone) that would become irrelevant if everyone was vaccinated.

Similar to “immunity passports”—the dubious historical practice of sending people who survived and became inoculated against illness into public life—the concept of vaccine passports is based on immunoprivilege. As Kathryn Olivarius, an assistant professor of history at Stanford University, wrote at the beginning of the pandemic in the New York Times, “when people with immunity to a deadly disease are given special treatment,” what happens “isn’t pretty.”

“There is already racial and geographic inequality in exposure to and testing for this virus,” Olivarius wrote. “The most vulnerable people in our society cannot be punished twice over: first by their circumstance and then by the disease.” The same is true for vaccination: it is unfair to punish people for having a vaccine withheld from them and then withhold their mobility while those with a passport could move freely.

What if our goal was to do away with vaccine nationalism and immunoprivilege because everyone was free of worry from COVID-19? Wouldn’t that be a more noble goal than conferring passport privilege on some and denying it to others? And wouldn’t that make more sense with an airborne pathogen?

At the same time, could we still have vaccine records? Absolutely. They are helpful for managing public health, and they are especially good to have before people spend time in congregate settings (such as schools, camps, dorms and nursing homes). A vaccine record is a very different concept than a vaccine passport, however. The two approaches evoke different modes of enforcement, privilege, militarization and legal architecture.

Vaccination is a collective project, and none of us are vaccinated until all of us are vaccinated. We don’t need to create status for some to travel abroad in 2021; we need everyone abroad and at home to be vaccinated in 2021 in order to render the vaccine passport moot.

This is an opinion and analysis article.