Go back to work, to travel, to have a social life, under one condition: having developed the antibodies against COVID-19. It is not the scenario for a new style film Contagion, but the dangerously close reality that could emerge, if the idea of using an immunity passport as a pass for the cohabitation phase with the coronavirus SARS-CoV-2 spread. Any document that limits individual freedoms on the basis of a biological condition risks becoming an instrument of discrimination and creating problems for public health rather than protections.
A commentary article published on Nature illustrates 10 scientific, ethical and practical reasons why relying on such a license would be harmful, counterproductive and detrimental to some fundamental rights. Below is a summary of these reasons.
1. We don’t know enough about COVID-19 immunity. More and more studies suggest that all patients returning from COVID-19 develop antibodies, but it is not clear what the level of immune response to reach to be protected from a new infection, nor how long an immunity lasts. If the protection from COVID-19 in the healed were similar to that which the body uses against SARS and MERS coronaviruses, it could last one or two years; but if it were closer to that developed against cold coronaviruses, it would only cover for a few months.
2. Serological tests are not always reliable. As we have mentioned on other occasions, serological tests are a valid tool for verifying the spread of COVID-19 within a population, but they are less reliable for the individual diagnosis of contact with the infection. They can sin of low specificity, and therefore measure antibodies other than those developed against SARS-CoV-2, with the risk of false positives; or low sensitivity, and need high quantities of SARS-CoV-2 antibodies to diagnose the infection (with the risk of false negatives in people with few antibodies).
3. We should be able to test the entire population. And do it at least twice for each person, to monitor each person’s immune situation, which with the pandemic still going on could change at any time. In a situation where even the essential workers and those who are certain they have had COVID-19 struggle to obtain tests and swabs, ascertaining the immunity of each seems an unlikely goal.
4. It is not possible to revive the economy with the only “healed”. According to the WHO, only 2-3% of the world population would have contracted COVID-19; even in the places most affected by the pandemic, the percentages of people who have developed antibodies to SARS-CoV-2 fluctuate between 14% and 30%. The majority of the population remains vulnerable to new coronavirus infection, and it is unthinkable to try to restart economic activities by sending only those who have already encountered the virus to work first, as sometimes assumed. At the same time, a restaurant or bed and breakfast could not think of standing up by accepting only customers who have contracted COVID-19 and are cured.
How many have contracted COVID-19? A study
5. A digital license would be detrimental to privacy. To control movements and to be updated, but also to reduce the risk of counterfeiting, an immunity passport should necessarily be digital. However, such an electronic document would expose you to high privacy breach risks, because it would reveal everyone’s location and travel history, recent contacts and stores visited. Already now, in some Chinese provinces, access to public places is regulated by QR codes that communicate the health history of each one, a tracking system that could survive the pandemic and remain in use even afterwards.
6. The freedom of minorities would be at risk. Racial, sexual or religious minorities would be subject to greater profiling activity. Discrimination incidents have already surfaced during the pandemic: China has been accused of forcing African-born residents to undergo tampons for COVID-19, while in other parts of the world, including Italy, there have been several episodes of intolerance and mistrust towards people of Asian origin. In New York, during the pandemic, anti-gathering checks were aimed more frequently at African American people. An immunity passport could be used as a segregation tool and pretext for monitoring certain segments of the population.
7. access to tests would not be the same for everyone. The lack of available tests or the willingness of some States or Regions to make them pay would create, as they already do now, profound inequalities in access to these tools. It could happen (it has already happened) that a richer and more privileged production category has the possibility to receive tests and swabs regularly, while workers who guarantee the arrival of food on our tables and who come into contact with hundreds of people every day must to fight for the right to a diagnosis.
8. A new social stratification would form. In the absence of a vaccine that is free and available to all, the diffusion of an immunity passport would favor the division between “immuno-endowed” who have already passed the COVID reef and “immunoprivates” who have not yet contracted it (luckily, because not they had the economic chance to find out or because they were loyal to the various lockdowns). This division would amplify the reasons for social division and also the tensions between the different States. Already today, HIV-positive people face restrictions in the freedom to move, live and work in countries where laws that violate the sexual freedoms and rights of gender minorities are in place, such as Egypt, Qatar, Russia or Singapore.
9. It would open the way to new forms of discrimination. Digital platforms for immunity to SARS-CoV-2 could one day be used to record other data on individual health, for example those relating to certain genetic conditions or the history of mental illness. Employers, insurance companies and law enforcement agencies may access this data and use it for instrumental purposes.
10. New public health problems would arise. In order to regain fundamental rights, COVID-19 vulnerabilities could voluntarily expose themselves to contagion (some COVID-parties were reported in various states during the pandemic). The need to earn an immunity passport would increase the risk of counterfeiting and would push individuals still vulnerable to the virus to pretend to be healthy and expose themselves to highly contagious situations, with foreseeable consequences on epidemic outbreaks.
it is necessary to join forces. Focusing on a divisive tool such as the immunity passport distracts from the most effective efforts to contain the pandemic, such as investing in positive tracking operations and the reconstruction of contagion chains, and devoting oneself to the development of a universal vaccine accessible to all. If in fact a vaccine was finally reached, but its distribution was not fair, the risks exposed so far would still arise.