Proof of vaccination wades into ‘murky territory’ ethically, experts say

Click to play video: 'Christine Elliott answers question regarding proof of COVID-19 vaccination'
Christine Elliott answers question regarding proof of COVID-19 vaccination
WATCH: Christine Elliott answers question regarding proof of COVID-19 vaccination – Dec 8, 2020

Ontario — like the rest of Canada — has no plans to mandate the newly approved coronavirus vaccine.

It does, however, have plans to provide immunized Ontarians a document or card to prove it.

While still only in development, the province’s health minister said the card could be used for travel and work, but also communal spaces like movie theatres or “any other places where people will likely be in closer contact.” The idea is that restaurants, theatres and offices could reopen with confidence by admitting those certified as vaccinated.

But with widespread vaccination months away, experts say the plan has holes.

“This is not only logistically challenging but very ethically fraught,” said Alison Thompson, a professor with the University of Toronto’s Joint Centre for Bioethics, which has been advising Ontario’s Health Ministry on other elements of pandemic planning.

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“Simply giving someone a piece of paper to say they’ve been immunized is a lot different from making it a prerequisite for attending a concert or riding the transport system.”

Ethical challenges

There are still a lot of unknowns about the vaccine that need to be considered before a plan like this holds weight, experts say.

Click to play video: 'Talk of coronavirus ‘immunity passports’ in Ontario'
Talk of coronavirus ‘immunity passports’ in Ontario

It’s not yet clear whether the vaccines will provide true and lasting immunity to the virus, though so far it seems promising. It’s also unclear whether the shots will be as effective at preventing transmission as they were at reducing the severity of illness during clinical trials.

Though all signs point to the vaccines being highly effective, we don’t know how it’s going to play out long-term, said Thompson.

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“A card or certificate is not going to be a great way of determining someone’s immune status,” she said. “It would provide a false sense of security.”

It also creates “two tiers of people,” which comes with pitfalls both ethically and legally, said Kerry Bowman, a professor of bioethics and global health at the University of Toronto.

“When you get different people doing different things, it creates questions of justice,” he said.

That gets increasingly tricky depending on where it’s being applied, he added.

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“Market forces will drive a lot of this,” he said.

There’s no question proof of vaccination will be required to reboot international travel safely, Bowman and Thompson agree, and it may become imperative for front-line staff at hospitals or long-term care homes, but ethical problems could arise among private establishments.

“If an employer wants to make this type of document mandatory, that becomes a discrimination issue based on immune status for employability or returning to work,” said Thompson.

“All of this gets into some pretty murky territory ethically.”

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Click to play video: 'Coronavirus: Concerns raised in Ontario about concept of ‘immunity passport’'
Coronavirus: Concerns raised in Ontario about concept of ‘immunity passport’

Passport debate

The Ontario government has been relatively mum on how it plans to shell out its proof-of-vaccination card or document.

In an email to Global News, the Ministry of Health said the province is looking at options “for the possible tracking and surveillance of vaccines” that could include “tech-based solutions,” as well as equitable options.

The project is in its early days, a spokesperson said, adding that more details would be provided in the coming weeks “as vaccines are made available to more people.”

Ontario is far from the first to float such an idea. There has been a lengthy debate over the pros and cons of proof-of-vaccination cards, or so-called immunity passports, as a tool to combat the pandemic, of which several governments and industries have been a part.

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Britain — the first country to dole out shots this week — has denied any plans for a “vaccination passport.” However, the country’s vaccine minister has acknowledged that a phone app used for contact tracing may eventually be updated to include a person’s vaccine status, which businesses like bars, restaurants and other venues could use as a condition of service.

People in Ontario could also face “restrictions” at places like theatres and cinemas without a provincial document, according to Health Minister Christine Elliott.

Charles Weijer, a professor of bioethics at Western University, sees two problems with this, the first being that it would “seriously undermine critical public health measures.”

“If some people don’t have to follow the rules (because they’ve been vaccinated), that could undermine the willingness of others to follow those same rules,” he said.

“We won’t be taking off our masks in public any time soon… Public health measures work best when the rules are clear and apply to everyone.”

Click to play video: 'Coronavirus outbreak: Could immunity passports become the new normal?'
Coronavirus outbreak: Could immunity passports become the new normal?

The second issue is enforcement. There will likely be a large appetite from businesses to have all staff vaccinated and use that as a way to lure back customers, but experts say leaving certification in the hands of “cash-strapped businesses” is a bad idea.

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“While many businesses will act responsibly, bad actors will be rewarded with more business,” said Weijer.

But there will be people with valid reasons for an exemption to the vaccine, Thompson acknowledged. A plan like this could create more of a grey area, she said.

If Ontario is going to hand out proof-of-vaccination cards, the province would also need to provide a document or process for those with legitimate exemption reasons, she said.

“There are a whole host of logistical challenges to try and implement a system like this.”

Logistical challenges

A proof-of-vaccination system could also introduce a “worrying” level of surveillance, said Thompson, which is why responsible data collection should be top of mind for governments right now.

Canada does not have a national vaccine registry, and even at regional and provincial levels, experts concede “it’s really hard to track.” There is a heavy reliance on paperwork and forms, experts say, rather than a robust digital system.

Should Ontario’s proof-of-vaccination be tech-based, as suggested, a vaccine registry will be important, said Thompson. But there could be privacy concerns should the two become linked, she said.

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“There are really important limits that need to be discussed about how that data will be used and who it will be shared with, but we haven’t really seen anyone talking about that yet,” she said.

And if it’s not tech-based? Perhaps, a plastic identification card like a driver’s licence or health card?

“Then how do we make sure those things are legitimate?” Thompson asked. “That’s another huge problem with that kind of an approach to infection control.”

There will inevitably be settings where this is appropriate, the experts agree, but for now, it’s “a bit of a moving target.”

“Are we really going to need this?” asked Bowman. “I’m circling around to that… I don’t know.”

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