Health Passports: Liberty or Stigma?

Should we accept the development and use of health passports in order to regain liberty and reactivate the economy, or should we resist?

Governments across the world are discussing the creation of health passports to help people return safely to work and leisure following Covid-19 lockdowns.

Holders of a health passport would be subject to fewer travel and social restrictions and would be allowed to undertake activities that require close physical contact.

However, health passports may also lead to a two-tier society and stigma toward those who do not hold one.

Should we accept the development and use of health passports in order to regain liberty and reactivate the economy, or should we resist?

What is a health passport?

A health passport, also referred to as an immunity passport or an immunity licence, would certify that you the holder had been infected with and developed immunity to the SARS-CoV-2 virus, or following development, have received the appropriate vaccination.  When you have immunity to the virus you will not spread the Covid-19 illness, nor contract it.

Why would a health passport be important?

Social movement and interaction has been severely restricted due to the global spread of Covid-19.  Holding a certified health passport would enable someone to work in services that require close personal contact.  This includes rest-home workers and health professionals where the risk of infection could have devastating consequences to others. It also includes the food supply and hospitality industries, hairdressers and many more. In this way, the advent of health passports could increase the liberty of some people, offer protection to the vulnerable and help stimulate economic recovery.

Immunity to contracting or spreading Covid-19 would also confer freedom to travel to national and international regions that have become Covid free.  As New Zealand works steadily toward elimination of the Covid-19 illness, our borders are closed.  This is having a dramatic impact on New Zealand’s $12 billion tourism industry.  However, we do not want tourists to bring Covid-19 back into New Zealand.  Currently all people entering New Zealand must undergo a compulsory 14 day quarantine.  This is not very practical for tourists – who visits a country to spend the first 14 days of their holiday in one hotel room?  Should we require that tourists can demonstrate that they are immune to the virus before we allow them across our borders?

And if it is reasonable for New Zealand to require health passports for visitors, it is surely reasonable for other countries to expect the same of New Zealanders who wish to travel overseas.  Given that a very low number of New Zealanders have had the virus and therefore there a very low rates of natural immunity in the NZ population, New Zealanders wishing to travel overseas will be at a disadvantage until a vaccine is developed.

As governments, including those of Estonia, Italy, Chile, Germany, and the United Kingdom begin addressing questions including

  • What form will a health passport take?
  • How will a health passport/licence be obtained?
  • Who will the regulatory agency be?
  • Will obtaining a health passport be free of charge?

the World Health Organisation has discouraged the development of health passports because so little is currently known about this new virus, including whether people who recover are immune to a second infection of Covid-19.  Further, to date there is an absence of a sufficiently reliable antibody test.

As work to understand how the SARS-CoV-2 virus interacts with the human body continues, it is essential that we consider the ethical and social implications of policies such as developing health passports at the same time.

Questions for discussion

Should health passports be introduced? What limits should be placed on health passports? Should the development of health passports be limited to the elimination of pandemics such as Covid-19?

If you were the owner of a business would you hire people with health passports in preference to those who do not have one?
If you didn’t, what implications for your business might this have? What are the implications of your answers for our future?

What implications are there with respect to health insurance, life insurance and general employment should health passports become an established part of our life?

Like contact tracing apps, health passports raise significant issues around personal privacy. Should personal privacy be sacrificed in order to slow down or prevent the transmission of illnesses such as Covid-19.

Is there any way to stop health passports being introduced?

Levels of lockdown, impact a person’s ability to interact with loved ones and friends; to attend work and school; to shop ‘normally’; to participate in leisure activities; and to receive treatment for non-Covid illnesses. There is also the impact on the economic wellbeing of individuals and communities. Given these considerations, that we cannot rule out a resurgence in Covid-19 cases necessitating further lockdown and that this is the first but not the last pandemic that will occur, can we justify NOT developing and using health passports?

What do you understand by the value of ‘fairness’? Would health passports be ‘fair’? Would health passports promote ‘fairness’ in our community?

Ironically, those of us who have been careful and have not been infected will be the targets for enforcement. How fair is that?

What additional burdens might the advent of a health passport place on minority groups within a population?

If people who have recovered from Covid-19 are able to engage in activities that other people cannot, will this lead to a form of Discrimination?

Discrimination takes many forms. Consider divisions of workforce, where nurses and physicians who have immunity may be given different responsibilities to those who don’t have immunity. Is this a problem or benefit?

How would you avoid people who do not have a health passport becoming stigmatised?

How would you prevent people holding Covid-19 parties in order to deliberately become infected in order to gain a health passport?

If a Covid-19 health passport is developed, what other illnesses and conditions that may limit a person’s civil liberties and opportunities might require licenses in the future?

Activities

University of Pennsylvania Professor Ezekiel Emanuel points out that we already certify people to do certain things related to public safety, for example to drive a car. People are tested and distinctions are made.

In New Zealand, for example, you may apply for a licence to drive a motorcycle, a car, a medium or a heavy vehicle. You are permitted to drive because you have been tested and certified ‘safe’.

Draw a T-Chart and explore the similarities and differences between a health/immunity passport and a driver’s licence.
Do you think the analogy is valid? Why? Why not?

Professor Ezekiel makes his driver’s licence analogy in an article he co-wrote and published recently.  What comment are the author’s making?

What are you thinking as you finished reading the article?

If you had a chance to ask Professor Ezekiel a question, what would it be?

The authors have attempted to answer criticisms they anticipated would arise as people read their article.  What criticisms of their argument for health passports have they overlooked?

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