Low endorsement among doctors worldwide for COVID-19 ‘immunity passports’

For several months, scientists have been talking about the use of golden COVID-19 passports – so-called “immunity passports” – to allow populations who have recovered to re-enter normal social and economic activity. However, a recent study shows that most doctors worldwide think that there is not enough evidence for this step. Moreover, other issues complicate its implementation, including fears about privacy issues, fraud and discrimination.

The study, published on the preprint server medRxiv* in November 2020, was a cross-sectional survey conducted in September 2020, aimed at assessing the views of a randomly selected, stratified physician sample on this matter, drawing names from physicians registered with the global networking platform called Sermo. This offers its registration service to verified licensed physicians.

The question asked of them was whether they thought there was sufficient knowledge of COVID-19 immunity and the duration of protection at the time of the study, such that digital immunity passports could be considered.

These digital immunity passports are being thought by some researchers to be potential proxies for the presence of neutralizing immunity against COVID-19, allowing the bearer to return to in-person workspaces or to travel without prohibitions. These are based on the presence of neutralizing antibodies, and can be verified via an app or QR code.

The use of such passports could help travelers cross national/regional/international boundaries, and workers could return to their employment, without putting others at risk. Those who favor this step point to the value of such passports in allowing people who are immune to avoid the restrictions indiscriminately imposed on all at present, as well as permitting those with the passports to move freely.

The current study used a form completed by over 1,000 physicians worldwide, from 40 countries and 67 specialties. Half of them were practicing in clinical specialties and handling frontline patients. Their median age was 49 years.

Over half of them (52%) said they felt there was not enough proof for such a provision to be implemented, while less than 30% said they agreed with this step. There was some regional disparity in their responses, with up to 35% of physicians in the EU agreeing that this measure was backed by adequate proof, but 60% of US physicians disagreeing with the idea.

Most physicians, even in Asia and the US, failed to support this plan at present. The reason could be, according to the researchers, that most physicians nowadays are busy managing the current burden of illness and death as the second wave has already hit many regions of the world. This daily struggle does not equip them, unlike ethicists, to ponder the relative importance of recreational travel in normal life, occupied as they are with saving the lives of patients stricken with this illness.

The authors comment, “For a physician workforce faced with daily demands of patients with COVID-19, treatment is a real-time priority and the idea of patient travel is more focused on sending them home from the hospital healthy (rather than sending them off for travel).”

On the other hand, the development of vaccines and the freedom of people to travel across borders are part of the community good. Of course, quality of life is inextricably linked to a healthy global population that can support a high-functioning global economy. Those who have recovered from the illness are one category of healthy people, under the current conditions, while those who are vaccinated and therefore protected against it form another category.

Both categories will seek a return to traveling for many reasons, whether to visit friends and families, to carry out their legitimate business or other interests, for reasons related to their health or that of others. The current trials will therefore be very important in providing answers to many questions about the immunology of COVID-19.

Earlier discussions have presented some of the disadvantages of such immunity passports include the uneven standards of accuracy of serologic tests, the incomplete state of knowledge as to whether individuals with protective immunity can still pass the virus on to others, and whether mild or asymptomatic infection is also protective, among other important areas.

Another area of unresolved discussion is whether the immunity passport should be based on vaccination-derived immunity, and whether vaccines can be extended uniformly to everyone, in that case. A whole other realm of argument centers on its ethicality and the dangers of reinforcing the supremacy of white and wealthy nations over the rest of the world, or of creating the risk of worker coercion and stigmatization.  

The researchers conclude, “Our findings suggest a current lack of support among physicians for immunity passports. It is hoped that ongoing research and vaccine trials will provide further clarity.”

*Important Notice

medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.

Journal references:
Dr. Liji Thomas

Written by

Dr. Liji Thomas

Dr. Liji Thomas is an OB-GYN, who graduated from the Government Medical College, University of Calicut, Kerala, in 2001. Liji practiced as a full-time consultant in obstetrics/gynecology in a private hospital for a few years following her graduation. She has counseled hundreds of patients facing issues from pregnancy-related problems and infertility, and has been in charge of over 2,000 deliveries, striving always to achieve a normal delivery rather than operative.

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