A nationally representative survey conducted in the United States suggests that the public is fairly evenly divided in its support of immunity certificates or “passports” to enable the selective lifting of restrictions placed on people during the coronavirus disease 2019 (COVID-19) pandemic.
Almost half (45.2%) of 1,315 respondents supported introducing the privileges, although more were in favor of private certificates than government passports.
“Social consensus will be difficult to achieve on the appropriateness of immunity privileges,” say Mark Hall (Wake Forest Schools of Law and Medicine, North Carolina) and David Studdert (Stanford University Schools of Law and Medicine, California).
Attitudes did not particularly vary according to political views and many other characteristics that typically mark divergent views over social and public health policies.
However, men were significantly more likely to be in favor of the privileges, as were non-Hispanic white and black individuals. Opposition was much lower among people who wanted the immune privileges themselves, while it was much higher among those who thought the privileges could damage the fabric of society.
Respondents were more supportive of the privileges being used to help people return to high-risk jobs or to attend large recreational events than to help people to return to work in general.
A pre-print version of the research paper is available on the medRxiv* server, while the article undergoes peer review.
The idea of immunity passports was first proposed in 2020
At an earlier stage of the COVID-19 pandemic, the idea of immune privileges was proposed as a means of lifting restrictions for recovered patients who are likely to have immunity due to previous infection with the causative agent – severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
The idea was quickly met with opposition, due partly to concerns about social fairness and partly to uncertainty over the extent and duration of any immunity acquired.
However, extremely few cases of reinfection have been reported to date, and recent studies suggest that even mild infection confers some level of protection. This evidence, together with the renewed implementation of COVID-19 restrictions, will likely see further calls for lifting restrictions on those with likely immunity.
What did the researchers do?
To gauge what the public’s attitudes might be towards these immune privileges, the researchers conducted a national online survey of 1,315 adults in June 2020, as the first round of restrictions were being lifted.
Participants were asked whether they support the idea of either government “passports” or private “certificates” showing COVID-19 immunity.
Multivariable logistic regression analysis was used to estimate associations between support and demographic characteristics.
What did they find?
Participants were fairly evenly split in their support of the immunity passes. Almost half (45.2%) supported the privileges, although fewer were opposed to private certificates (48.1%) than to passports authorized by the government (42.6%).
Respondents were more supportive of using the privileges to enable returns to high-risk jobs or attendance at large recreational events than to enable returns to work in general.
Multivariable analysis revealed that women were 36% less likely to support the privileges than men, while Hispanics and other ethnic minorities were 44% and 42% less likely to support the privileges than whites.
However, no significant differences in support were observed across other demographic characteristics that typically mark divergent views on social and public health policies such as age, socioeconomic status and chronic illness.
Views did not vary according to political affiliation
Support also did not significantly vary according to political affiliation and views about the government.
This finding is particularly noteworthy considering how deeply politicized so many aspects of COVID-19 public health policy have been,” writes the team.
Furthermore, the researchers say: “Of note, views about immunity privileges did not vary according to attitudes about the desirability of free markets and government intervention.”
However, levels of opposition were much lower among those who personally wanted a passport (24%) and much higher among those who thought the privileges would be damaging to the social fabric of their community (77.1%).
What are the implications of the findings?
Hall and Studdert say the public is clearly divided over the appropriateness of using COVID-19 immunity privileges, although views do not vary along the usual political lines or by characteristics that suggest vulnerability to infection.
Social consensus on the desirability of an immunity privileges programs may be difficult to achieve,” they warn.
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.