COVID-19 immunity certificates: Everything to know about this controversial solution
These certificates act as a pass for people who have already recovered from COVID-19. But there are questions about their efficacy.
The coronavirus pandemic has forced millions of people to shelter in place, closing down businesses and freezing communities to help public health officials lower the number of hospitalizations from the disease. As governments look for ways to reopen the economy, many countries and even businesses are considering "immunity certificates" as a way to safely start things back up.
The concept behind immunity certificates is that people who have been tested and are considered immune for the COVID-19 outbreak would be issued a pass to go outside. The passes would likely be issued through a device, making immunity certificates another way that technology plays into proposed solutions for the coronavirus pandemic, joining contact tracing apps and robots with thermal cameras patrolling the streets.
Like those other solutions, immunity certificates raise concerns about privacy , security, inequality and efficiency. While several countries are looking at the passes as a way to potentially end quarantining, privacy and health care experts are warning that immunity certificates have many challenges to consider -- like if they're even accurate.
Here's a breakdown of immunity certificates and the concerns around implementing it as public policy.
What are immunity certificates?
Immunity certificates, sometimes referred to as immunity passports or immunity cards, are a form of identification to help mark people who have been infected with COVID-19, recovered and developed antibodies to the disease. The certificates are given under the impression that developing antibodies means you've developed an immunity, but that's still up for debate.
Part of the reason why governments issued shelter-in-place orders is because COVID-19 spreads at an exponential rate, and is contagious even when people don't have any symptoms. People can spread the disease even if they don't know they have it, prompting officials to shut down businesses and public activities to "flatten the curve." There have been more than 1.5 million confirmed cases in the US and around 94,000 people have died.
The shutdowns have devastated the economy, with more than 43 million Americans filing for unemployment benefits. Governments are looking at immunity certificates as a way to identify who would be able to go back to work. Forbes reported that businesses are looking at this option too. The certificates are reliant on antibody tests, which look to see if your immune system built up resistance to protect against COVID-19.
The hope is that with enough testing, instead of everybody ordered to self-quarantine, people who have developed immunities would be able to go outside while governments look to jump-start the economy.
What is an antibody test?
When your body is exposed to a virus, the immune system builds up proteins designed to attack that pathogen -- and those proteins are called antibodies. Antibodies in a person's blood indicate they've carried the disease, and in many cases, means they're protected against it.
Antibody tests are not a new concept developed because of COVID-19, and neither are immunity certificates. Health care workers, for example, are tested for immunities to Hepatitis B before being hired, and schools can require immunization records before children can be enrolled as students.
Policymakers are looking at using it for COVID-19, as governments expect an influx of antibody tests arriving soon.
How are immunity certificates supposed to work?
After getting tested for antibodies and showing immunity to COVID-19, the certificates could be issued in many different ways. Several proposals have recommended different forms for these certificates, like a physical card, a QR code on a mobile app or a sticker on a passport.
Harvard University's Edmond J. Safra Center for Ethics released a white paper on how it should be implemented, warning that paper copies could be easily counterfeited, and recommended digital certificates.
"Because paper credentials are subject to fraud and often require independent verification, such systems are unwieldy and impossible to scale to the challenge at hand," Dakota Gruener, the whitepaper's author and executive director of ID2020, said.
Where are they being used?
China's version is not explicitly called an immunity certificate, but functions similar to one. The country has been using a color-coded app to indicate whether a person should be quarantined or allowed in public spaces since March, called the Alipay Health Code, according to The New York Times.
Chile launched its own COVID-19 Immunity Card program on April 20, according to Bloomberg. Immunity certificates are still in their early stages, but as antibody testing becomes more widely available, more countries are considering adopting the policy.
In May, Estonia started testing out digital immunity passports for businesses, according to Reuters.
Where are they being considered?
Immunity certificate programs are being considered in the US, the UK, Germany and Italy.
On CNN's New Day, Dr. Anthony Fauci, the National Institute of Allergy and Infectious Diseases' director, said last month that the US was discussing using immunity certificates to help identify who is vulnerable to the disease.
At a press conference on April 2, the UK's health secretary Matt Hancock said the government was looking into immunity certificates, which could come as wristbands.
The German government has not commented on implementing immunity certificates, but researchers out of the German Centre for Infection Research, the Robert Koch Institute, the Institute for Virology at Berlin's Charite hospital and the government's public health agency plan on conducting a mass study on how many people are immune to COVID-19.
It's expected to have more than 100,000 volunteers, with tests and regularly repeated to get a larger sample of the nation's population. The study looks to issue immunity certificates from the testing results, Der Spiegel reported.
In May, Germany's health ministry said it was working with the German Ethics Council to assess an immunity certificate program.
The Italian government is also looking to conduct hundreds of thousands of tests for COVID-19 antibodies, and suggested giving a "license" to go to work for those who show signs of immunity, according to The New York Times.
This is all contingent on the idea antibody tests actually work for COVID-19, and scientists are still unsure about that.
Wait, what?
Because COVID-19 is a relatively new disease, not much is known about the disease and what antibodies mean for it, or even how to properly test for it.
Nikolai Petrovsky, a professor at Flinders University in Australia and the secretary-general of the International Immunomics Society put it this way: "If you understand the nature of these tests, you would say this is a crazy idea. It's an idea that has come from someone trying to shortcut social isolation."
What are the issues around antibody testing for COVID-19?
Antibody testing and immunity certificates work for things like Hepatitis B and measles because there are proven vaccines for the diseases, Petrovsky explained.
With COVID-19, there's not much information supporting immunities and antibodies, and enough research refuting it, the professor said.
Antibodies don't all have the same lifespan, Petrovsky said. While antibodies for pathogens like specific strains of influenza can last your whole life, with other human coronaviruses, antibodies have lasted only about 10 months, Petrovsky said.
There hasn't been enough time to determine how long antibodies for COVID-19 stay active, he added. That means that a person issued an immunity certificate one month might be susceptible to the disease again the next.
There's also concerns about the validity of tests. The UK government has bought 3.5 million antibody tests for COVID-19, but it's unclear how reliable they actually are. Some tests could only pick up a very high amount of antibodies, while others would pick up any amount.
"My company's test might be 100 times more sensitive than another company's tests," Petrovsky said. "One test could show someone negative, one test could show someone positive. Which one do you use for a certificate?"
What does the World Health Organization say?
In response to the concept of immunity passports, WHO published a brief in April stating there's currently no evidence that people who recover from COVID-19 have antibodies that protect them against a second infection.
WHO warned that as few as 2% to 3% of the population have actually developed antibodies in their blood to COVID-19.
"Right now, we have no evidence that the use of a serological test can show that an individual has immunity or is protected from reinfection," the WHO's technical lead on COVID-19, Dr. Maria van Kerkhove, said at a press conference.
As such, there isn't enough evidence to guarantee the accuracy of an immunity passport.
Coronavirus updates
Assuming they get rolled out, how would certificates be distributed and secured?
There are several proposals on how this data would be handled and secured.
Health information is particularly sensitive, and one of the few things that data privacy laws in the US actually protects. With the COVID-19 pandemic, it could be especially damaging if a data breach leaked information about hundreds of thousands of people who have immunity to COVID-19.
If it had any personal identifiable information, people who have immunity certificates could be contacted for their antibodies or to duplicate the QR code from people who are desperate to return to work.
Harvard's white paper recommended that this data not be stored on a central server, but rather on local devices, and that the information be encrypted in transit and at rest.
"A centralized credentialing program, in which a single entity (likely the government) collects a list of everyone who has been tested and their test results, would leave citizens exposed to privacy violations and abuse," the white paper said. "We believe that efforts to create centralized credentialing programs should be actively opposed by civil society."
A white paper from MIT information technology professor Alex Pentland points to existing mobile payment systems and using the encryption and security infrastructures already in place for financial institutions and applying them to health care providers.
"Imagine a society where credit unions, banks or other civic institutions serve as repositories for citizens' health data, much as they already do for their financial, identity, educational and operating license status," Pentland writes. "This personal data forms the basis of each citizen's digital identity, and determines their ability to legally perform various actions (e.g., making a credit card payment, employment as a doctor, entering a bar)."
There would be risks under that model too, as financial institutions often share data about your credit card transactions with advertisers.
Harvard's white paper also recommends that the certificates be issued through a digital wallet app, which could generate and encrypt a unique identifier that can't be tied to a specific person or device.
Companies like NXP, which work on digital passports, have also been in talks with different countries for implementing digital immunity indicators for international travel.
What are the privacy concerns surrounding them?
If this rolls out -- which several health officials have recommended against -- the privacy concerns will come down to who handles that data.
Both the Harvard and MIT white papers warn against having that data being stored on one central server or being delivered by one source would be detrimental to personal privacy. The apps that the certificates would be distributed on would be another cause for concern.
For example, in China, researchers found code in its digital certificate data that was labeled "reportInfoAndLocationToPolice," which sends location, city name and an ID number to a server, according to The New York Times.
These apps also don't have to be rolled out by governments. They could be developed and distributed by private businesses that want to verify that their own employees are safe to return to work.
That scenario brings up questions of who is behind the app, who is developing it and if there are any safeguards being used. Today's data economy means that an innocuous app that millions of people use for checking the weather can also be used for selling their location data behind the scenes.
The American Civil Liberties Union called out privacy concerns surrounding immunity passports, noting that COVID-19 immunity could be tied to future conditions like access to housing, employment and travel.
"The existing legal framework may not be sufficient to prevent this information from being shared, especially if it is held by private entities," the ACLU said. "Many members of marginalized communities, including immigrant communities, might have reason to fear that their health status information will be used for law enforcement or immigration purposes, or to affect government benefits or health insurance."
If digital certificate apps roll out, it would be an essential tool for people to leave their homes following the pandemic -- one that governments and workplaces could require, unlike the optional apps today that take your data.
"Where you have large scale immunity testing and you're looking at authentic government documentation on immunity, there's privacy questions about making sure the data is handled right and not abused," said Mark Surman, executive director of the Mozilla Foundation.
He also questions the validity of the proposed solution, noting that these certificates are making a lot of assumptions based on unproven theories.
"Creating anything that is inferred, by design, is pseudoscience at best and an invasion of privacy as well," he said.