NY's Vaccine Passport App Raises Concerns About "Digital Segregation"

One in every five New Yorkers has gotten at least one dose of a COVID-19 vaccine as of this week. That is far from the herd immunity needed to beat back the pandemic, but it is enough for governments to sketch out plans for restoring some version of pre-pandemic life. One of those options is a vaccine passport.

New York State is piloting a smartphone app called Excelsior Pass to verify a person’s vaccination status or recent negative COVID-19 test for entry into events at the Barclays Center or Madison Square Garden. Developed in partnership with IBM, the state program is a microversion of what international leaders have started demoing in the European Union, China, and Israel. All piece together some type of digital proof of vaccination in a bid to reopen businesses and allow international travel.

The concept of a vaccine passport isn’t new, per se, but storing one on your phone or the internet cloud would be a technological achievement.

“From a digital standpoint, this will be unprecedented,” Bruce Y. Lee, a public health policy expert of the City University of New York, said. For decades, the World Health Organization has issued so-called yellow cards, technically named the International Certificate of Vaccination or Prophylaxis, to show proof of immunizations for entry into some countries. A group of researchers recently penned an editorial in the International Journal of Infectious Diseases arguing authorized COVID-19 vaccines should also be included in WHO’s vaccine certificate.

The WHO is working on a digital certificate for COVID-19 vaccines but said in February that authorities shouldn’t require such a pass for international travel due to ethical concerns and given it’s unclear if the vaccines fully stop the virus’s transmission. President Joe Biden directed federal agencies in a January executive order to “assess the feasibility” of linking a digital verification to the existing international paper certificate. U.S. airlines are pushing his administration to establish a system.

The best implementation would involve national leadership because it could ensure that everyone uses a recognizable standard, according to Lee, who is also the executive director of Public Health Informatics, Computational, and Operations Research (PHICOR). Otherwise, the country could end up with a different system in all 50 states—a frustrating pattern in the country’s pandemic response that public health experts have criticized as confusing and chaotic.

New York’s Excelsior program works like a mobile airline boarding pass, according to Governor Andrew Cuomo’s office. It has a QR code that can be scanned or printed out. The software is not available in app stores yet because it is still in the testing stage.

The app permits a user to download the confirmation of their vaccination or test collected from the state’s network of providers. That information is translated into the digital card that would be scanned upon entry into a stadium. The card is built using blockchain technology, the same platform used to secure transactions of cryptocurrencies like Bitcoin. Blockchain allows IBM to build the information into a verifiable “digital health pass” without “exposing and without storing the underlying medical information,” said Eric Piscini, the head of IBM’s digital health pass project and the global vice president of emergency business networks.

“As a platform operator, as IBM, we do not keep this information,” Piscini said. “We don’t have access to this information—the medical information about yourself. We just enable what we call a verification service.”

In the immediate term, various questions remain about the efficacy of such programs in mitigating coronavirus infections. Lee noted that scientists don’t yet know how long immunity lasts from the vaccines or natural infection.

“There's a feeling that the vaccines probably protect against transmission, protect against being infected or shedding the virus,” Lee said. But he said more research is needed to verify that level of protection. Lee also questioned whether localities should be relaxing restrictions at all right now, regardless of programs to certify a negative test result or proof of vaccination.

READ MORE: CDC Gives Fully Vaccinated People The Go-Ahead On Some Small Indoor Gatherings

“We’re still within the danger zone,” he said. “The weather has been changing a little bit, but we’re still in the cold and dry part of the year, and that may promote transmission of the virus. And there’s the spreading of the variants.”

Some experts are concerned about intensifying disparities between those vaccinated and those who haven’t gotten the shots, as well as creating a new threat to health privacy.

“There's a lot of reason to believe that it would enforce digitized segregation, building on our segregated medical infrastructure,” said Albert Fox Cahn, the executive director of the Surveillance Technology Oversight Project, an advocacy group sharply critical of the state’s announcement about Excelsior. “Blockchain can provide some privacy protections, but it's hardly fool-proof, and it's hardly protective across the board.”

He fears the technology would be yet another form of government surveillance that would have the possibility of politicizing the vaccine. It could also exacerbate the digital divide under a model requiring electronic proof of vaccination for everyday life, not just traveling abroad.

“This sort of high-tech coercive model [has] a really strong chance of backfiring,” Cahn said.

S. Matthew Liao, the director of the Center of Bioethics at New York University’s public health school, said that socioeconomic and racial disparities in the vaccination campaign so far would put certain communities at a disadvantage if the lack of a “vaccine passport” keeps individuals from traveling, going about daily life, or getting a job.

“We want to make sure that everybody has access to the vaccines and then roll out the passport,” Liao said. But he also suggested it could be a motivator for people to get the shot. “That could be a good thing because we need to achieve herd immunity.”