Caylan Ford: Like COVID-19, digital passports could be with us forever

Once we go down this road, we may ruefully discover that there is no off-ramp
A health worker checks the QR code of an arriving person before allowing them access to the area for different vaccines at the smart vaccinodrome in the suburbs of Casablanca, Morocco, on Thursday, Oct. 28, 2021. Abdeljalil Bounhar/AP Photo.

When a government radically alters the way we live and relate to one another, it should be able to explain, at a minimum, why it is doing so. And when their plans involve extraordinary new powers to surveil, coerce, and control the population, we might also hope for an account of how and when those powers will be rescinded, and what limiting principle will constrain their use.

Proponents of digital health passports have failed to clear even the most basic of these hurdles. Instead, they have offered conflicting, unrealistic, and sometimes incoherent explanations of what the new digital passport regime is meant to achieve. 

Are vaccine passports supposed to let us “finish the fight” against SARS-CoV-2, as Prime Minister Justin Trudeau has promised? Of course not. There is no “finishing the fight” against an endemic virus. 

Will the passports end transmission of the disease? No. The vaccines are not designed to stop transmission, and the virus can be spread by vaccinated and unvaccinated people alike. Is the point to ensure that hospitals and ICUs are not overwhelmed by COVID-19 patients? That is a legitimate goal, but it’s undermined when vaccine mandates result in the firing or suspensions of thousands of front-line healthcare workers, many of whom already have natural immunity. 

Maybe the passports are just a psychosomatic measure, meant to help vaccinated people feel safer and less anxious as they go about their lives. Or are they a blunt instrument to drive up vaccination rates in hopes of achieving herd immunity? If so, how high does the rate need to be? 80 percent? 90 percent? 100 percent? What will we do when the vaccine’s efficacy fades, or if new variants emerge with mutated spike proteins that escape vaccine-induced immunity?  No one seems to know. 

Lacking clear or realistic objectives, there is no way to evaluate the success of these new public health measures. And if success or failure cannot be measured, neither can they be declared.

This should worry us, because the elected leaders currently enacting vaccine passports have not committed to any limits—either practical or temporal—on these new powers.

We should not be overturning our most taken-for-granted social norms without first considering the risks and probable long-term consequences. Because once we go down this road, we may ruefully discover that there is no off-ramp.

If you believe that unvaccinated people are uniquely responsible for spreading SARS-CoV-2 and prolonging the pandemic, then you might not see the problem with mandates and digital health passports. You may even agree that unvaccinated peoples’ movements and liberties should be severely restricted, and their reticence and selfishness punished until they do their part and act responsibly. This attitude is reflected in President Joe Biden’s statement that “our patience is wearing thin” with the unvaccinated, or remarks by Prime Minister Trudeau to the effect that “those people” are endangering “our children.” 

But the assumption that unvaccinated people are a significant public health risk is at best overstated and reflects a misunderstanding of the nature of the virus and the purpose of the vaccines. 

Covid-19 vaccines are not designed to stop transmission of the disease or eradicate the virus. Unlike vaccines for diseases like smallpox or polio, they do not provide sterilizing immunity. They are “leaky,” and allow for frequent breakthrough infections. Fully vaccinated people infected with the delta variant have been found to carry just as much viral load as unvaccinated infected people, meaning they can transmit the disease just as easily. In the United Kingdom, which relied heavily on the AstraZeneca vaccine, the rate of Covid-19 infections is now higher in fully vaccinated people than in unvaccinated people in almost every age category. 

The vaccines also have a limited window of efficacy: after just five to six months, the Pfizer vaccine’s effectiveness at preventing infection declines below 50 percent. One Israeli study found that its effectiveness at preventing symptomatic Covid-19 cases dropped to just 16 percent after six months, while a new pre-print study from Sweden found that by seven months post-vaccination, the Pfizer and AstraZeneca vaccines had no detectable effectiveness at preventing infection (thankfully, the vaccines’ effectiveness at preventing hospitalizations and severe illnesses is much more durable).

Even if a country achieves 100 percent vaccination coverage, SARS-CoV-2 will continue to circulate, infect, and sicken people. Barring an actual miracle, it will become endemic to the human population, just like seasonal influenza and cold viruses. 

The function of the COVID-19 vaccines is not to eradicate the virus or prevent transmission but to attenuate the severity of symptoms and reduce the risk of serious illness or death. If we believe that vaccinations work—and that is the obvious assumption behind vaccine mandates—then vaccinated people have little reason to fear incidental exposure to the virus. To suggest otherwise is to imply that the vaccines are ineffective. 

Children have even less cause for worry, as they face a negligible risk of serious outcomes from the virus. An unvaccinated child is more likely to die of drowning or seasonal influenza than they are to die of COVID-19, and their risk of hospitalization is far lower than that of even fully vaccinated adults. Moreover, if the virus is endemic and ineradicable, then it is preferable that people contract it and begin developing a robust immune response in childhood when their risk of developing serious illness is lowest.  

And then there’s the matter of natural immunity. A sizeable portion of the population has already acquired immunity to COVID-19 after contracting and recovering from the disease. Researchers at Columbia University estimated that a third of Americans had acquired natural immunity by the end of 2020; many current estimates put the figure at 50-60 percent of the U.S. population. Natural immunity confers significantly stronger and broader protection against the virus and its variants than the vaccines alone. The largest study on natural immunity found that it is six to 13 times more effective at preventing (re)infection than the Pfizer vaccine.

A sizeable portion of the population has already acquired immunity to COVID-19 after contracting and recovering from the disease.

From either an ethical or an epidemiological perspective, it makes no sense to require people to get vaccinated against an illness for which they have already acquired superior immunity. This is especially true under the circumstance that many developing countries are still struggling to procure enough vaccines for high-risk populations that actually need them. 

Another justification for vaccine passports mirrors the early pandemic calls to “flatten the curve.” Compared to immunologically naïve people, recently vaccinated people do appear less likely to contract or to transmit COVID-19. Through mass vaccination and routine “booster” shots, it may therefore be possible to slow the spread of the disease and lower its overall prevalence in the population. The point is not to eradicate the virus—that can’t be achieved with current vaccines—but to delay its inevitable progression to an endemic illness and reduce the number of people getting sick at a given time. 

For jurisdictions concerned about COVID-related strain on hospital capacity, reducing the overall level of community transmission is an understandable goal. But the trajectory of viral outbreaks is unpredictable, and this one has proved stubbornly impervious to containment measures. A new study in the European Journal of Epidemiology found that there is no discernible correlation between an area’s vaccination rate and new COVID-19 cases; if anything, higher levels of vaccination were faintly correlated with an increase in new cases. 

More worryingly, a contingent of immunologists have warned of the possibility that mass vaccination strategies (as opposed to targeted protection for the most at-risk individuals) could actually make the disease more virulent. Viruses want to survive, and they evolve and mutate in ways that help them do so. Because existing vaccines train the immune system to recognize only one part of the virus—the spike protein—mutations to the spike protein can make the virus less detectable to the immune systems of vaccine-dependent persons. In a population with extensive vaccine coverage, selective evolutionary pressure will favour variants with mutations to the spike protein (the delta variant is one such example). Rather than contributing to herd immunity, mass vaccination might end up undermining it, leaving us with more transmissible variants, and less robust immune responses

This remains, for now, a speculative possibility. Like so much about this virus, we can’t evaluate these risks with a high degree of confidence, and that is all the more reason to proceed with caution and humility. But instead of admitting uncertainty, our elected leaders have done the opposite, staking their political legitimacy on the promise that vaccine passports and social segregation will end the pandemic. This risks creating a “path dependency” problem: with each step that a government takes along a particular policy path, the political cost of reversing course rises. 

There are plausible public health reasons for governments and health authorities to want to drive up vaccination rates, particularly among older individuals and those with co-morbidities who are at greatest risk of being hospitalized or dying of COVID-19. But there is no compelling epidemiological justification for segregating vaccinated from unvaccinated people. Whether or not a person holds a digital vaccine passport is not a reliable indicator of their immune status or the transmission risk they pose to other. Yet the failure to produce a QR code on demand is almost certainly a sign of something else: deviant non-conformity.  

Social comity and openness will suffer in a society filled with digital checkpoints, where neighbours are told to be suspicious of each other’s health status, families shun their unvaccinated members, and where every shop, café, and theatre is required to turn away customers who don’t carry the right digital papers. (As I write this, a woman at the café table next to mine is describing one of her friends as “filthy” for refusing vaccination; her companion agrees that the friendship must end).

To the extent that vaccine passports are plainly irrational — for example, by failing to recognize natural immunity — compliance with such a regime is demoralizing. And like so many emergency or war-times measures of times past, we can expect these new mechanisms of surveillance and control to remain with us in the post-pandemic era, repurposed for new ends.

If you support the use of digital passports, it’s probably because you agree with the criterion on which they discriminate. You are vaccinated, and you want other people to get vaccinated. You may even believe that non-compliant individuals deserve to be socially excluded. But what if the standards change? What if, one day, your QR code flags you as an undesirable, based on criteria that seem arbitrary, unjust, or entirely mysterious? We speak of totalitarianism as the image of the boot stomping on the human face forever. This is not a boot, but an algorithm in the cloud: emotionless, impervious to appeal, silently shaping the biomass.

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