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YOUR-VOICE

Opinion: Why we’re not ready to require ‘immunity passports’

Catherine L. Troisi and Amelia Khoei
Destiny VanSciner, 32, left, gets an oral swab test for coronavirus from a family nurse practitioner at St. John's Well Child and Family Center in south Los Angeles on May 18.

As we consider how to reopen society, some people have raised the idea of immunity passports. Based on the presence of coronavirus antibodies, such passports would allow people to return to work under the presumption that they cannot contract COVID-19. However, at this point this proposal is premature and dangerous.

People make many different antibodies in response to viral infections, but only some of those antibodies are protective. It is unclear whether antibodies detected in the current serologic tests actually indicate immunity, and the currently available tests have not been well vetted, leaving well-founded concerns about the reliability of results. A false positive would be especially dangerous, as people would assume they are protected when they are not.

We can safely assume that most individuals who recover from COVID-19 are immune for a specific period of time. There are many factors, however, that we don’t understand. Does everyone develop protective immunity? Does it depend on the severity of the infection? How long does immunity last?

A preliminary report from Columbia University found that immunity to the four members of the coronavirus family that cause mild colds does not appear to last long and that re-infections can occur within one year of the initial infection. Longitudinal studies will ultimately assist in unraveling more information about COVID-19 and infection, and, eventually, we will have answers to these questions. However, there are still other unintended consequences of the use of immunity passports to determine ability to safely resume work or physical proximity.

The ability to resume a pre-coronavirus life by obtaining an immunity passport may encourage people to attend “coronavirus” parties where people deliberately get infected. The assumption is that people not in recognized vulnerable populations will have a mild infection, quickly recover and be protected. Data show otherwise.

Although deaths are highest among older populations and those with other health conditions, those under age 65 have accounted for 55% of hospitalizations. We are just starting to learn about long-term complications following infection, including potential lung fibrosis, kidney damage and heart damage. Some children are developing an inflammatory syndrome. Deliberately infecting oneself could lead to serious disease, death or long-term health consequences.

There are ethical considerations as well. What would the cost of an immunity passport be and who would issue them? An unintended consequence would likely be the establishment of black markets to obtain fraudulent proof of immunity. These would place both the holder and their contacts at risk of infection, particularly if the card is used to secure employment in a high-risk occupation. If testing costs and issuance of the card are expensive but necessary to obtain employment, low-wage workers will be impacted retroactively by this “work tax.”

Finally, there is possible discrimination with immunity passports. Could an employer require one before hiring? Doing so may be illegal. Litigation is likely. Privacy concerns also come into play. Employers do not have the right to know about other health issues. Can insurers charge higher premiums to those without an immunity passport? And if medical insurance is dependent on employment, but employment is dependent upon immunity, there is a Catch-22 for those who are susceptible to the virus and would need insurance if they experience infection.

We need to think carefully through these issues before we declare immunity passports a solution to return to work safely. With these concerns in mind, the WHO is not recommending the use of immunity passports. There are too many unanswered questions and too great a risk for increased transmission of COVID-19 as well as discrimination for immunity passports to be advisable at this time.

Troisi is an epidemiologist at University of Texas Health Science Center at Houston School of Public Health. Khoei is a medical student at Baylor College of Medicine and UTHealth School of Public Health.