For most Europeans, holding a passport or national ID card allowing them to engage in international mobility for work, education, tourism or personal reasons is something taken for granted. However when such documents become linked to other purposes, e.g. multifunctional ID cards linked up with an array of public services, banking, etc. It can create new forms of exclusion if not done in an inclusive way that protects the fundamental rights and personal data – especially health data – of Europe’s most vulnerable populations.
On 28 January, EU Member States adopted guidelines, developed by the eHealth Network, pertaining to the Commission’s recommendation to introduce an EU-wide vaccination certificate for COVID-19, which will be mutually recognised, interoperable and uniform. This was foreseen in the EU Vaccines Strategy released in June 2020. The European Commission (EC) has been working on the certificates in collaboration with the World Health Organization (WHO) in full respect of EU data protection rules and based on consultations with the European Centre for Disease Prevention and Control (ECDC), the European Medicines Agency (EMA) and the Health Security Committee.
For the time being, the purpose of the certificates is limited to the medical sphere only, capturing basic information about their holders (name and national ID number, date of birth, type of vaccine, number of doses received, batch number, as well as the place of vaccination), some of which are coded. However, tourism-dependent countries like Greece, as well as other industry stakeholders like the International Air Transport Association (IATA) have argued in favour of extending the use of certificates to provide proof of vaccination in an international mobility context, thereby turning them into de facto COVID-19 “vaccination passports”. This poses an ethical dilemma, creating a rift between vaccinated individuals and vulnerable groups who, for many different reasons, are unable to obtain a certificate. The individuals affected might be people who cannot get vaccinated / for whom additional considerations apply for health reasons (e.g. allergy sufferers, pregnant or breastfeeding women, those with underlying medical conditions, children and adolescents, those who have tested positive, etc.), members of disadvantaged groups excluded from national health systems, or who worry about the repercussions of sharing their personal data. Given national governments the option to collect more data than is required to issue the certificate means that potentially sensitive personal information about health status, ethnicity, criminal record, profession, residency status, etc. could be revealed, which in turn could exacerbate the exclusion of the most vulnerable and result in denunciation, or even detainment and deportation.
A number of European countries including France and Germany have argued against dividing society into people with special mobility rights based on their vaccination status and people who would not be able to exercise such rights. They argue that, in light of the slow and uneven roll-out of national vaccination campaigns, and the many uncertainties about which population groups are included in national vaccination strategies and the timeline for when different segments will receive the jab, the debate about such “passports” is premature.
It is not only the Greek government which explicitly raised the issue at the EU level. Although most European countries already require a recent negative COVID-19 test to enter their territories, a few countries such as Poland or Denmark have already issued such passports. They argue that providing proof of vaccination against certain communicable diseases has long been a prerequisite for travel to countries outside of Europe.
In the end, the current lack of scientific information about the ways in which the vaccine contributes to limiting the spreading of the virus and its mutations, and how it interacts with / reinforces the measures already in place (physical distancing and lockdowns, wearing masks in public, hand hygiene, etc.) has temporarily stalled the conversation, but the pressure to issue them could grow as more ordinary people already immunised demand their rights to freedom of movement.
From a health equity perspective, it is clearly crucial to reach risk groups in the most timely, effective and inclusive way possible. While the focus is currently on vaccinating older people, those with co-morbidities and healthcare personnel, it will be crucial to reach a high level of vaccination across the EU by the summer to attain herd immunity. Yet most national vaccination strategies omit the many marginalised vulnerable groups that will require vaccination as a matter of priority.
Unless everybody can receive the vaccine without fearing legal consequences, explicitly linking vaccination status to additional privileges would mean turning a blind eye to the fundamental rights of vulnerable groups, which could be endangered by an unfettered introduction of certificates relying heavily on the digital sharing of personal data. As the debate about building a European Health Data Space evolves, it will be important to develop options (including legislative) for ensuring that new digital solutions, including vaccination certificates – which are extremely useful for enhancing public health on the one hand and yet also present ethical problems on the other – are introduced in an inclusive, non-discriminatory way.
Most importantly, all members of society need to be able to access the available vaccines. The urgency of the pandemic crisis necessitates the adoption of a truly universal health coverage approach so that everybody who would like to be vaccinated can be, regardless of their personal circumstances.