The idea of coronavirus “immunity certificates” has figured into conversations among government officials and corporate leaders around the world looking for ways to safely reopen businesses and restart economies amid the lethal pandemic.
While the concept may sound simple enough—issue certificates or “passports” to people whose blood tests positive for coronavirus antibodies, thus allowing them to leave quarantine and return to work—it faces a number of medical and practical hurdles.
Among them: insufficient evidence so far that individuals become immune once exposed to the virus. Such certificates also raise ethical concerns, including the prospect that otherwise healthy individuals might seek to become infected to earn that prized documentation.
Uncertainty About Antibody Tests
Uncertainty surrounding the relevance and reliability of antibody tests may present the first and most fundamental obstacle.
“Could you have the antibodies and still pass it along to others? How can you certify that someone’s OK to come back and how frequently would you have to do that?” asked Chris Collins, associate professor of human resource studies at Cornell University’s Industrial and Labor Relations School in Ithaca, N.Y., a school that has been conducting focus groups with Fortune 500 companies on pandemic-related issues.
“I think the idea is well-received. It’s putting it into action that’s the big challenge,” he said.
In a brief late last month, the World Health Organization (WHO) noted that no study had yet assessed whether the presence of antibodies, which indicate a person has had the disease, actually translates into immunity from the virus driving the COVID-19 outbreak.
Furthermore, antibody tests need further validation, as they may give false positive and false negative results, WHO said, warning that immunity passports could inadvertently exacerbate the virus’s spread.
“At this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an ‘immunity passport’ or ‘risk-free certificate,’ ” the organization said.
“People who assume that they are immune to a second infection because they have received a positive test result may ignore public health advice. The use of such certificates may therefore increase the risks of continued transmission,” WHO said.
Days after the organization issued that brief, Chile’s top health official said the country would proceed with plans to issue “release certificates” in early May, but that the documents wouldn’t certify immunity until medical uncertainty surrounding the issue is clarified, according to news reports.
Health officials in Asia have reported that some patients who recovered later tested positive for the virus, although the significance was unclear. A top South Korean health official cautioned that researchers have much to learn and said the virus may be the “most challenging pathogen” in decades, CNN reported.
Officials in various countries have discussed the immunity-certificate idea.
“Even if it is a good idea, it does not seem feasible yet,” given uncertainties surrounding testing, said Raquel Flórez, an attorney with Freshfields Bruckhaus Deringer LLP in Madrid.
Among the potential legal concerns, she said, immunity passports might lead to discrimination, that is, “engaging only employees that have the immunity passport,” leaving others aside. “And the same may go in terms of allowing people to move freely or travel, so that it could give rise to a new ‘class of super humans’ that will have privileges over the rest.”
Questions also may arise about test scarcity and cost, “and would this be available only to rich people,” Flórez said. In addition, the passports could pose legal problems regarding data protection and privacy rights.
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Dr. Mark Cullen, M.D., Stanford University professor of medicine, biomedical data science, and health research and policy, and founding director of the Center for Population Health Sciences in Stanford, Calif., cited what he called compelling social reasons not to issue immunity certificates.
Even if researchers determine whether and for how long antibodies denote immunity, Cullen imagined a passport system in which only someone who has had the virus is employable. “Think of the social advantage, think about the value on a dating site for example,” he said.
A person could say, ” ‘I’m immune, date me. I’m not sick, I won’t make you sick.’ What a fabulous credential, socially and economically,” he explained. And that could lead to bigger problems: Young people who feel they’re at low risk for getting seriously ill might opt to have COVID parties or ignore social distancing just to get infected on purpose, Cullen said.
“What it means is you’re amplifying the infection in the community, and you’re putting people at risk in the community,” he added.
While there are circumstances and industries in which antibody testing for employees makes sense, such as health care workers, Cullen said it’s a dangerous societal game to make illness a benefit. “It’s scary enough that I would not even advise a 20-year-old to gamble in this way,” he said.
So far, Spain’s government hasn’t indicated that it will issue immunity certificates, according to Flórez. Some Spanish regions, however, such as Castile and León, have announced the intention of using some sort of “immunity card” through an app that records individuals who have recovered from coronavirus, similar to the vaccine registry that is sometimes required to travel abroad, she said.
Some Italian politicians have raised the issue, but so far there are no immunity certificates, “and most likely they will not be set up in the future” because the authorities rely on the expert opinion that it gives no certainty on avoiding future infection, Flórez said.
Researchers may know more about immunity in a few weeks, according to Cullen. “But to use it as a passport, and I think the word passport says it all … we’re not ready for that,” he said.
Dinah Wisenberg Brin is a freelance reporter and writer based in Philadelphia.