Digital Immunity Passports: Adding Strain to Already Stressed Healthcare Systems or a Ticket Back to Normality?

By René Seifert, co-head of TrueProfile.io

COVID-19 immunity passports have been touted as a possible way to help take the strain off increasingly stretched healthcare systems, a shrinking economy and a struggling tourism industry.

In a nutshell, immunity passports aim to link an individual’s identity with their COVID-19 test status, allowing those who have recovered from the virus to return to work and help restart the economy. An immunity passport would rely on antibody tests – which are intended to show whether someone has recovered from the infection – to then provide certification that a person is immune and cannot catch the virus again.  

In theory, the benefits are plainly obvious. By providing a tool that can display and link an individual’s identity with their COVID-19 antibody test status, this can allow those who have had and recovered from the virus to return to some sense of normality. For example, by providing hospital staff that have recovered with immunity passports, healthcare systems can ensure that these are the staff treating COVID-19 patients as opposed to getting a member of staff who hasn’t got immunity to treat infected patients, which substantially reduces the risk of the latter both contracting and spreading the virus.

However, the realities are much more complicated, and several challenges and questions must be answered before a widespread rollout is put in place.

A recipe for discrimination and added strain on healthcare systems?

Firstly, if immunity passports were to be rolled out, those citizens with a passport could enjoy some preferential treatment, while those without continue to be confined to a life in lockdown. Consequently, this leads to the very real danger of a ‘two-class’ society emerging: those that have immunity and can live their lives as normal and those that don’t, who will continue to be subjected to health restrictions. This could have a knock-on effect of amplifying financial and social inequalities. For instance, employers may prefer to hire those with confirmed immunity over those that still have the risk of contracting the disease. 

Further, there is the danger that citizens may infect themselves on purpose to gain immunity, placing further strain on already stressed healthcare systems. For example, from what we have learnt from COVID-19, a healthy 20-year-old might deliberately choose to get infected in order to return to work, as they know that their chances of having a severe case of the disease is very low. However, by getting infected and not staying in rigid quarantine throughout, they could cause a flare-up of a whole new infection cluster. This has the potential to place increased pressure on healthcare systems across the world, of which many are just starting to get to grips with and control the pandemic.

A snake in the grass for data security?  

There is also the question of data security. By the very nature of COVID-related immunity passports, they will contain sensitive and personal health data. This has made them a hot topic when it comes to data privacy, with many concerned that personal details may be at risk of getting into the wrong hands. Inevitably, this makes digital passports more likely when compared to paper-based approaches, which are less likely to satisfy the stringent security and data protection protocols required to ensure health data is both protected and unalterably linked to a person’s identity. 

Additionally, a key concern is around insurance companies, who I’m sure would love to get their hands on the healthcare-related data contained in immunity passports. An important consideration will be to ensure that any data in immunity passports remains under the full discretion of the individual and regulators should enforce that not choosing to disclose the contents of immunity passports does not carry any repercussions relating to a person’s insurance.

A role for blockchain?

Operating out of the highly user-friendly legal framework of GDPR is already a strong starting point to ensure that the individual remains in control and can share their health data whenever they choose. However, it is also crucial that any development in immunity passports not only focuses on digitising the test results of citizens, but also harnesses the latest innovative technologies that can ensure privacy-by-design, such as blockchain. 

For example, a blockchain-enabled immunity passport could also work if the end-users provide proof of ID before testing and a permanent digital fingerprint of the signed certificate is placed on the blockchain, which is used by a verifier (such as an employer) to check its authenticity. Crucially, as sensitive medical data, such as COVID-related test results, is stored as a ‘fingerprint’, this offers a form of encryption and ensures that the digital certificate provided to the end-user is secure and tamper-proof by design, which means it is unalterably linked to their identity.

This could have a number of important consequences. Firstly, providing citizens with access to an unalterable, digitised blockchain-enabled immunity passport would give them a form of secure, portable credentials that they could share with anyone, including their employers and authorities, at any point to prove they are immune from COVID-19. For those more concerned about the security of personal data, as each fingerprint is individual and does not reveal any information about whom the document belongs to, it also safeguards the information it contains. 

Steady on: is COVID-19 immunity possible?

There is clearly purchase to the role that blockchain can play in alleviating data privacy concerns. However, before we get ahead of ourselves, a strong dose of caution needs to be caveated here before the debate about the impact of immunity passports on healthcare, security and society goes any further.

Firstly, immunity tests need to possess high levels of sensitivity and specificity which are essential measures to express the rate of false negatives and false positives of a result. Whereas the former could be seen rather as bad luck for the individual not revealing their true immune status, the latter could turn into a communal health hazard as the person believing to be immune is in fact not and might still get infected and subsequently spread the disease to others. 

Secondly, before any rollout of digitised immunity passports is even conceived, for immunity passports to work effectively there needs to be concrete scientific evidence on whether citizens can become immune from COVID-19 and for how long. However, at present, scientists simply don’t know how long someone remains immune to the coronavirus — or even if they can become immune at all. In fact, a recent study found asymptomatic carriers have very few or no detectable antibodies just weeks after infection, suggesting they may not develop lasting immunity^[1].

This has the potential to derail the concept of digital immunity passports entirely. 

As such, a more sensible line of action would be to follow the science; for a digitised immunity passport to truly work effectively and be taken seriously, it is crucial that the antibody test is proven to show that end-users cannot get infected again. This should not mean that government’s and healthcare bodies abandon the development of digital immunity passports altogether, but any development must be contingent on what the scientific evidence tells us.

It is only then the debate around the impact immunity passports could have on the security of data and struggling healthcare systems can be truly worthwhile.  

^[1] https://www.nature.com/articles/s41591-020-0965-6#Sec8