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Leaders around the world are grappling with the challenge of trying to reopen parts of society while avoiding new outbreaks of the coronavirus. Every safety measure that’s lifted in an effort to alleviate the economic pain of lockdown brings potential risk of another wave of infections.
There is one group, however, that may be able to return to everyday life without the danger of contracting the virus: people who have already had it. Some countries have proposed creating a system of “immunity passports” that grant those who have recovered from COVID-19 — and are presumably shielded from a second infection — the right to return to normal activities.
The Chilean government was set to issue the world’s first immunity passports earlier this month before halting the plan. The U.K., Germany and several other nations have discussed similar programs. Infectious disease expert Dr. Anthony Fauci said passport plans “have some merit” once the science around immunity is established.
When we get sick, the body triggers an immune response to fight off whatever we’ve come down with. After we’ve recovered, antibodies remain in our systems that protect us from future infections. A vaccine works in a similar way, using a benign version of a pathogen to spark an immune response without the threat of initial infection.
While it’s still too early to know whether contracting the coronavirus leads to enduring immunity, scientists suspect it may give at least some temporary protection, based on studies of similar outbreaks.
Why there’s debate
There’s near unanimous agreement that not enough is currently known about immunity and the coronavirus to safely start any immunity passport programs. If more clarity comes from research in the coming months, supporters of the passports believe that recovered people could be a critical part of establishing a sustainable “semi-normal” society until a vaccine is widely available.
Issuing immunity passports could allow people to safely return to work, which could stimulate the economy for everyone. Those people might also be able to help support vulnerable populations, since they are unlikely to pass the virus along to others.
The idea has been met with significant skepticism from many public health experts. A key concern is over how much immunity, if any, recovered patients have. It’s also impossible to know in the short term how long that immunity might last, they say. Some pathogens provide protection for decades; in others, only a few months.
Another problem is the accuracy of tests used to determine who has antibodies to the virus. Critics of passport plans say currently available tests have too high a failure rate to be relied upon for any public policy. Especially worrying is the high rate of false positives, which leads people to think they are safe from the virus when they are not.
Even if all the scientific issues were to be resolved, there are reasons not to create immunity passports, some argue. The passes risk dividing society into two groups, the vulnerable and a small privileged class with rights denied to the rest of society. The system might also cause people to deliberately infect themselves so they can go back to work if they’re able to survive.
The passports could help bring the economy back to life if immunity is proven
“If everything works, the antibody tests and the assumption that recovered people get enough immunity to not get COVID-19 again, then immunity passports would help us get out of stay-at-home orders and economic shutdown. In theory, people who have an immunity passport could safely return to work because they would not get sick again and start passing the virus around.” — Chia-Yi Hou, The Hill
Anyone with a false positive result would be a huge threat to those around them
“Imagine the psychological state of a person who thought they were in the all clear and has gone back to work in a care home and ended up killing several people.” — Health psychologist Susan Michie to Wired
People who aren’t at risk have a right to return to their normal lives
“Immunity licenses could promote individual liberty and benefit society without invidious discrimination. A fundamental principle of public health is choosing the ‘least restrictive alternative’ — that is, restricting personal freedom only where necessary to achieve crucial public health objectives. People should be given a chance to show they are immune and are safely exempt from restrictions properly applied to those at risk of infection.” — Govind Persad and Ezekiel J. Emanuel, Washington Post
People would get sick on purpose to obtain an immunity passport
“If the government allows the immune to return only to certain jobs or if employers prefer to hire those who are immune, that could also create a set of perverse incentives to deliberately get infected with COVID-19, especially for the young and otherwise healthy who might think it’s worth the risk for a job.” — Sarah Zhang, The Atlantic
There’s strong reason to believe recovered patients will have immunity
“There is reason to assume that recovering from the virus will provide some amount of immunity. The key is to further develop our antibody tests to better understand who is immune to the virus and conduct research to determine how long this immunity might last. Then, we should provide credentials to those who are immune — through a Covid-19 immunity passport — so that those individuals can resume their lives.” — Saju Mathew, CNN
It’s far too soon to be considering immunity passports
“There are too many problems and unknowns to use antibody testing to decide who gets an immunity passport and who doesn’t. Countries now considering it might find out they will either have to accept enormous risks or simply sit tight for longer than initially hoped.” — Neel V. Patel, MIT Technology Review
Essential workers could benefit significantly from immunity passports
“Immunity passports would be helpful for frontline workers, like those in health care, the postal service, grocery stores, public transit, warehouses, and childcare. Many low-wage workers in these industries are still working throughout the pandemic, risking exposure to the virus just by going to their jobs every day. If they knew they were immune to infection, they could go about their day without worrying if they could catch the virus from patients or customers.” — Emily Mullin, OneZero
Antibody tests are too unreliable
“It is folly to base freedom of movement on such fallible testing. Passport holders and society would have a false sense of security while non–passport holders would have their civil liberties and work opportunities unwarrantedly abridged.” — Jayakrishna Ambati, Balamurali Ambati and Benjamin Fowler, Scientific American
The passports would lead to discrimination
“Once reliable tests are broadly available, this public health breakthrough could trigger some difficult legal questions. The country may soon have to deal with a new concept of bias: antibody or immunity-based discrimination.” — Jonathan Turley, Los Angeles Times
Immunity is more complicated than a simple positive or negative result
“Many serological tests aren’t like pregnancy tests, with a yes or no result. They will reveal the levels (or titer) of antibodies in a person’s blood. And that’s where things can get a bit trickier. At this point, scientists can’t say for sure what level of antibodies might be required for a person to be protected from a second Covid-19 case.” — Andrew Joseph, STAT
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