Abstract
Immunity certificates related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been under discussion since the beginning of the pandemic with conflicting opinions. In order to identify arguments in favor of and against the possible implementation of documents certifying immunity of an individual based on serological testing, we developed a qualitative study in Geneva, Switzerland. The study took place between two lockdowns with a sense of semi-normalcy during summer 2020 in Switzerland but at a time when no vaccine was available and seroprevalence was below 21%. Eleven focus groups with members of the public and 14 semi-structured interviews with stakeholders were conducted between July and November 2020, with a total of 68 participants with an age range between 24 and 77 years. Interviews and focus groups transcripts were coded with the ATLAS.ti CAQDAS. Few participants considered immunity certificates based on serological testing as an acceptable public health measure. Major concerns included the reliability of scientific data related to COVID-19 immunity and serological testing potential re-infection as well as the possibility that the use of certificates could result in deleterious outcomes. Discrimination, counterfeiting, incitement for self-infection, invasion of the private sphere, violation of personal integrity, and violation of medical secrecy were perceived as the major risks. Benefits of immunity certificates were more perceived when in relation to vaccination, and included gains in medical knowledge and protection in certain contexts involving leisure or work-related activities. The consequences of implementing immunity certificates are numerous, and the acceptability by the general population has to be considered when engaging in such policy. Even if the results provide a snapshot of arguments discussed around immunity certificates based on serological testing before the implementation of the COVID-19 vaccine, most of the issues discussed are central in the current debates about vaccination certificates.
Highlights
“Immunity passport,” “risk-free certificate,” “release certificate,” “immunity certificate,” “antibody(ies) certificate,” “COVID-19 immunity-based licenses,” many terms are employed to name a document aimed to certify immunity of an individual against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing COVID-19 (1–3)
With the COVID-19 vaccine rollout, conversation has intensified over this subject with immunity certificates seen as a solution to free individuals from social restrictive distancing regulations (5)
The objective of this qualitative study is to identify arguments in favor of and against the possible implementation of immunity certificates related to SARS-CoV-2 in Switzerland, and to pave the way to a policy-based discussion
Summary
“Immunity passport,” “risk-free certificate,” “release certificate,” “immunity certificate,” “antibody(ies) certificate,” “COVID-19 immunity-based licenses,” many terms are employed to name a document aimed to certify immunity of an individual against severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the virus causing COVID-19 (1–3). Immunity certificates are perceived as useful to avoid additional lockdowns, to further individual freedom and end physical restrictions, to resume activities and restore economic markets by opening workplaces and facilitating travel, to enable close social interactions while mitigating complications from infection especially for some individuals whose work involves close interactions with “vulnerable” people and/or patients, to have access to facilities such as nursing homes, to socialize or even to offer psychological support to individuals, while protecting public health and healthcare services (3, 5) For both types of certificates (natural or vaccine-acquired immunity), discussions about their implementation are dominated by ethical arguments (7). No immunity certificates were implemented in any country, and vaccine certificates were not publicly discussed
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