Abstract
In responding to the widespread impacts of the COVID-19 pandemic, countries have proposed and implemented documentation policies that confer varying levels of freedoms or restrictions (e.g., ability to travel) based on individuals’ infection status or potential immunity. Most discussions around immunity- or infection-based documentation policies have focused on scientific plausibility, economic benefit, and challenges relating to ethics and equity. As COVID-19 vaccines are rolled out, attention has turned to confirmation of immunity and how documentation such as vaccine certificates or immunity passports can be implemented. However, the contextual inequities and local variabilities interacting with COVID-19 related documentation policies hinder a one-size-fits-all approach. In this Comment, we argue that social science perspectives can and should provide additional insight into these issues, through a diverse range of current and historical examples. This would enable policymakers and researchers to better understand and mitigate current and longer-term differential impacts of COVID-19 immunity-based documentation policies in different contexts. Furthermore, social science research methods can uniquely provide feedback to inform adjustments to policy implementation in real-time and help to document how these policy measures are felt differently across communities, populations, and countries, potentially for years to come. This Comment, updated as of 15 August 2021, combines precedents established in historical disease outbreaks and current experiences with COVID-19 immunity-based documentation policies to highlight valuable lessons and an acute need for further social science research which should inform effective and context-appropriate future public health policy and action.
Highlights
1234567890():,; In responding to the widespread impacts of the COVID-19 pandemic, countries have proposed and implemented documentation policies that confer varying levels of freedoms or restrictions based on individuals’ infection status or potential immunity
Most discussions around immunity-based documentation for COVID-19 have focused on scientific soundness, economic benefit, and ethical challenges of implementation whilst drawing on a narrow selection of historical examples (Persad and Emanuel, 2020; Voo et al, 2020; Phelan, 2020; Voo et al, 2021)
The International Health Regulations, which are drawn up through international consensus for infections such as yellow fever, do not yet govern travel based on vaccination for COVID-19, resulting in heterogeneity of approaches between countries (Ferhani and Rushton, 2020; World Health Organization, 2021)
Summary
As variants of COVID-19 emerge, past experience with other infectious diseases has been one important source of information to guide current action. Immunity-based documentation policies that allow freedoms to certain populations while restricting others’ may result in people seeking infection in order to access these freedoms as well (Phelan, 2020). Such commentaries have frequently pointed to two cautionary historical precedents of intentional infection: yellow fever in the US antebellum South and ‘chicken pox parties’ in the twentieth century. The pursuit of intentional infection may remain a risk in the COVID-19 pandemic where access to vaccines is lacking.
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