Declining community transmissions amid enhanced testing measures, and optimism about the rollout of vaccines for COVID-19, have spurred efforts to reopen borders. This has also inspired new discussions of how to create a ‘digital health passport’ that will allow people to travel between countries, facilitate trade and possibly revive the tourism industry without afflicting those considered vulnerable.
At a minimum, such a passport needs to include data about the individual, the type of vaccination they received, and the diagnostic test used to declare them virus-free. In addition, this information needs to be verified by a reliable authority.
The closest historical parallel we have is the emergence of e-passports. These smart passports carry a chip containing biometric data, such as a photo or a fingerprint, encrypted on a machine-readable chip that allows immigration officials (or automated gates) to more easily verify the document and authenticate the holder.
Part of the challenge involved security issues — such as keeping the information private, ensuring it hadn't been tampered with, confirming its source, ensuring the chip in the passport and the reader can authenticate each other, and preserving the integrity of the public and private keys necessary for a connection to be established.
Most countries now have an e-passport, but it took 50 years to develop the International Civil Aviation Organization (ICAO) standards to make them possible.1
This journey presents a cautionary tale for those that dream of digital health passports being implemented with a snap of the fingers.
Related read: The Making of a Fit-for-Purpose Digital Health Ecosystem
It's unlikely that all these issues will surface in the case of a digital health passport. The urgent need for a solution is clearly focusing the minds of policymakers, industries suffering from the COVID-19 pandemic, and providers of technology solutions. But this urgency itself may cause an obstacle, spawning a range of initiatives that lack interoperability.
While privacy remains an ongoing challenge, past lessons have been learned well. Virtually all the major initiatives in creating digital health passports stress the need for individuals to control and own their health and identity credentials, and be allowed to see, and have a say in, how that data is being used.
Some lessons from e-passports, however, do not apply to the health passport. One difference is that the digital health passports may ultimately have both physical and digital forms, while also being entirely operable in digital form, either in person in an app or online. The paper version, such as a computer printout or a card, will be necessary for those not carrying mobile phones. But it is vulnerable to being lost, exposing sensitive data, or being altered or counterfeited. So it must contain some element that allows it to be verified online, most likely via a QR card, and for the user to be able to print off another copy if needed.
Efforts are therefore focused on developing standards which, if not entirely overseen by one body like the e-passport, then at least are interoperable. With so many people dedicating time and resources to finding an equitable solution to the problem, ensuring that they all work together is likely to be the greatest challenge. There is widespread agreement that open standards should be used where possible, and extensible enough to allow for wherever COVID-19, and its successors, take us. As the Good Health Pass Collaborative, developed by a group of like-minded partners, says: "One thing is clear: in this race to market it is unlikely that a single solution will be implemented universally – or even across the entire travel industry."2 Indeed, having a single solution may not be desirable: a government may have different requirements to an airline or an event venue. But this may also result in fragmentation that undermines the health and economic benefits of digital health pass systems.
There are other issues that are neither technical nor organisational but need to be wrestled with, such as social cohesion and ethics. If governments decide that vaccines are proving to be effective, do they allow those who carry vaccine passports to start using them immediately? Or do they wait until everyone who wants (or is required to have) a vaccine has one? Are liberties being infringed upon by allowing some people to move and not others?
Resolving these issues will be critical for the success of the emerging digital health passport ecosystem. While many organisations are taking great pains to work cooperatively on the challenges, questions remain about whether they will succeed in time to make a difference in the current pandemic, and how such digital solutions can help us in future pandemics.
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1International Civil Aviation Organization. Strategy guiding international civil aviation into the 21st century. Retrieved from https://www.icao.int/Documents/secretary-general/rpereira/strategy.pdf
2Good Health Pass (2021). A Safe Path to Global Reopening. Retrieved from https://www.goodhealthpass.org/wp-content/uploads/2021/02/Good-Health-Pass-Collaborative-Principles-Paper.pdf
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