In the context of ongoing Covid-19 vaccination campaigns, different states and non-state actors are rolling out Covid-19 certification schemes. Building on the learnings from the event “Tackling the immunity certificate conundrum” which was co-organised by foraus in late April, four main policy recommendations have emerged: (1) international coordination is key; (2) flexible governance schemes are needed to adapt to changing scientific knowledge; (3) the inclusion of the public from the start is key to avoid backlashes and discrimination; and (4) ethical framework conditions need to be in place.
What are we talking about?
Ever since the World Health Organization officially declared Covid-19 a pandemic more than a year ago, the handling of health data and the use of digital technologies in efforts to contain the pandemic have increasingly gained importance. Especially with the global rollout of vaccination campaigns, the question of how data related to Covid-19 vaccination, infection, and testing should be used increasingly gained attention. As a consequence, different certification schemes have been developed at a high speed, without necessarily leaving the time for public consultation. Before diving into the four recommendations, a few clarifications are necessary. First, while the political reality around Covid certification is constantly evolving, this blogpost doesn’t target specific country situations, nor related ‘opening’ decisions but rather aims at providing constructive arguments regarding necessary framework conditions. Second, even though many different names exist, the general term ‘Covid certificate’ and ‘Covid certification systems’ will be used below. A Covid certificate can provide documentary evidence that a person had a COVID-19 vaccination, has had and recovered from the disease, or has tested negative (e.g. Swiss system). Other systems can be more restrictive and include only vaccination data.
I. International coordination is key
To ensure effective use, Covid certification schemes need to be coordinated at the international level. The ‘International Geneva’ should take a leading role in defining a framework for international coordination and setting global standards. At the technical level, the World Health Organization’s Smart Vaccination Certificate Working Group is coordinating efforts on an internationally recognized vaccination certificate. It is aiming at applying international standards such as the HL7 FHIRE International Patient Summary to ensure the data is represented in a consistent way across countries and that patients can retain the information about their vaccination status on their digital devices. More generally, Geneva can be the central platform for best practice sharing. But to have an influence, the standards developed in Geneva need to be applied by states globally and recognised as legitimate by citizens around the world.
II. Public inclusion & communication
Another major factor is the inclusion of the public into the discussions around the certification schemes. This also relates to the larger problem of diminishing trust in science and policy decisions in the context of Covid-19. Early communication and feedback loops with the public are key for governments to ensure measures are understood and followed. Public authorities and international organisations should further build up internal competencies regarding the communication of policies and better explain the scientific findings they are based on. In Switzerland, the missed communication around the recommendation not to use masks during the first Covid-19 wave amid shortages followed by the reverse message once sufficient masks became available again has for instance undermined trust in public health recommendations by the government within parts of the population.
III. Flexible governance schemes to quickly adapt to changing scientific knowledge
Given that scientific understanding over Covid-19 is constantly evolving and new variants emerge with time, the certification systems need to remain flexible in order to integrate new learnings. For instance, the validity period of certificates might have to be adapted once more clinical data on vaccinated populations becomes available, potentially providing evidence of a different immunity impact than expected, or additional Covid ‘booster’ vaccines be taken after a certain period. Furthermore, these changes should be coordinated among states and groups of states in order to avoid having different systems and assessments from one country to another. In addition, there should be clear rules regarding the conditions required to stop using Covid certification systems — in order to avoid them staying in place indefinitely and potentially be used for other purposes than initially defined.
IV. Ethical considerations as part of the solution for sustainable and trusted systems:
One major conclusion from the workshop’s discussions was that accountability mechanisms and regular rounds of evidence assessment on the functioning of Covid certification schemes should be put in place. To this end, public committees could also be included in the discussions at WHO level, as well as at national level, from the start. In order to guarantee people’s trust in Covid certification systems, transparency around data usage, storage, and related questions as well as the criteria chosen to hand out a Covid certificate to people are essential. Finally, the issue of equity regarding people, who either live in regions with low vaccine rates or testing capacities or are part of populations with so far less available evidence about potential vaccination risks (e.g. pregnant women) was highlighted as well during the workshop. The recommendation which came out of it was that anti-discrimination guidelines should be considered in exceptional cases and evidence be collected on potential equity challenges during the implementation of Covid certification systems. This could then serve to adapt criteria or political decisions regarding the use of vaccination certificates (when their use is mandatory, recommended, or prohibited).