Plans for coronavirus immunity passports should worry us all
If you’ve had Covid-19, an immunity passport could be your ticket out of lockdown — but even companies designing such systems aren’t sure it’s an idea that will or should ever be widely used.
An immunity passport or health certificate is a way of proving to others — your boss, an airline, or a bouncer at a bar — that you have antibodies against the coronavirus that causes Covid-19. It could be a piece of paper, a QR code or a colour code on an app, but regardless of the format, it aims to show you aren’t at risk of spreading infection.
However, the World Health Organisation (WHO) warned in April against immunity passports on the grounds that we don’t yet know how immunity works with Covid-19. It seems that having had the disease means it’s likely that you won’t catch it again, but it remains unclear exactly how long that protection lasts or how strong it will be. The science is still, distinctly, undecided. Plus, we don’t yet have readily available, proven antibody tests. “The WHO has said very clearly that the science is not there,” says Imogen Parker, head of policy at the Ada Lovelace Institute.
The idea of a digital immunity passport or certificate also raises security and privacy concerns, not dissimilar to those around contact tracing apps. And, the system raises the spectre of a two-tier society, with those thought to be immune carrying on with life as normal while the rest remain in various states of lockdown.
Despite such challenges and warnings, variations on an immunity certificate or passport are already being used in Chile, while Italy and Germany are considering the idea. The UK is actively interested, with health secretary Matt Hancock saying the government was working on “systems of certification” – though immunity must be better understood and testing sorted first.
Plenty of tech firms have leapt into the fray to offer digital versions, and Estonia is trialling a system called ImmunityPassport developed by a group called Back to Work, led by Transferwise founder Taavet Hinrikus. As the country loosened its lockdown, it sought tools to aid that process, especially for employers to know their staff had been tested. Estonia already has digital identities for all of its citizens, so the project was linked to that system. “The idea was they could act on data, rather than guessing about symptoms,” says Harsh Sinha, the CTO of Transferwise who also worked on the project.
Sinha says the work started amid wider discussions of antibody tests, with colleagues wondering if there was a way to certify tests and show that evidence to someone else via a smartphone. Certified tests are logged in the system, and users can share their status via a temporary QR code. Once scanned, it shows the necessary health information and a photo of the user for identification. The aim was to give frontline workers more confidence that work was safe, as well as to let people who had recovered from the disease help care for older relatives.
A team of half a dozen colleagues worked evenings and weekends to cobble together a system, knowing that governments would struggle to move fast. “We wanted to build a quick, iterative prototype,” says Sinha. It’s open source and generic enough to be adapted to scientific evidence as it emerges. While working on the project, it became clear that antibody testing was questionable, suggesting immunity passports may never prove useful.
“We were clear that the probability of this seeing the light of day was less than one per cent,” Sinha says. That’s because without readily available, reliable, antibody testing, such an app has little use. “The data capture has to be there from the test,” Sinha says. “Without that the tech is as good as nothing.”
Even with testing, as we still don’t know how immunity works, there’s little point in a wider rollout, says Hinrikus. “Until that becomes clear, there is no point in expanding the pilot,” says Hinrikus. “We should be clear about that, we are building this to save time in the future… Once we have agreement around immunity and availability of widespread and cheap testing, then we could roll it out more widely. But we’re not suggesting that based on the current low quality tests that we should actually be using this.”
Beyond the science, there’s another hurdle to immunity passports: privacy. These tools will hold health data that’s key to work and social life, so keeping that secure and private is necessary. The ImmunityPassport system created by Transferwise staff is held centrally and – by necessity – not anonymised, but it holds a limited amount of personal data: your name, photo and status.
There is a decentralised version in the works, created by researchers at the Turing Institute. Their Secure AntiBody Certificate (SecureABC) system lets a healthcare or test provider issue a digital or paper certificate confirming a positive antibodies test, says Chris Hicks, one of the lead researchers on the project.
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The user would be given a QR code to print or hold in an app, which could be scanned to prove test results and identity via a photograph. “It’s a decentralised system in the sense that the user keeps their certificate and the healthcare provider is essentially offline when proving the antibody testing result,” Hicks says. “We aim to replicate the privacy of traditional non-digital identity documents like drivers licences and passports where the issuer doesn’t learn each time that I use one in a shop to prove my age.” His co-author David Butler adds the team prefers the term antibody certificate rather than immunity passport, as the former may not lead to the latter. “It’s a more accurate reflection of what the certificate does,” he says.
And that’s a key point, as these systems aren’t necessarily specifically about immunity, says Husayn Kassai, CEO and co-founder of Onfido, which is supplying its identification verification to certification projects. Alongside showing results of an antibody test, they could also show whether you’ve had a recent infection test or are showing symptoms. “It could check if you are carrying the virus right now – in which case you should be in isolation,” Kassai says. “Or it could be a general health check-up… if your breathing is abnormal, maybe they shouldn’t come back to work.”
Either system, a test if you have the virus or a symptom checker, could be used by airlines to allow passengers on flights or check into hotels, or even concerts, he says. A symptom checker-style system is being trialled at a US university, with students filling out a digital form before being allowed on campus.
Parker of the Ada Lovelace Institute warns that symptom-based systems could cause problems if they include a wider range of health or demographic factors to assess risk – for example, men are more at risk of Covid as are BAME groups. “Currently we have very clunky ways of effectively risk-scoring groups,” Parker says. “The idea that you might limit people’s rights based on those sorts of categorisations is hugely problematic.”
Regardless of the type of testing used, any health certification raises ethical issues that workers could be forced to divulge their health status to employers, and that this data could divide society. Hinrikus argues that’s one reason why such systems should be carefully deployed. “Like any tool, it can be misused. I think there are very clear cut cases, where we’re talking about elders or frontline workers, where it makes a ton of sense but demanding the whole population to use this is probably a no-go.” In between those extremes, he says, is a lot of grey space where use cases will need to be discussed and carefully considered.
If the only way to go to work, regain a normal social life, and see family is to have immunity, there are some concerned that could drive people to intentionally get infected, especially those groups who are statistically less likely to face serious illness from Covid-19 – an idea that’s been compared to “chicken pox parties”. “I think it’s a valid concern,” says Rebecca Brown, of the Oxford Uehiro Centre for Practical Ethics at the University of Oxford. “But having immunity is an advantage whether immunity passports exist or not.”
Brown explains there’s also an ethical quandary around keeping recovered people in lockdown when they no longer need to be there. “If you have a group of people who are immune, and you have a blanket lockdown in place, it’s not clear how you’re justifying maintaining those people who are immune in lockdown,” Brown says. “What is the justification for keeping those people in a situation where their civil liberties are restricted in a way that’s very unusual?”
Plus, Brown adds, people who know themselves to have recovered from Covid-19 don’t need a test to prove it to themselves, and that’s likely to lead them to behave differently regardless of a digital certificate. “If you’re not putting other people at risk by travelling around a bit more or visiting family, it seems quite likely that people might make that decision on their own,” she says. “Introducing an immunity policy as a way of formalising that and is a way to confirm if they actually are immune or if they’re faking it or guessing at it.”
Politicians looking for an easy way out of lockdown should know this tech isn’t as simple as it looks. “It is really critical that… this isn’t seen as a solution to the really very difficult solution that we’re currently in,” Parker says. “There are all sorts of challenging questions that need to be considered.”
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