As we near the one-year anniversary of stay-at-home orders in the United States, COVID-19 vaccine distribution has begun, albeit in rather messy fashion. In the U.S. to date, over 49 million people have received at least one dose of the Pfizer or Moderna vaccines, and over 24 million have received their second dose as well, according to the CDC. Despite promises of smooth and widespread vaccine distribution from the Trump administration in the fall of last year, the vast majority of vaccinations have only been administered under the direction of President Biden’s COVID-19 Task Force. And stories of people skipping the line, political favoritism, and wealthy individuals gaming the system continue to taint the process nationwide.
Soon, though, with the Johnson & Johnson vaccine on the way, anyone who wants to get a vaccine will (in theory) be able to get one—if their job and other circumstances permit. This, in turn, has led technocrats to recommend the use of vaccine passport apps to enable safe re-opening of public spaces by this summer. This isn’t the first time app-based solutions have been recommended during the COVID-19 pandemic. Contact-tracing apps first hit the digital marketplace by the summer of last year, yet have struggled to find their feet in part due to issues regarding privacy and surveillance—issues that vaccine passport apps share as well.
However, concerns regarding privacy rights are not a luxury that all can afford, including the socioeconomically disadvantaged, racial and ethnic minorities, immigrants and refugees, and the formerly incarcerated—all of whom have historically been over-surveilled by the government. No matter the slew of assurances from tech giants, vaccine app adoption will continue to encounter hesitancy among marginalized communities where individuals have routinely been forced to renounce their right to privacy, often in order to qualify for government assistance or in the name of public safety. Ignoring this “poverty of privacy rights” means ignoring a sizable subset of the population who are less willing to give up what privacy they have left, less trusting of institutional authorities, and less likely to be afforded equitable healthcare to receive the vaccine in the first place.
Equity in vaccine distribution is a major hurdle to achieving herd immunity—a hurdle even for those who are already eligible. Low-income communities, communities of color, and immigrants are thus far among the least likely to have received the vaccine, and yet have been more likely not only to get sick with COVID-19 but to die from it, too. Adequate access to health care remains a barrier, and the ability to schedule and show up for a vaccination appointment remains contingent on internet access, flexibility from employers, and reliable transportation.
Additionally, vaccine hesitancy that exists in subsets of these communities is due both to a long history of systemic discrimination and abuse by medical institutions—such as the U.S. Public Health Service Syphilis Study at Tuskegee and forced sterilization of Black, Latina, and Indigeneous women across the country—and to ongoing disparities in quality of care for minority groups in health-care settings today. Misinformation campaigns by anti-vaxxers have also specifically targeted these communities, exacerbating the situation further.
In response to such hesitancy, one might argue that uptake may improve if individuals are unable to participate in indoor activities, such as going to the grocery store or movie theater, without a vaccine passport app in hand. And such an argument wouldn’t be without precedent. For instance, SB-277 in California outlawed personal exemptions from vaccination requirements for entry into both private and public schools following the 2015 Disneyland measles outbreak. And under immigration laws, the Department of Homeland Security mandates that those entering the U.S. for the first time or current foreign nationals applying for residency must be vaccinated based on recommendations from the Department of Health and Human Services. Required immunization “cards” for commercial travel have also existed for quite some time, and the evolution to developing an “e-vaccination certificate” system for travel post-pandemic is unsurprising. Though vaccinated individuals currently receive a CDC-issued paper COVID-19 vaccine record, plans are already underway in the private sector to attempt a nationwide app for immunization status.
However, while the public may support some form of vaccination verification to enable safer participation in indoor activities, a recent survey by Brookings pointed to concern that apps have a higher potential for violations of privacy and civil liberties than paper cards, particularly since U.S. law does little to protect against discrimination based on proof of immunity. Additionally, not only would these apps face challenges in terms of varying enforcement mechanisms, e.g. entering a school versus a grocery store, but aforementioned hesitancy—with respect to both vaccination and app adoption—remains a major obstacle to overcome. Countering vaccine misinformation and distrust of public health authorities, as well as ensuring privacy protections, will be an ongoing battle. Furthermore, even those who want to use a vaccine passport app may not be able to because of limited access to smartphones.
Ultimately, relying solely on vaccine passport apps to reopen society will translate primarily into privileged communities being afforded a return to normalcy. Such apps can be of use in very limited circumstances, like commercial air travel, but these efforts are essentially trivial to the more pressing consideration of vaccinating the general public equitably. The focus must remain on addressing the underlying concerns of marginalized communities by improving government engagement with community leaders to promote vaccine accessibility and uptake and providing alternatives to signing up for vaccine appointments for those without smartphone or Internet access (like landline phone and mail-in scheduling).
Concentrating on vaccine passport apps as a silver bullet for getting back to normal is a mistake so long as an equitable vaccine rollout remains out of reach, and marginalized communities continue to be left behind.