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. 2020 Aug 4;222(5):715-718.
doi: 10.1093/infdis/jiaa352.

Ethical Implementation of Immunity Passports During the COVID-19 Pandemic

Teck Chuan Voo  1 , Hannah Clapham  2 , Clarence C Tam  2   3
Affiliations

Ethical Implementation of Immunity Passports During the COVID-19 Pandemic

Teck Chuan Voo et al. J Infect Dis. .

Abstract

A number of countries are planning the use of "immunity passports" as a way to ease restrictive measures and allow infected and recovered people to return to work during the COVID-19 pandemic. This paper brings together key scientific uncertainties regarding the use of serological tests to assure immune status and a public health ethics perspective to inform key considerations in the ethical implementation of immunity passport policies. Ill-conceived policies have the potential to cause severe unintended harms that could result in greater inequity, the stigmatization of certain sectors of society, and heightened risks and unequal treatment of individuals due to erroneous test results. Immunity passports could, however, be used to achieve collective benefits and benefits for specific populations besides facilitating economic recovery. We conclude that sector-based policies that prioritize access to testing based on societal need are likely to be fairer and logistically more feasible, while minimizing stigma and reducing incentives for fraud. Clear guidelines need to be set out for which sectors of society should be prioritized for testing, and rigorous mechanisms should be in place to validate test results and identify cases of reinfection.

Keywords: COVID-19; SARS-CoV-2; coronavirus; disease control policy; equity; ethics; immunity passports; serological assays; stigma.

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Figures

Figure 1.
Figure 1.
Positive predictive value (PPV) of a serological test (y-axis) at varying levels of population infection prevalence (x-axis), for tests with different sensitivity and specificity profiles. The PPV indicates the probability that an individual who tests positive truly has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). For a test with 95% sensitivity and 95% specificity (dashed line), if population infection prevalence is 5%, there is a 50% chance that an individual who tests positive truly has been infected (and a 50% chance that the result is a false positive).
See this image and copyright information in PMC

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