WWe have come to another of those times, in this pandemic, where it is critically important that countries respect a central decision-making body rather than go their own way. The issue on the table now is the use of health certificates to regulate international travel.
Sometimes pandemic decisions need to be made locally to reflect the local context – the wearing of masks in schools is one example – but sometimes they really need to be centralized. We’ve seen what can go wrong if they don’t: for example when, in the absence of federal policy, US states ended up bidding against each other for personal protective equipment from China. .
International travel is an obvious case where coordination is needed – globally this time. For the world to get back on its feet, families must be reunited, trade must resume, and scientists must travel. We can consider this because we have effective vaccines and some countries have achieved full coverage of more than half of their population. At the same time, the Delta variant is tearing apart around the world, causing a new spike in Covid-19 cases and deaths, and the vaccine supply is extremely uneven. In these circumstances, border crossing should be as smooth as possible – so that all populations are protected but none are discriminated against. Frictions will hamper the recovery and doubly penalize countries that are already in the back of the queue for vaccine supplies.
Enter the health certificates. Many jurisdictions put them in place to control access to all kinds of services, including international travel. In the interest of global fairness, the World Health Organization (WHO) has said that a negative viral test or proof of cure from Covid-19 should be an acceptable alternative to vaccination, when it comes to to cross borders – and it has published guidance on the use of quarantine in combination with it. But he also recognizes that as the vaccine rollout expands, vaccination will become the preferred endpoint – and rightly so. Requiring a negative test from all inbound travelers, whether or not they are vaccinated – as is the case in the United States right now – creates friction of a different kind, since tests must also be booked and paid for. .
This means that jurisdictions urgently need to agree on which vaccines they will accept. At the moment, there is no such agreement, only a patchwork of different demands. Earlier this month, we heard about the EU’s Covid digital certificate not recognizing the India-made version of the AstraZeneca vaccine, Covishield. But that was just the start. Canada accepts Covishield, but not the two Chinese vaccines – made by Sinopharm and Sinovac – which are being rolled out in China and many other countries. In England, meanwhile, the Covid vaccination status service accessible through the NHS app describes itself as ‘internationally compliant’ but does not yet record doses received abroad – even from vaccines approved in the UK. United. It has created headaches for many, including UK-based doctors I spoke with who have worked on Covid vaccination campaigns in Africa.
There is an obvious solution to this: All countries should adopt the WHO Emergency Use List (EUL) of Covid vaccines. At last count 10, these have met a minimum standard of safety and efficacy. The WHO list is the one on which many countries base their immunization strategies, if they do not have their own mechanisms for evaluating and approving medical interventions. Countries with such mechanisms – usually the wealthier ones – tend to have approved fewer vaccines by their own national standards. The WHO list is the most inclusive, and inclusiveness is what is needed now.
As Marian Wentworth, CEO of the US-based global nonprofit Management Sciences for Health, explains, the decision on recognized vaccines for travel is fundamentally different from the decision to approve a vaccine. in the first place. The calculation is not about individual risk, but about the risk that an individual poses to another population. Assuming a traveler has received a full course of any vaccine approved by the EUL, they will pose a much lower risk to their destination population than their own unvaccinated members. The EUL standard should therefore be sufficient to let it enter.
The friction caused by the lack of standardization on this issue takes different forms, one of which is vaccine reluctance. It is now a major problem in parts of Africa, and although the causes are complex, Wentworth says many Africans wonder – reasonably – why vaccines that are good enough for them are not good enough for them. Americans or Europeans.
The format of any universal health certificate is also important. Countries have rushed towards digital solutions; but again, in the interest of inclusiveness, some public health experts favor “dumb technology”. It could be the little yellow vaccine booklet, officially called the International Certificate of Vaccination or Prophylaxis, issued by the WHO, of which it is now hastening to print additional copies.
A paper certificate works even when the power is off or you don’t have a smartphone. It is integrated with existing health information systems and does not raise confidentiality issues. The downside is that it is easily tampered with – a risk that is high in a pandemic when the supply of vaccines falls short of demand. For this reason, some tech organizations have come up with solutions that are a step forward, such as a digitally signed QR sticker that can be attached to a card and only conveys a person’s identity and immunization status.
Covering all the bases, the WHO will release its guidance on digital health certificates in a few days. Countries will then decide whether or not to apply it. They should, because the sooner they do it, the sooner we can all get back on track – fairly.