With vaccine coverage on the horizon, many people are starting to think about how to document immunization. In this article, CITF-funded researcher Dr. Kumanan Wilson from the University of Ottawa and the Bruyère Research Institute and colleague Colleen Flood from the University of Ottawa, discuss how SARS-CoV-2 immunization passports could work, the infrastructure required to operationalize them and potential barriers and limitations to their use.

In recognizing that public authorities and private entities may soon require people to provide proof of immunization to SARS-CoV-2 in certain contexts, it is important to understand how these immunity passports could be developed and how they could be used in collaboration with other efforts to safely reopen society. The authors discuss precedence for immunity passports citing smallpox scars in the past and the current need for yellow fever immunization when entering countries where yellow fever is endemic. Digital platforms such as smartphones are proposed to host the immunization passports, working in a similar way to electronic boarding passes.

Authors Wilson and Flood highlight how international bodies such as the World Health Organization and the World Economic Forum have explored potential standards and immunization passport solutions, with an initial focus on international travel. In Canada, the authors argue that provincial and territorial governments should ensure their ability to issue a secure digital vaccination record from a government repository to operationalize immunization passports. The authors reinforce that national standards must be aligned with international initiatives in order for them to be effective.

The authors recommend establishing several core requirements, such as those articulated by the Royal Society’s criteria for vaccine passports in the United Kingdom. These requirements ensure that the immunization passports contain all relevant information, are standardized, secure, and meet ethical requirements.

Wilson and Flood caution that if governments do not implement immunization passports, corporations such as airlines or sport venues may develop their own requirements and systems. Allowing private companies to develop their own immunization passports leads to concerns related to equity, privacy and coercion. The authors note that immunization passports are not without their ethical challenges. Limited access to vaccines, technology and other resources may prevent people from using immunization passports and these factors must be addressed at the outset. This is an ongoing and timely discussion that will only continue to become more important as Canada enters the next stage of its vaccination campaign.

K Wilson and C Flood. Implementing digital passports for SARS-CoV-2 immunization in Canada. CMAJ 2021. doi: 10.1503/cmaj.210244; early-released March 3, 2021