Every day, millions of Americans’ immune systems are reprogrammed by sophisticated strands of frozen nucleic acid. They teach our cells to detect and destroy a virus that was totally unknown to our species 18 months ago. The occasion is commemorated with a scribbled-on piece of paper.
The American proof-of-vaccination system is, to put it generously, archaic. It hasn’t been a priority amid the crisis. But now some lawmakers are trying to create a more sustainable system to keep track of shots. For example, last month, New York Governor Andrew Cuomo announced a vaccine passport for residents, consisting of a website and smartphone app. The state bills it as “a free, fast, and secure way to present digital proof of vaccination.” Similar systems are already in place in Israel, China, and the United Kingdom, and are being considered elsewhere.
Republican leaders have aligned themselves against any such thing. Governors such as Florida’s Ron DeSantis, Texas’s Greg Abbott, and South Dakota’s Kristi Noem have promised to prohibit vaccine passports. Noem, for example, made a stunning comparison to voter-ID laws, accusing those who oppose Georgia’s new voting-rights restrictions but favor vaccine passports of “‘woke’ left” hypocrisy. An opinion piece this week in The Wall Street Journal warned, “Restaurants in most parts of the U.S. have already reopened, at limited capacity in some places. A vaccine passport would prohibit entry by potential customers who haven’t received their shots.” (Emphasis the authors’.)
To be clear: Vaccine passports don’t prohibit people from entering restaurants; cities, states, and restaurants do. And a vaccine passport is not like a voter-ID law; it’s more akin to an ID. No one is suggesting you’d need it in order to vote.
Falsely conflating the documentation itself with a vaccine requirement is a pervasive argument, but it’s usually either disingenuous or inane. Putting a system in place to help people document their vaccination status is not the same thing as demanding that everyone get vaccinated. Focusing on the very existence of vaccine passports is a distraction that risks dividing people at a moment when unity is crucial.
Vaccine requirements have been the subject of heated arguments for as long as inoculation has existed. There is a genuine, important debate to be had. People who support mandatory vaccination cite the collective nature of infectious diseases: If you forgo vaccination, you put your community at risk. It’s not like forgoing sunscreen and getting skin cancer. But for others—even those who support vaccination generally—strict requirements represent a breach of individual bodily autonomy: For the state to mandate an injection of anything (much less something produced by a multinational corporation profiting from the transaction) is simply unconscionable.
The American approach has been, historically, to let people do what they want. Individuals have the right to forgo vaccination, just as they have the right to forgo operating a motor vehicle if they don’t want to get a driver’s license. But if they choose not to get vaccinated, they will face limitations on what they can do.
Hospitals, for example, can require employees to get particular vaccines; people who don’t want them are free to refrain from working where they could transmit an infectious disease to patients undergoing chemotherapy. School systems can require children to be vaccinated; parents who don’t want their kids to get shots are free to homeschool. The armed forces require personnel to get certain vaccines in order to attend basic training and prior to deployment, to avoid an outbreak in the ranks and potentially putting everyone they defend in peril. In instances when shots are required, private institutions have traditionally required a signed note from a doctor, and recorded their employees’ vaccination status in a database.
The ongoing, expansive distribution of COVID-19 vaccines has prioritized speed and safety over documentation. Instead of being administered exclusively at pharmacies and primary-care offices, shots have been given by podiatrists in empty stadiums, convention centers, and casinos. There is no single, centralized electronic medical record linking these places, no one cloud in which your vaccination status is noted. Your own doctor (if you have one) may have no way of verifying whether you’ve been vaccinated. So far the paper cards handed out at vaccine sites serve as the only evidence.
These cards aren’t meant to last long or be carried around. They’re for personal reference. Some people have laminated them, but I wouldn’t know how to go about getting something laminated. Nor would I want to take a big, laminated card with me everywhere I go. Plus, it’s paper with handwriting on it. As official documents go, forgery wouldn’t exactly require a master. (You can already buy one online.)
This disjointed system presents a challenge as the United States reopens. Some places—such as hospitals and schools—will inevitably require staff or students to be vaccinated against COVID-19. Already, Brown University and Rutgers have announced that all students must be vaccinated in order to attend the fall semester in person. The hope is that these sorts of requirements will allow schools to return to the normalcy that everyone so desperately wants. Given the unique circumstances of the moment—a still-acute crisis that continues to kill nearly 1,000 Americans every day—COVID-19 vaccine requirements will likely extend beyond schools and hospitals. In Israel, gyms and hotels already require proof of vaccination for employees and patrons. In the U.K., Prime Minister Boris Johnson has indicated that people will soon need proof of vaccination in order to enter a soccer stadium or pub. Enforcing such rules fairly requires a system for verifying vaccination status.
President Joe Biden has not endorsed vaccination requirements. In the U.S., such mandates will exist, but will be determined by individual businesses, industries, institutions, cities, and states. This patchwork approach will make reliable documentation only more necessary. If you travel domestically, you may need to prove your vaccination status to go into, say, a theater in New York City, even if your usual theater in Philadelphia doesn’t have such a rule. The people taking tickets at the door will need a centralized registry to check.
That registry may take the form of an app, a card, or a website. Ultimately, different areas and entities in the U.S. may end up using all three. While the federal government could offer an app that people might use if they wanted—particularly people who travel often between states—White House Press Secretary Jen Psaki has said that the federal government will not maintain a centralized database of who has been vaccinated.
Vaccine passports, in some form, are going to be a basic necessity as the United States begins to crawl its way out of the pandemic. Nevertheless, the idea has staunch opponents. The recent Wall Street Journal op-ed called the idea of issuing vaccine passports “unjust and discriminatory,” and suggested that it would somehow lead young, healthy people to jump the line and snap up limited doses of vaccines so they could go to the movies. Such fraud and abuse may be incentivized in the very near term, but that potential will grow more far-fetched as the vaccines become available to more Americans. If passports are likely to incentivize anything, it’s vaccination. The perks of vaccination—say, free Krispy Kreme donuts for the rest of 2021—might be more appealing if a user-friendly system made them easier to claim each morning.
The op-ed makes a broader argument, too, that vaccine passports contribute to “a coercive scheme to encourage vaccination.” This is a common strain in conspiracy theories intended to turn vaccination from a public-health tool to a political wedge. But a tool is not inherently coercive. Could it be misused? Sure. Could records of people’s immune status fall into the hands of a scheming demagogue and be used for authoritarian ends? Well, conceivably. Could they be used to divide societies, disenfranchise people, and exacerbate disparities? Theoretically. Could you go to jail if you run a red light and don’t have a vaccine passport? These things are all hypothetically possible. But they would hinge on a malevolent, unchecked government abusing its authority and passing unconstitutional laws. It’s far more likely that vaccine passports would simply help societies reopen and hasten the end of the pandemic.
Vaccine documentation has a long historical precedent, dating back to the 18th century, and hasn’t resulted in this sort of nightmare before. If you had not been evidently disfigured by smallpox, or did not have an apparent-enough scar on your arm from the primitive inoculation process of the time, then you needed documentation of your immunity in order to enter the U.S. Various states required such proof in order to work or attend school. Privately owned social clubs and businesses also asked for proof, and cities drew quarantine boundaries that could be crossed only with documentation. But the documentation itself was not what restricted individual autonomy. If anything, having a way to demonstrate proof of vaccination gave people more freedom, not less. To this day, federal and state authorities in the U.S. can and do impose quarantine requirements and issue lockdown orders during emergencies. A document proving vaccination could free people from such restrictions.
For those who are genuinely concerned about the existence of passports leading to vaccine-based discrimination, the target of debate should be the requirement for vaccines, not for certification once they’re received. If your favorite restaurant institutes a ban on unvaccinated patrons, you could argue about how it is trampling your liberties. Or you could just not eat there.
As divisive as vaccination policy can be, a voluntary system for documenting your own vaccination status should be uncontroversial. We should be debating how best to deploy such a system; instead, a basic tool has been misrepresented to fuel a culture war. We are moving toward a vaccine-stratified society, and we will have to work continuously to prevent and minimize the inequities that can arise in any such scenario. This will require a fair, equitable, widely available system for accessing one’s own documentation. As the bioethicist Arthur Caplan explained to me recently on The Atlantic’s Social Distance podcast, we’re likely entering a world where certain establishments may have signs that say something like No shirt, no shoes, no shot, no service. Many people will feel safer inside as a result. Others will object. When division does arise, it will not be helped by having a faction of people who carry around self-laminated certificates.
While many Americans will inevitably balk at vaccine mandates and sharing health data with elected officials, as a country, we’ve historically proved willing to share that information in exchange for free stuff. Nudges like free donuts may ultimately be what makes Americans comfortable with the idea of a vaccine passport. It’s not just Krispy Kreme. Instacart is now offering a $25 coupon if you’ve been vaccinated. Employees of Target, Amtrak, and McDonald’s get several hours of additional pay.
All these measures would likely be more efficient and more fairly executed with a simple vaccine passport. As more and more people are inconvenienced by trying to prove they’ve been vaccinated, the need for an app will become clear. We’ll wonder why this was ever a debate.
The Atlantic’s COVID-19 coverage is supported by a grant from the Chan Zuckerberg Initiative.