COVID-19 – The pros and cons of vaccination certificates
Now that the COVID-19 vaccine is finally available in Canada, there has been a lively debate about creating a vaccination certificate that would give anyone who has been vaccinated more freedom than the rest of us. This raises many questions. Let’s take a look at some of the ethical issues involved.
The idea of a vaccination certificate is currently being hotly debated all over the world. For the moment, however, such a document only exists in a few countries. If vaccination certificates were adopted in Canada, they could allow people to lead more normal lives. Some Canadian provinces are looking into the issue.
Determining eligibility criteria for such a certificate is an extremely complex matter that raises a host of ethical questions. The advantages appear obvious. One thinks immediately of people who work in hospitals and see patients all day long. It would seem to make sense for them to have a document authorizing them not to wear personal protective equipment against COVID-19, or simply to care for patients.
The certificate may also be required in more general contexts. For example, it could be issued for people who want to return to work in person, go to school, or conduct non-essential business. On the other hand, it would be impossible to prevent everyone who is not vaccinated from leaving their homes. Such a violation of civil liberties would be unacceptable.
A COVID-19 vaccination certificate could be an effective tool for protecting our borders. For instance, it could be required for all those returning from a trip. Anyone boarding a plane could also be obliged to have one. In fact, travel is the context in which it would be the easiest to institute such certification, because this is familiar territory. We’re already used to having to obtain visas or vaccinations prior to entering certain countries. Screening tests, also, are not unusual.
Whatever choices are made, we should keep in mind that a vaccination certificate will have enormous benefits for those who are vaccinated, while for those who are not, it could be seen as punitive. Not having a certificate could considerably limit their interactions with family and friends, their travel and, in some cases, their employment opportunities.
In fact, unvaccinated people could remain deprived of certain freedoms until herd immunity is achieved, which will not happen for several months, perhaps even a year or two. And all the while, others around them will be beginning to live normally again. Because of the constraints involved, vaccination certificates may only be required in very specific situations, such as when there is a high risk of infection for the unvaccinated person and his or her relatives.
That said, there are some people who cannot be vaccinated or for whom vaccination is medically counter-indicated. I believe exceptions should be allowed for such people. This is complicated, however, by the fact that such exceptions would leave them less well protected, whereas the purpose of the vaccination certificate is precisely to ensure that they are.
For the certificate to gain public acceptance, sufficient information would need to be made available and it would have to be clear. If we fail to clearly explain its purpose and usefulness, it could be very difficult to implement and enforce.
Prior to moving forward, every possible situation needs to be considered. Limiting travel abroad for vacations is one thing but preventing someone from attending their mother’s funeral is quite different. Likewise, shopping for pleasure is not the same thing as going to buy medicine and food. Should there also be exceptions for non-luxury movement?
Accounting for different situations will not be easy. The nuanced approaches of governments are often confusing and are easy to criticize. People prefer simple, black and white solutions that are easy to understand. In this case, however, nuances are important. Vaccination certificates should not be seen as the magical solution for getting us out of the pandemic. Things are not that simple.
The most common suggestion is to create an electronic certificate that could be obtained through a smartphone app. But that raises another ethical issue: some people still don’t have that kind of phone, and they are often the most vulnerable. That would constitute discrimination, which, of course, should be avoided.
There is also the risk of fraud. Certain individuals could cheat and create false vaccination certificates and use them without being immunized. Although we don’t yet know what such certificates might look like, we can assume that they it wouldn’t be very complicated to forge such documents, especially for people who are tech-savvy.
Public concerns regarding data confidentiality should not be overlooked either. We should therefore ensure that only authorized persons have access to the information contained in the vaccination certificate.
Finally, the question arises: who will decide whether a vaccination certificate is required? The government or the private sector? If ever we choose to go down this road, I propose that it must absolutely be the government that decides. A clear, nuanced policy based on consultations with experts would have to be elaborated to ensure that the use of certificates is justified, and that it is as non-discriminatory as possible.
That said, some private companies may wish to take the lead on this matter. If they require their customers to have a vaccination certificate, they could claim that their services are safe. For example, airlines could require passengers to present such a document upon boarding (the Australian airline Qantas already does so). Grocery chains and entertainment venues could ask the same thing of their own customers (many are currently considering this). From an ethical standpoint, such initiatives are very risky. Allowing private actors to proceed in this way opens the door to discrimination.
Ms. Ravitsky was interviewed by Maryse Guénette.