The joy, anxiety, and anticipation of getting a COVID vaccine in America culminates, quite anticlimactically, with a piece of white cardstock. Some have already lost their vaccine cards or never got them to begin with. Others have their names misspelled and crossed out on it. Many are having trouble reconciling how something so simple—and easily forged—can carry such import and weight.
The White House has recently clarified that there will be no federal vaccine passport. “The government is not now, nor will we be supporting a system that requires Americans to carry a credential,” press secretary Jen Psaki said in her briefing Tuesday. However, she did mention that both private and public sector companies are coming up with vaccine screening technology—like IBM’s Excelsior Pass being introduced in New York—to determine who can enter certain events and spaces. (For more, listen to the recent What Next: TBD episode on the fight over vaccine passports.)
While the role of the COVID-19 vaccine—and the CDC vaccine card—is still being clarified, confusion continues to circulate. Slate spoke with two experts to parse the history and future of these little white cards. Mark Levine is a New York City Council member and their Health Department Committee chair, and George Rutherford is a professor and director of the Prevention and Public Health Group at the University of California—San Francisco’s Medical School. The two separate conversations have been combined below, and they have been condensed and edited for clarity.
Elena DeBré: Should we laminate our cards? I heard Staples and Office Depot and Office Max were offering free lamination services … but I also heard that maybe this isn’t the best idea. Some people even said lamination took the ink off their cards.
Mark Levine: There are no official guidelines from the Health Department yet. Many people are laminating, but there’s also the possibility that there will be the need for booster shots. And so, some people have recommended you hold off on laminating, in case you have to write a third date on there. In fact, Dr. [Anthony] Fauci has stated that it’s possible that within six to 12 months, we might simply just ask people to get a third dose of Pfizer or Moderna as opposed to a booster shot, because that might suffice to manage the threat of the variants.
George Rutherford: No, no, no, no, no, no, no. If you had kids, you’d know that they have vaccine cards that you have to show at school all the time. And then if you travel internationally, like Africa or even South America, you have a World Health Organization vaccine card stapled into your passport. It’s just a piece a paper—that’s all. Mine’s all fallen apart. I’ve had to staple it into my passport four times. So, having less than wonderfully painted immunization records is sort of par for the course.
Why do you think people are so stressed about having just this tiny card as their physical COVID-19 vaccination record?
Rutherford: I think it’s just that a lot of people haven’t had to touch vaccine records before. And the electronics are still catching up. The card is just a temporary fix that the CDC decided to have quite early on—it was just the best fix possible.
What should I do if I never get a vaccine card in the first place? Or if I lose it?
Levine: Don’t worry, you don’t have to get revaccinated! Officially, the guidance is that you return to the place where you received your vaccination, and that they should be able to reproduce the card.
Should I plan to carry it with me every day?
Rutherford: I think it will be very occasional use and that people will bring it with them when they know they’ll need it. (I stapled mine in my passport along with my yellow fever card.)
So, will I have to hold onto this card for the rest of my life?
Levine: Well, all of this raises the question of having some sort of electronic system for tracking vaccination.
Historically, is there any electronic record keeping of vaccination information?
Rutherford: Vaccinations are part of your medical records. So there are electronic records of it, and it does get reported up to the state. And because you have to keep track of it all—you have to do return appointments—there is an underlying electronic system. I think there’s all this background work going on about electronic registers and electronic records and stuff like that. But the only thing you’re seeing right now is your card.
What’s happening with the electronic vaccination tracking in New York right now?
Levine: The state has launched an app called the Excelsior Pass—the first state in the country to do so. It can both track vaccination and negative COVID-19 tests. It’s being piloted at Yankee Stadium, Citi Field and Madison Square Garden. Although you can also enter events there by showing your … test results if you haven’t been vaccinated.
I’ve heard there’s some pushback and concerns about the Excelsior Pass. What are those?
Levine: There are real concerns about privacy with the systems. And the state has offered essentially no details and privacy protections for the Excelsior pass. There are some interesting and innovative ideas that would offer an electronic solution without requiring a central database. One idea is using A.I. to recognize a legitimate vaccination card or a lab report on a negative COVID test. It might not be perfect, and it might be vulnerable to some falsification. But it would give you an electronic certification on an app and wouldn’t require any information being sent off your device to a central database.
Are you concerned about the rise of fake vaccine cards ? Do you think the card should be harder to replicate?
Rutherford: It’s somewhat of a concern. These things are hardly tamper-proof. It’s not like they’re a $50 bill or something. It’s just a card and people can just Xerox it and make all they want. But creating a more complicated card would have taken too long. We had to get the vaccines going.