The Fight Over Vaccine Passports

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S1: When Diane Dimond wakes up in the morning, he has a little routine. He plays The New York Times spelling bee on his phone to warm up his brain. Then he checks The Washington Post. That’s where he works, covering health care policy.

S2: But after I do those things, I do look at the CDC vaccine data page on how the rollout is doing. And I try and keep an eye on a few different indicators of the case. Count two.

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S1: And right now it feels like the pandemic is in a delicate place. The pace of vaccinations is ramping up, but so are new cases. As the CDC director said, we have so much to look forward to, so much promise and potential of where we are and so much reason for hope. But right now, I’m scared.

S2: And I was trying to figure out, is that a reasonable position? Is she as a new official, maybe speaking off the cuff in a way that the White House didn’t support? And everyone I talked to said, no, this this is fair. This is accurate. We have seen great progress over the past few months. We’re now at a moment where that progress could get blown up if the cases keep going up and the protections keep

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S1: being rolled back. As I talk to Dan, I thought about my Monday morning when I went to a mass vaccination site in Brooklyn to get my first shot. I was really hopeful, standing in line in the cold with all sorts of other New Yorkers, like we were all doing our part together. And then I had this thought as I was sitting there in the observation area after my shot, like how how in the world do we keep track of all these people?

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S2: It’s been hard because at times people showing up for vaccine appointments, they haven’t done a lot of preregistration, they may have only heard that the vaccine was available because some doses were otherwise going to be thrown away. And there are mass vaccination sites, their pharmacies. There are all sorts of different providers at this point administering these shots. The data does get rolled up and collected and sent to health officials. But there’s no data in this moment that would allow scientists to be able to say this. Many people with these conditions got vaccinated this week with the Pfizer shot.

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S1: This kind of data could be really important for the next phase of the pandemic, the part where we try to climb out of it, which could require knowing who specifically has been vaccinated for travel, for school or work. Right now, states, private companies and the Biden administration are trying to agree on how to make some kind of credential that shows a person has been vaccinated, otherwise known as a vaccine passport. Today on the show, why vaccine passports might be the key to a post Copan life and why they’re so controversial. I’m Lizzie O’Leary and you’re listening to What Next, TBD, a show about technology, power and how the future will be determined. Stick with us. OK, I think that this term vaccine passport gets thrown around like we all understand what it means. Is there a definition like what does what does vaccine passport mean?

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S2: I think it depends who you ask. The Biden administration would say this would be documentation of people who have been vaccinated and they can present it as needed to travel authorities to businesses that are requiring some proof of the shot. They actually try and avoid the word passport. Lizzi, they they’ve talked about credentialling of this information or vaccine verification. Republicans would say that passports are an infringement. This is an increasing argument from from the right that passports are an attempt by the government to collect data in an inappropriate way to butt into people’s personal health decisions. And even the use of the word passport is creating some complaint that this is an elitist term, that only people who travel internationally have passports. Why? Why are we even cottoning on to that term at all?

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S1: I mean, it’s not all that different from the, like, little yellow card that you get if you’ve gotten a yellow fever shot or something like that when you travel or if you traveled in the past, I’ve I’ve had inoculations and had to show that to cross some borders.

S2: I remember doing the same when I went to South America, I think in college. But the idea is a little different, only that we’re in the middle of a global pandemic. Right. Like there’s more import on being able to demonstrate that you’re protected against covid-19. As we’re trying to ramp down covid-19,

S1: there are some countries pursuing vaccine passports. Perhaps the most notable is Israel, which has rolled out the digital green passports. People have been vaccinated, Kencho. They’re passing a smartphone to enter a gym or restaurant or concert venue. But of course, Israel, like other countries with vaccine passport systems, including Denmark and China, has a unified national health care system. Well, let’s talk about the United States, because there are obviously a number of things that make the U.S. different. But the biggest one that stands out to me is that we have no national health care system. It’s not like you can just look at a great big database and check. Yes, Lizzie has been vaccinated or no, she hasn’t.

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S2: Right. There’s no single database. There’s no single provider. There’s no single ability to mandate what all patients or all providers might do. So in the case of, say, China, which was draconian at times, and locking down its citizenry, there was an ability to do more centralized planning in the United States. The president and his team can step behind the White House podium and urge these things. They can issue guidelines and standards. But so much is up to individual states, individual leaders.

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S1: Yeah, I noticed that, that here in New York we have something called the Excelsior Pass, which I guess what theoretically, if I want to go to a Brooklyn Nets game, I could show that on my phone. But it feels so fragmented. I guess they’re, what, 17 at least different approaches to to some sort of vaccine passport in the U.S. So far,

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S2: there are at least 17 that bypass the levels. They had identified all those different options and some documents that we obtained at the Post. So it’s possible that there are even more passport models. Those are just the 17 that the Biden folks had had run through in their list.

S1: Well, so so how might this work on, like, a really granular level? Like who would provide if we’re going to use me as an example, a vaccine passport type interface on my phone, and then who would make sure that my private data wasn’t out there for data brokers to sell or hackers to steal?

S2: In terms of providing these passports, there are a variety of ways it could happen. There could be a Web site, for instance, that all Americans go to and download the free software, the free app, and put it on your phone. And this is maybe one of the standard passport models at the White House, signs off on millions of Americans adopt that, put it on their phone, show it in places that require the passport verification. There also could be a world where if you are a patient of the VA, the Veteran Affairs Department, the VA has millions of its own patients and could say to its patients, hey, here is a passport that we’ve developed, we approve. You can download it and you can use it as needed when maybe you come to VA facilities, but not necessarily require people to have it. Just sort of like if you have that medical health record on your phone, similar sort of idea that providers that are very interested in having that data handy that they would be rolling it out. To their patients to.

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S1: There’s also this thing called the Vaccine Credential Initiative. What is that,

S2: the vaccine credential initiative of all these different passport models? It’s one of the ones that I’m watching most closely, maybe the most closely. In fact, this is a consortium of hundreds of organizations, including Microsoft and Salesforce, that is trying to come up with standards and technology for these passports to use. And they are pursuing and open source data model that’s very different than, say, the IBM model in the state of New York. And one fear is that if every state pursues its own proprietary system, then you’ve got all these different vaccine passports that don’t necessarily work together, as well as an open source model where the data is made available and different developers can then use the standard that the vaccine credential initiative has developed.

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S1: The systems that are underway or being developed in the U.S. right now feel like a patchwork. And I guess I wonder what happens if there isn’t some sort of central coordination? Is it risky if we have this multifaceted response?

S2: I think we’ve seen over the past year the risks of a patchwork response to coronavirus and different states having different rules and inconsistent language. It just makes it that much harder to contain the virus and to coordinate across the country. At the same time, one could argue that a strength the United States is the power of federalism and that different states should have flexibility in what they do, because the situation in Massachusetts is very different than the situation in Texas. But the risk is real is the idea that there won’t be ways to make sure that people are vaccinated even as the economy is reopening. That makes a lot of public health experts nervous for good reason. We are trying to get past the pandemic and without ways to know that Americans are protected. That could plunge us back in.

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S1: Well, take me through what the administration is talking about, because you got a hold of some documents that showed that the administration and some private companies are talking about a standard way for Americans to prove they had been vaccinated. What are those discussions like?

S2: Those discussions at this point are pretty high level policy. What the government is looking to do is make sure that these digital passports that, again, are already being developed, that would ever comes and whatever companies might pursue in the United States, meet basic privacy standards, are protected against fraud, are also accessible to as many people as possible. The HHS officials who are doing a lot of the groundwork that the basic blocking and tackling around data standards and coordination, they’ve they’ve urged patience. What they’re worried about is moving too quickly, rolling out, say, a passport that could be hacked, that doesn’t protect people’s private information, that only increases fear and concern in the middle of this bigger concerting year that we’ve all lived through.

S1: There’s so many different parts of this story, and I want to go after them one by one. But I want to talk about the tech part of this a little bit, because it seems complicated. I mean, in the course of the pandemic, there have been notification apps and a lot of those fizzled. Like if you came in contact with someone who officials knew had tested positive, there were supposed to be testing apps. And those also kind of fizzled. I guess it feels like I don’t know, I feel a little skeptical of some of these kind of loose knit groups of interests, whether they are a big hospital system or a tech company or the government or everybody kind of all working together, because so far the stuff doesn’t seem to have worked.

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S2: Yeah. And they only seem to work and really contained constrained environments. I don’t know if you’ve read or done any reporting on the NBA’s bubble in Florida last year when the basketball players started up there. They’re contained season. And in that case, there were such strict standards around alerts that when you got too close to other people, you get this alert that would say you’re sitting too close and other data checks. And it did seem to work. There were no no cases of covid in this contained environment. But we’re not like that as a free country. You can’t require people to wear all these things or produce all these documents. So I do agree that skepticism is warranted. And whatever vaccine passport model emerges in the United States is almost certainly going to look different than what passport model is used in China or in Israel, in countries where national security and personal decisions are so intertwined from the government messaging to say in Israel, people doing compulsory military service, it’s just a very, very different ethic in the United States. So I think it’s right to be skeptical. That whatever emerges will look anything like what has emerged overseas.

S1: When we come back, how vaccine passports could discriminate. The concerns about vaccine passports tend to fall into two camps, equity and politics, vaccine distribution in the U.S. is already unequal, even though racial data uncovered vaccines is incomplete. CDC numbers show that nearly two thirds of people who received at least one dose are white. That could mean a disproportionate number of people of color are being excluded from places that require a vaccine passport. Beyond race, there are other questions about how vaccine passports might discriminate, unequal access to technology, for example, and there are other concerns.

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S2: For instance, if you privilege people who are vaccinated. Are you discriminating against people who might have religious objections to get the vaccine? Are you are you discriminating against people who might have some medical condition that makes them very nervous about getting the vaccine? So this this has emerged as a real threat and problem, not just among Republicans like this is a widespread bioethical concern. I did talk to Zeke Emanuel, the former adviser to the Biden covid response. He worked in the Obama White House, a bioethicist himself, and he said he thinks these passports are coming no matter what, and that they do have value. But all the bioethicists, all the officials I talked to say it’s important to tread lightly here. And that’s another argument, not to mandate anything because you’re further potentially widening those equity gaps that you alluded to.

S1: Well, and I wonder if you might inadvertently discourage vaccination in that way. If you have marginalized communities or people who aren’t documented, who might be nervous about interacting with the health care system, vaccination system, if they know that that data is going somewhere central, that’s going to be tracked, if that makes them even more reluctant to to get vaccinated.

S2: That fear makes total sense to me, especially after talking to some voters who are vaccine hesitant. I will say that the government has insisted there will be no central database. This is not like the Trump administration, which collected data from people who were helping refugees come into America over the past number of years. And the fear from that was if you showed up to help these refugees and you were an undocumented immigrant yourself, it would it might scare you because that data could be shared with with people who might deport you. So this is a very different model, at least from the government’s perspective, where they don’t want to be the keepers of this data.

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S1: Let’s talk about the politics a little bit. The Republican line that has emerged in the past few days is that this is big government run amuck. And you hear that from, say, Florida Governor Ron DeSantis.

S3: We are not supporting doing any vaccine passports in the state of Florida, but we always said we want to provide it for all but mandated for none. And that was something that if

S2: the government was doing what some Republicans said it was doing, I might understand that argument. If the government really was creating a passport and forcing all of us to present it, if we just wanted to go into a bar, then I could see where they’re coming from. But that’s not what the government is doing.

S1: Well, I guess I wonder that even though you, for example, have been very clear in your reporting that this is not something that the government has any plans to mandate. That message is so stark and does play into some people’s fears. It could potentially mess with any kind of vaccination confirmation system in this embryonic stage.

S2: I think it’s already messing with it. I was talking to White House officials this week after some of our stories broke in the post about what the White House was doing around vaccination credentialing and was hearing about the concerns that people are now bringing to the White House, business leaders, politicians, some of those concerns valid and backed up by what’s actually happening. Some of those concerns amplified by the talk radio’s fear of what these business leaders were worried would happen. So at minimum, is creating a headache for people trying to execute on this plan and maximum it might scare Americans away. It might it might stop what could be a good health initiative from taking hold if millions of people think there’s some nefarious ulterior motive.

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S1: You have been talking with the administration. You’ve been talking to critics of the administration. How much are they leaning into working on this right now, knowing that it’s sort of secondary to getting people vaccinated in the first place?

S2: Good question. That’s exactly the calculus that they’ve made one, the focus right now needs to be getting shots and arms, getting vaccinations up because of the case numbers rising. The threat of variance, worrying about presenting proof of vaccination is tomorrow’s problem, not today’s. That said, the Biden administration very much wants things to go back to normal as as much as they can the summer. And if we are in an environment where people are mingling, socializing, wanting to go back into, say, a bar and not being able to control for the risk that some people might be vulnerable to covid might not have gotten their vaccine. I know the White House wants to make this work as soon as realistically possible, but they’re still doing enough data collection work, organizing with the private sector and yes, wanting to make sure that vaccinations reach a point that you’re not privileging the still minority of Americans who have gotten shots and not excluding the sixty five percent of people who have yet to get a shot.

S1: Is it important to get some sort of vaccine tracking system in place while the vaccinations are happening? It sort of makes me wonder if you can collect that data and sort of assess that status post facto or if it has to happen in the moment when that shot is going into the arm.

S2: I was talking to a former administration official about this exact problem yesterday, and this former official was venting about those paper copies that people put up on social media to tout that they’ve been vaccinated. You may have done that, too. I can remember

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S1: I didn’t I have mine now.

S2: I was going to check Instagram and we were done and see if it was there. But the missed opportunity to have done more up front work as opposed to like a paper card, but to have some of the digital tracking set up two months ago, that that is something that folks are absolutely lamenting because you can do this work later. It’s just going to be harder. Right. And you also have the threat of people putting up their private information about when they got vaccinated and where. And if you’re worried about fraud, around proof of vaccination, all of these paper cards circulating on social media with people’s personal data, we’ve already seen potential data risk that could exceed what might happen to some of these digital passports.

S1: What do you think the timeline is right now? Where do we go from here?

S2: So we’re talking at the start of April. My expectation is that we won’t see anything from the administration on this for at least a few weeks. They are they’re consumed with other challenges right now, rolling out more vaccines, getting the case numbers down, working on priorities that have nothing to do with covid like infrastructure. So this issue, which is so knotty and thorny, probably doesn’t rise to the front of the agenda until late April or May, when there might be more shots.

S1: Diane Dimond from The Washington Post, thank you so much, Lizzie O’Leary.

S2: It is delightful to be with you. Thanks for having me.

S1: Diane Dimond investigates health policy and politics for The Washington Post. That is it for us today. TBD is produced by Ethan Brooks and edited by Allison Benedikt and Tori Bosz. Alicia Montgomery is the executive producer for Slate podcasts. TBD is part of the larger What Next family. And it’s also part of Future Tense, a partnership of Slate, Arizona State University and New America. I want to recommend you take a minute and listen to Thursday’s What Next about LA’s housing crisis and the showdown over a public park. What next will be back on Monday. Have a good weekend. I’m Lizzie O’Leary. Thanks for listening.