In August 2021, I wrote a blog article about digital COVID vaccine records, a form of digital health passports. At the time, it was a pilot program in New York City, as businesses toyed with ways to get patrons back into their establishments safely. I listed the pros and cons, noticing more cons than pros to this practice. The cons mostly concerned privacy, security, and the discomfort of being mandated to do something.
The concept has gained momentum in the few months since, though the phrase ‘digital vaccine passports’ has fallen out of favor, replaced with digital vaccine credentials. States including Massachusetts and California are putting digital record measures in place, seeking to establish some form of standardized, interoperable, and secure framework. If actions speak louder than words, those entities have found the advantages of such records outweigh their disadvantages.
Businesses that thrive on groups of people coming together in a physical location have decided to require such measures for the simple, pragmatic reason of avoiding a repeat of 2020 when their businesses shut down and their livelihoods hung by a thread. With those memories still vivid, businesses such as concert halls, sports venues, movie theaters, entertainment venues, and restaurants have found vaccination records to be the most practical avenue to open for business and stay open, hopefully with a return to profitability.
Schools and universities have followed similar protocols, requesting vaccination records (not necessarily in digital form), conducting frequent testing on-premises, and maintaining masking practices. This may not be ideal, but repeating the 2020 experience was a worse option.
Standardizing the rules, paying the bills, and adapting to a new normal
The practical benefit of a digital vaccine passport does not erase the need for those records to be secured and to prevent data breaches. Such a breach would hurt public trust and cause another round of confusion and uncertainty that can take months to untangle. The World Health Organization is among the international entities working to establish a framework that addresses just that. Vaccine Credential Initiative, of which EPIC, Cerner, Allscripts, and Athenahealth are founding members, is another.
Then there is the matter of who pays the bill to make sure those security measures are in place. In the case of state or federal mandates, responsibility could fall on the issuing state and federal entities. Businesses that require that patrons present records may also be required to contribute a token amount of their earnings—not much different than paying for a utility they rely on to conduct business safely and reliably.
In the long term, COVID-19 vaccine records will become a simple line item in our health immunization records that already list diphtheria, tetanus, influenza, polio, and other vaccines we receive during an annual physical. They will be considered part of preventive care; health plans will cover them. Just like students are required to produce a health record that shows up-to-date vaccinations for school, and just like drug and urine tests requested of some employees when starting a new job, employers are now asking for candidates’ vaccination records.
Implications for health plans, technology providers, and individuals
Encouraging the use of digital vaccine records is a pragmatic way for health plan providers to encourage vaccinations, reduce the pool of enrolled members susceptible to contracting the virus, and reduce the likelihood of costly COVID hospitalization. For technology providers with robust relationships with EMRs, this moment in time presents an opportunity in time to leverage those records and secure the data with robust measures based on WHO or other standards, and promote them to state and federal agencies, business groups, and associations.
Vaccinated individuals are now free to move about the country, travel internationally, and resume social events with a simple mask and other common-sense measures. They may even be viewed as more desirable candidates when applying for jobs. (Of course, the Omicron variant may be about to change all that). Still, unvaccinated people face a far higher risk of contracting the virus and being left out of social events and venues until the pandemic is fully in the rear-view mirror; given the Delta and Omicron variants and others yet unnamed, that may well take years. Concerns around personal medical records are valid, but missing out on social life is not a pragmatic option.
If you have questions as things continue to develop, please reach out to me at [email protected].
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