Immunity Passports: A Debate Between Jay Bhattacharya and Alberto Giubilini

Today we’re publishing a debate about the pros and cons of immunity passports between Dr. Alberto Giubilini, a Senior Research Fellow in the Oxford Philosophy Faculty, and Dr. Jay Bhattacharya, Professor of Medicine at Stanford University. If any readers would like to participate in this debate, please send your contributions to and we’ll publish a round-up in a few days’ time.

Here is an extract from Dr. Giubilini’s contribution:

There are many people among the most vulnerable to COVID-19 who cannot be vaccinated for medical reasons. These would be exempted from passport requirements – medical exemptions are normally applied where vaccine mandates are in place. Besides, there are many people in the most vulnerable groups who, even if they have been vaccinated, are not protected, given that vaccines are not 100% effective. We need to maximize the chances of protecting these people as far as is reasonably possible. (Which excludes lockdown. These are unreasonable measures.)

Their freedom to have a normal life, to travel, to go to public spaces, to socialise – in other words, their fundamental freedoms (the very same ones that lockdown denies) – presuppose that they are able do all these things as safely as possible. If I am an unvaccinated vulnerable person and I have reason to think very few people in my local pub or in my community are vaccinated, in an important sense I am not free to go to the pub or to the shops. (I would only be free in a legal sense, but that is not the kind of freedom that matters the most.) Doing that would mean taking on quite a large risk (I am in a vulnerable group after all), and that would be true even if I am vaccinated (vaccines are not 100% effective, after all).

Because my liberty matters and arguably the state has a responsibility to protect it as much as is reasonably possible, I can reasonably expect some safeguards to be in place to guarantee that it is safe for me to do all these things.

An immunity passport scheme can offer some extra level of protection to vulnerable people by significantly reducing the chances of transmission without all the costs of lockdown. Vaccines might not be as effective at preventing transmission as they are at preventing disease, but even a reduction of risk can be important.

And here is an extract from Dr. Bhattacharya’s reply:

Vaccine hesitancy among those most susceptible to severe outcomes after Covid infection (primarily the elderly) is the key public health problem at this point in the epidemic. Age is the most important risk factor for severe Covid infection outcomes; there is a thousand-fold difference between the mortality risk faced by the oldest individuals and the youngest after infection. A comprehensive meta-analysis of seroprevalence studies published in the Bulletin of the World Health Organisation finds that people aged 70 and over have a 95% infection survival rate. In comparison, people under 70 have a 99.95% infection survival rate.

In the U.S., more than 80% of the elderly population has already received one vaccine dose (of the two shot regimens), and 70% are fully vaccinated. It has been difficult for states to move that fraction higher for various reasons, but perceived doubts about the vaccine’s safety features prominently among the explanation. While the adenovirus vaccines have triggered a safety signal in younger populations that have led regulatory agencies to issue black box warnings, there have been no safety problems established for these vaccines in the older population. But the issue is one of perceived safety rather than actual safety.

To that specific population that is already largely distrustful of public health authorities (and with much good reason given their manifest failures during this pandemic), the imposition of immunity passports will have the paradoxical effect of reducing vaccine demand. A certain kind of person, over-represented in the vaccine-hesitant group, will respond to an immunity passport requirement by wondering why, if the vaccine is so great, public health authorities and businesses are coercing him to get it? I confess that I have had this thought, even though I have read the vaccine trial data closely, think that the vaccines are great, recommended vaccination strongly to my older friends and family members, and am fully vaccinated myself. Worse, there is the distinct possibility that the distrust of public health created by Covid immunity passports will foster further erosion of the popular support for other vaccines such as the MMR vaccine that protects against measles, mumps, and rubella. If this occurs, it would be a disaster from a public health perspective.

The debate is very much worth reading in full.

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