On the 30th September 2021, His Excellency, Dr Mokgweetsi E.K Masisi addressed the nation on State of Public Emergency (SOE). In his address, Masisi stated that the proclamation of SOE was approved for a period of a six month each on September 2020 and MARCH 2021. As SOE was coming to an end mapping the way forward is necessary, key of which includes amongst other things, The Public Health (Prevention of Introduction and Spread of Covid-19) order which states that: all persons entering Botswana shall be subjected to PCR testing, unless they carry a valid 72-hour negative PCR test result. All though Masisi did not make mention of vaccine passports and vaccine certificate as mandatory requirements elsewhere these are a requirement.
The COVID-19 pandemic has had a devastating impact on global health for almost two years, resulting in nearly 200 million cases and over 4 million deaths worldwide, various reports and scholars have indicated. Despite a range of non-invasive public health measures, (i.e., physical distancing, and masks) vaccines have been one of the more critical and effective interventions to slow the pandemic. The highly efficacious vaccines represented hope for many, including global health organizations who have called for strategies to maximize vaccine equity since their conception. While many high-income countries (HICs) agreed to prioritize global vaccine equity, in truth, individual health outweighed community health.
With millions of people receiving covid-19 vaccines globally, some countries have already started planning the implementation of “vaccine passports”, accessible certificates confirming covid-19 vaccination linked to the identity of the holder. The purpose of vaccine passports, governments argue, is to allow people to travel, attend large gatherings, access public venues, and return to work without compromising personal safety and public health. There remain, however, considerable practical and ethical challenges to their implementation as presented by various scholars.
As countries grow eager to reignite their economies and people increasingly yearn for mobility and normalcy in life, pressure is mounting for some form of COVID-19 health status certificate that would support these desires. There has already been an explosion of COVID-19 passport initiatives for domestic use and international travel. From doctors’ examinations to ship inspections, clean bills of health have secured passage through centuries of human plagues. Today’s best-known health passport is the International Certificate of Vaccination or Prophylaxis, created by the World Health Organization (WHO). WHO’s Yellow Card has certified vaccinations for cholera, plague, and typhoid, among other infections. There is certainly precedent for a COVID-19 vaccination passport certifying that the holder can travel, study, play, and work without compromising personal or public health. Among newly proposed COVID-19 passport schemes are the WHO’s Smart Vaccination Certificate, the European Union’s proposed Digital Green Pass, and the Africa Centres for Disease Control and Prevention’s “My COVID Pass.”
Vaccine passports are not only permissible under international health regulations, but they also already exist. The World Health Organization for instance endorses certificates confirming vaccination against yellow fever for entry into certain countries. Contrary to immunity passports, which may, perversely, incentivise infection, vaccine passports incentivise vaccination, an international public good with many positive benefits including individual and population immunity.
Regarding the issuance of the COVID-19 vaccine passport, which records the COVID-19 vaccination history, etc., if the COVID-19 vaccine passport is being used overseas, will the government of Botswana consider issuing the COVID-19 vaccine passport? The EU (European Union) for instance is considering the introduction of a passport for the COVID-19 vaccine, which has a record of COVID-19 vaccination history. The Chinese government has begun issuing COVID-19 vaccine passports to overseas travellers to prove that they have already been vaccinated with the COVID-19 vaccine.
If internationally required to issue a passport for the COVID-19 vaccine, will the government of Botswana issue a passport for the COVID-19 vaccine or not? If so, has it already invited tenders for the same? If not, Why the wait? Will issuing a passport for the COVID-19 vaccine lead to discrimination against unvaccinated people In Botswana? Has there been conversations around these? What is the position of the civil society and the opposition political parties as well as human rights activists on the vaccine passports and vaccine certificates? Will the government of Botswana not consider using COVID-19 vaccination certificates in the country at domestic level? On the flip side will it only consider issuing a “COVID-19 vaccine passport” to Batswana traveling overseas. Will all these be supported by the development of legislative framework and new policy regarding vaccination and mandatory vaccine passport and certificate and exclusion thereof at domestic level.
Given the momentum, what are the main principles that COVID-19 passports should follow to ensure their appropriate use?
According to the literature, a COVID-19 passport should be scientifically valid. Passport holders must be protected from illness so that they can carry out the activities for which the passport has been issued and to avoid burdening health services. A passport would ideally certify that holders are not, and cannot become, a source of infection for others. Vaccines have high efficacy in preventing symptomatic COVID-19, and there is growing evidence that they can prevent transmission too.
No vaccine is perfect, and it remains to be determined whether vaccines meet minimum requirements for preventing infection and illness. The duration of protection conferred by vaccines should be tied to passport expiry dates, perhaps with options to revoke passports if new coronavirus variants compromise efficacy.
The vaccination certificate according to WHO, should be portable, affordable, and linked safely and securely to the identity of the holder. Ideally, it will be internationally standardized with verifiable credentials and based on interoperable technologies. Forgery and personal data security are dominant concerns, but such problems are routinely solved for financial and other sensitive transactions.
Many issues surround the fair use of vaccination passports. The widely held view is that documents must avoid discrimination and inequity. Ideally, a passport would be exclusive only with respect to its primary purpose, which is to protect the health of individuals and others with whom they come into contact. But such exclusions inevitably raise barriers elsewhere. Some, such as restrictions on nonessential leisure activities, should be relatively easy to manage. The greatest risk is that people for whom vaccination is unacceptable, untested, inaccessible, or impossible are denied access to essential goods and services. This could happen where there is vaccine hesitancy or refusal among certain ethnic minorities; where there are no data on vaccine efficacy for people at risk, such as children and pregnant women; where migrants are undocumented and unreachable; where passports are exclusively digital, barring people without smartphones; and where people are not yet eligible for vaccination. These examples signal the need for alternatives and exemptions.
Some decisions about how to use passports will be made by public debate and consent, drawing on social and ethical norms. Others will be determined by domestic and international law. Some employers elsewhere have already announced “no jab, no job” policies. Will be the case in Botswana? What role are the Trade Unions playing in this space? In such cases, the freedom of choice for individual employees, set against a firm’s duty and preference for the care of all staff, might be tested in court.
COVID-19 is a new human disease. The challenges presented by vaccination passports are also new in detail, but mostly familiar in kind. Adding to current, imperfect certification procedures by diagnostic tests, vaccination passports are likely to be widely adopted during the pandemic and its probable sequel, endemic and episodic disease. The choice about how passports are used should be guided by exemplary science, appropriate technologies, and fair use for all.
It is important to note there are contentious issues involved in introducing CVC, which is sometimes called as ‘COVID passport’. First, those who are in favour of this proposal argue that vaccine passports are ‘seen as a tool to hasten a return to normalcy, a safety measure that will facilitate opening up of sectors of the economy further, which in turn will hasten recovery’. On the other hand, those who are not in favor say that this kind of tool could ‘create a two-tier society whereby only certain groups are able to fully enjoy their rights’. The latter is being supported by the World Health Organization (WHO) which states that the national authorities and conveyance operators should not introduce requirements of proof.
In conclusion, will it be a good idea to force people into the vaccine passports or it should it be by choice? CVC can just be an option, noting that CVC raises several ethical issues. Noting the huge social and political issues on this matter and potential issues about discrimination, privilege and exclusion of younger generation who would be the last line to be vaccinated, will the government of Botswana force people into the vaccine passport and certificate or will it adopt the two-tier approach of having CVC and none CVC to cater and cover domestic population? Will it adopt and or adapt to the WHO CVC framework and the Africa CDC Vaccine passport “My Covid Pass”.
*Thabo Lucas Seleke is a researcher and scholar, Global Health Policy Analysis ( LSHTM)
