Why the controversy over a vaccine passport?

There are many examples of the long-established right for public institutions such as schools, employers, governments and businesses to protect the health of others by requiring individuals to provide proof of vaccination or of a past infection, or seek a medical or religious exception. So why has COVID-19 vaccination become a lightning rod for controversy over “vaccine passports” and claims of violations of medical privacy or individual rights?

Medical historian Dr. Howard Markel has written two popular books on the history of infectious diseases and efforts to stop them over the centuries.

“Ways of proving vaccination or past disease have long existed in different forms, and for different diseases, even before we understood what actually caused infections or had vaccines against them,” said Markel, who directs the University of Michigan’s Center for the History of Medicine, Ann Arbor, Michigan.

He said proof of vaccination doesn’t take anybody’s freedom away and will help allow you to have more freedom.

“In fact, they increase your freedom because they allow you to travel where you want to go and do what you want to do. It’s a non-issue and those who say otherwise are making controversy where none should exist,” said Dr. Markel.

Health law and medical ethics researcher Kayte Spector-Bagdady, said institutions rarely have the right to require anyone to get vaccinated, but if you want to work somewhere in particular, or want others to provide you services (such as schools, or businesses, or travel), they might have the right to ask you to provide proof of vaccination first.

“Not only might they have the legal right, but they might also have the legal obligation to protect others,” said Spector-Bagdady, who is the associate director of the University of Michigan’s Center for Bioethics and Social Sciences in Medicine.

Smallpox plagued humankind for thousands of years and killed one in three people who caught it, before worldwide vaccination eradicated it in the late 1970s. The Supreme Court affirmed the right of health departments to require smallpox vaccination in 1905. That ruling, and other judicial and legislative actions since then regarding the right to require proof of vaccination in certain circumstances, will all inform what governments, businesses, universities, school districts and others will do regarding COVID-19.

“You are free to make choices about vaccination, but all of our choices have consequences,” said Dr. Markel. “It simply means you won’t be able to go places or do things that will require you to show you’ve been vaccinated. If you think that’s freedom, have at it.”

Currently, vacationers, journalists, missionaries and nonprofit organization workers bound for many African countries have to carry a special certificate proving they’ve been vaccinated against yellow fever. From the late 1980s until 2010, people with HIV/AIDS could not travel or immigrate into the United States. Spector-Bagdady says that one of the big questions still unresolved is whether the COVID-19 vaccine will be treated more like the annual flu vaccine or the measles vaccine.

The flu shot is strongly encouraged for everyone by medical professionals, but only required in limited circumstances such as hospital workers. But the measles vaccine is required in many more situations, including enrollment into many public schools.

The federal government is expected to issue guidance for the use of COVID-19 vaccine status soon, but it seems unlikely to set a standard for a national document beyond the white cards issued to vaccinated people. Other countries are creating their own standards and passes.