Bioethicist: 'Immunity Passports' Could Do More Harm Than Good

May 29, 2020
Originally published on May 29, 2020 6:37 pm

"Immunity passports" have been proposed as one way to reboot economies in the wake of the coronavirus pandemic.

The theory is this: The approval of the so-called passports would rely on the positive results from an antibody test of your collected blood sample. If you have antibodies to the coronavirus after recovering from an infection, you might be immune from future infection and therefore could be authorized to work and circulate in society without posing a risk to yourself or others.

At least, that's the idea.

But it "could create a lot more harm than it does good," says Natalie Kofler, who teaches bioethics at Harvard Medical School.

As she argues in a recent essay for the journal Nature, Kofler says a system that hinges on a blood test could cut off already marginalized populations from access to critical public resources, wherein "an immunoprivileged sort of status or an immunodeprived status" would dictate "where and what they can go do."

In any case, she says, scientists aren't certain that it's even possible to achieve immunity from the coronavirus and how long that immunity would last.

"I am really concerned that too much attention time and funding is being given to a policy that's likely to firstly, not work, and also create more risks than it does benefits," Kofler says in an interview with NPR's All Things Considered.

Here are excerpts from the interview:

Who is interested in using "immunity passports"?

Governments including the U.K., the United States — as well as Chile has actually already begun to roll out a version of an immunity passport.

Private companies are also interested, particularly in partnering with certain app developers to create applications that would allow for people on their phones to validate and show their immunity status, in which case could allow private companies, like certain hotels and even sporting events, to control who can enter their premises.

Another issue that you raise is equity — that the poor will simply not have as much access to these immunity passports. Explain what you mean.

Those that are already marginalized by society — the poor, minority groups — they end up being often last in line for access to these precious resources. So we have a lot of concern about who would actually be able to have their immunity status validated. You could have people that just aren't able to access society because they can't even be able to certify their immune status.

If immunity passports aren't the answer, what is then?

I really think that attention needs to be given right now to really developing a vaccine is effective but also that is going to be universally available. And I also do support maybe thinking about ways that we can protect particularly vulnerable locations and spaces.

It may be that, for example, to enter certain nursing homes or [long-term care] facilities to enter certain penitentiaries where there's high density — people who are [at] higher risk of COVID-19 — that we might have health check status there. We may want to check for presence of virus in people who entering and exiting.

But not on the individual level where everybody is gonna either have an immunoprivileged sort of status or an immunodeprived status to be able to depend on where and what they can go do. I think that that could create a lot more harm than it does good.

Listen to the full interview at the audio link above.

Copyright 2020 NPR. To see more, visit https://www.npr.org.

AILSA CHANG, HOST:

Passports have been proposed as one way to get economies fired up again. These passports would rely on an antibody test - the theory being, if you have antibodies to the coronavirus you might be immune, and therefore you could be certified to work and circulate in society without posing a risk to yourself or to others. At least that's the idea, but this idea has a lot of flaws, according to bioethicist Natalie Kofler. She wrote about it in the journal Nature and joins us now. Welcome.

NATALIE KOFLER: Hi. Thanks for having me.

CHANG: Well, thanks for being here. First of all, who is interested in using these so-called immunity passports? Are we talking about governments, private companies, both?

KOFLER: Both, at this point. We've heard about certain governments that are exploring immunity passports as a potential policy to help reopen economies, governments including the U.K., the United States, as well as - Chile has actually already begun to sort of roll out a version of an immunity passport. Private companies are also interested particularly in partnering with certain app developers to create applications that would allow for people on their phones to validate and show their immunity status, in which case that could allow private companies like certain hotels and even sporting events to control who can enter their premises.

CHANG: OK. Well, let's talk about a few of the concerns that you raise in your article. First, there's this whole issue of immunity itself. I'm curious. Does having antibodies to COVID-19 mean you are actually immune to another infection by the virus?

KOFLER: So having antibodies to COVID-19 means that you have survived the virus, right?

CHANG: Right.

KOFLER: You've been infected and recovered. Likely, this gives some immunity to future infection. However, scientists still don't know how that immunity might work, meaning we don't know if everybody who has survived has a robust-enough immune response to be able to prevent future infection. We also don't know if immunity is possible from COVID-19 and how long it might last. If it's anything like the coronavirus that causes the common cold, immunity might last for only as little as, you know, four to six months. If it's like other coronaviruses, it could last longer, like the SARS virus could give you immunity maybe for one to two years.

CHANG: Right. What about the tests that even test for antibodies? I mean, do we even have enough of those tests? And are they reliable enough to support a whole system of immunity passports?

KOFLER: So one concern of ours is that there's currently real issues on - of the reliability of available tests for antibodies. There are some available that do have high enough sensitivity and specificity to be able to use as a measure for antibodies within people trying to determine their potential immune status. The problem there, though, is again a numbers issue. So there's only very few manufacturers of highly reliable tests. Roche is one of them out of Switzerland, for example. And right now, for example, they're guaranteeing, you know, several million tests a month to be produced, but that's going to be nowhere near enough to be able to validate entire, you know, populations...

CHANG: Yeah.

KOFLER: ...Of nations for their immune status.

CHANG: Well, another issue that you raised is this whole idea of equity, that the poor will simply not have as much access to these immunity passports. Explain what you mean by that.

KOFLER: Yeah, so we're really concerned about - knowing that immunity assessment through these antibody tests is going to be dependent on how many tests are available and knowing that those tests are going to be a scarce resource, those that are already marginalized by society - the poor, minority groups - they end up being often last in line for access to these precious resources.

CHANG: Right.

KOFLER: And so we have a lot of concern about who would actually be able to have their immunity status validated. You could have people that just aren't able to access society because they can't even be able to certify their immune status.

CHANG: Well, then, you know, given that there are several concerns with immunity passports, they may not be the answer - what is then?

KOFLER: So I really think attention needs to be given right now to really developing a vaccine that is effective but also that is going to be universally available. And I also do support maybe thinking about ways that we can protect particularly vulnerable locations and spaces. So it may be that, for example, to enter certain nursing homes or long-care facilities or to enter certain penitentiaries where there's high density people who are going to be at higher risk of COVID-19 that we might have health check status there, right?

We may want to check for, you know, presence of virus in people who are entering and exiting but not on the individual level, where everybody is going to either have, you know, an immuno-privileged sort of status or immuno-deprived status to be able to depend on where and what they can go do. I think that that could create a lot more harm than it does good.

CHANG: Bioethicist Natalie Kofler is also an adviser for the Scientific Citizenship Initiative at Harvard Medical School. This was so interesting. Thank you very much.

KOFLER: Thank you for having me. It was my pleasure. Transcript provided by NPR, Copyright NPR.