Closed petition Do not roll out Covid-19 vaccine passports in Jersey

Background
The Government of Jersey is exploring the potential introduction of a COVID Status Certification scheme. As part of that process, it is recognised that consideration must be given to the following:
a) all associated ethical and legal implications, including the potential for inequality discrimination should vaccination status become a condition of travel and / or access to certain spaces or facilities such as gyms, concert venues and restaurants (1)

b) the fact that Jersey is ahead of many countries in the world with its vaccination programme. Further division between the vaccinated and unvaccinated has the potential to raise political and ethical questions. Supporting initiatives such as COVAX is important to ensure global equitable access to a vaccine, particularly protecting health care workers and those most-at-risk. This is the only way to mitigate the public health and economic impact of the pandemic (2)

c) the COVID-19 vaccination is not mandatory. Limiting access to services based on vaccination status risks the implication that the vaccine is mandatory. Any framework that comes into place will need to be harmonized, when it comes to standards and use cases, by a normative body – such as the World Health Organization (WHO) – to ensure that its use is ethical and fair (3).

Overview of issues
Ethical
There are many ethical theories and concepts that can be applied to a complex issue such as CSC. As the COVID-19 vaccination is a health care intervention it is not unreasonable to apply a principle-based ethical approach to CSC that operates in health care – autonomy, beneficence, non-maleficence, and justice (4).
The extent to which these principles will apply will vary depending on whether a CSC provides proof of vaccination status and / or proof of immunity or evidence of negative COVID-19 PCR test.

Ethical Considerations

Autonomy
People should be self-governing and allowed to make decisions for themselves.
The vaccination is not mandatory, and people are able to determine whether or not to be vaccinated. However, one can also consider the rights of an individual to travel. The introduction of CSC could afford greater freedoms for this to take place but is not without risk. The rights and freedoms afforded to individuals does not provide them with the freedom to potentially harm others (5).

Non-maleficence
The avoidance of doing harm
Travel, importing new cases of COVID-19, and the risk of new variants could certainly be harmful to the island. A third wave and increased public health restrictions would impact many islanders. A fully informed risk analysis of the risk presented is required.

Beneficence
Active altruism
CSC places the onus on the individual. A more altruistic approach could be striving for herd immunity, looking to benefit the whole population as opposed to individuals.

Justice
Suggests that the COVID-19 vaccine is available and fairly distributed
Given the limited supply and need to prioritize the vaccine roll-out this principle does not apply. Inevitably, any benefits introduced before all of those eligible have been offered a vaccine could be considered unjust. The COVID-19 vaccine is not yet licensed for children and represents an injustice to any person who cannot be vaccinated on health grounds.

The Ada Lovelace Institute convened a group of multidisciplinary experts to explore the evidence, risks and benefits of the potential roll-out of digital vaccine passports (6).

They identified the following immediate and future risks:

Immediate Risks:

1. Undermining public health by treating a collective problem as an individual one
Ultimately it will be national and international herd immunity that provides protection. CSC may offer a false sense of security and increase risky behaviours before this is achieved.

2. The opportunity cost of focusing on vaccine passports
In reality, the gap between having confidence in the scientific evidence on transmission and achieving population level herd immunity may indeed be relatively short. The UK remains on course to meet the target to offer a vaccine to all those in the phase 1 priority groups by mid-April, and all adults by the end of July (7). Jersey estimates that 80% of eligible islanders could have received 2 doses by the end of August (subject to vaccine supply).

3. Exacerbating distrust by marginalised groups and increasing vaccine hesitancy
Linking vaccination to travel has been suggested as a way to encourage vaccine take up and address vaccine hesitancy. It must be acknowledged that the opposite may also be true. People may feel strongly that their liberties have been impacted by nature of being unable or unwilling to be vaccinated. It may also implicitly suggest that vaccination is mandatory if it affords additional benefits or imposes restrictions on those not vaccinated.

In Jersey vaccine uptake has been very good. 87% of the population 80 years and over have now been fully vaccinated. A 4insight survey, commissioned by the Government of Jersey, revealed that 83% of respondents positively supported getting the vaccine. It is therefore not clear if further incentivisation is required. A more balanced approach could include communications supporting vaccination towards achieving the collective benefit of the community as opposed to a benefit linked purely to an individual.

4. Exacerbating inequalities within societies
‘The Data Divide’ explores how the accelerated adoption of data driven technologies and systems during the pandemic may have affected inequalities (8). People from Black, Asian and minority ethnic backgrounds, and people on an income of less than £20,000 a year, indicated higher levels of concern that they would be unfairly discriminated against than White respondents and higher-income respondents.

This survey revealed that two thirds (64%) of the public were not concerned that vaccine passports will be discriminatory against them as individuals. Slightly more than half (55%) thought that they are likely to lead to discrimination against marginalised groups, such as young people, people who are shielding, members of the LGBTQI+ community, people from a minority ethnic background or those who are in precarious work (e.g. on zero-hours contracts or gig workers).

5. Increasing inequalities between nations
Jersey is in a privileged position and ahead of many countries in the world with its vaccination programme. While this may afford on-island benefits and achieving herd immunity may be possible sooner than elsewhere, this will be compromised if new variants are brought on to the island and allowed the circulate. The risk of a third wave must not be overlooked, and the impact of a further lockdown would have implications for all. Jersey cannot be considered independent of the global inequalities and access to vaccinations.

Future Risks:

6. Normalising health status surveillance by creating long-term infrastructure in response to a time-bounded crisis.
Consideration must be given to the longevity of CSC in the context of so much uncertainty and the future of SARS-CoV-2. The potential to revoke or impose time limits on any status should be incorporated from the outset.

7. Scope creep and information flows
Concerns have been raised regarding data protection and the expansion of CSC beyond its initial remit.

The Royal Society identified core ethical principles in their report ‘Twelve criteria for the development and use of COVID-19 vaccine passports’ (5).
Vaccine passports that are exclusively digital could exacerbate the digital divide for the elderly or those without digital devices.

Behavioural science

A rapid review of behavioural responses to COVID-19 health certification was recently published (9). Literature suggests certificates to enable international travel is generally supported. Outside of the context of international travel, health certification in relation to COVID-19 has the potential for harm as well as benefit.

Legal

Advice will be sought on all legal matters related to the potential introduction of CSCs in Jersey, including any potential requirement for new or amended legislation.

In the event that GoJ were to contract with a third-party provider of an ‘off-the-shelf” CSC / COVID passport app, GoJ would need to give particular consideration to the risks arising from such schemes including:
• creation of related digital infrastructure
• the ‘rules’ for where these systems should be implemented
• local standards, enforcement and regulation (4).

Operational

The vaccination programme was developed as part of the public health response to the global COVID-19 pandemic. Linking vaccination to travel could exert pressure on the vaccination programme.

The vaccine programme must continue to be delivered at pace, in an equitable, efficient manner. While high coverage remains key, the vaccine programme should not be compromised by those wishing to avail of the perceived travel benefits of vaccination.

Summary

This is a highly complex issue requiring consideration of many ethical and legal issues. As evidence regarding the impact of vaccines on transmission emerges from real world data the Government of Jersey needs to be in a position to address the public policy issues that arise, creating clear and specific guidelines and law around any appropriate uses, mechanisms for enforcement and methods of legal redress.

It is unlikely that CSC would become mandatory, but residents must be afforded the ability to provide digital proof of vaccination as this may become a requirement by external carriers in the future.

This response is by the Minister for Health and Social Services.