Because it makes little sense to talk about an immunity license for the vaccinated

A passport for recipients of vaccine doses is difficult to implement and scientifically creaky. What is different is a national registry for epidemiological purposes

(photo: Dimhou / PixaBay) It was already talked about between spring and summer - always out of all proportion - in relation to serological tests, and now the idea of ​​assigning people with immunity licenses or vaccination passports has returned to circulation. The intention could be the noblest: to encourage adherence to the vaccination campaign, providing one more good reason to consent to the call when it is your turn. However, the transition from a declaration of intent to the practical realization of a system of this kind would be very complex and would leave room for many distortions.

And if on the one hand it is considered urgent and necessary to find ways to reducing the number of skeptics in the face of new vaccines, on the other hand it is difficult to develop gentle pushes (nudging, in English) that are both effective and sensible from an ethical and health point of view. However, delivering a certificate that acts as a pass at national or international level does not seem to be the best setting.

Some criticalities of the license

Before such a system can really be implemented, it would be necessary find answers to a series of questions. Starting from the simplest things: how long should this license be valid, if we still do not know the duration of the immunization guaranteed by the vaccine? And how would the differences (in efficacy, duration, speed of the induced immune reaction) be managed between the different formulations developed by the various pharmaceutical companies and which should arrive on the market in the coming months?

Even assuming that the proposal to limit access to stadiums, public transport, cinemas and other places on the basis of the license does not pose critical issues from a regulatory, constitutional and ethical point of view (which is very likely) , it would then remain to understand how to manage all that gray area that the vaccination campaign inevitably leaves. For example, there are people who cannot be vaccinated, for reasons of immune dysfunction or previous severe allergic reactions: what should we do in these cases? Assign the license ex officio, or deny it indefinitely? The same would also apply to millions of children and young people, for whom, as is well known, there is no vaccine available, nor do they seem to be able to get one soon.

And it could go on indefinitely. As we know, the vaccine determines different immune responses from individual to individual and in general there is no formulation that guarantees 100% immunity. According to the pre-approval studies, we speak of 90% -95% depending on the case, but it is plausible that at the level of the general population the guaranteed coverage is a little lower. Likewise, it has not yet been ascertained whether the various vaccines are capable of preventing disease only or even transmission, and this could make a huge difference in terms of containment rules.

Among other details , which are not so marginal, there would then be the question of when to actually activate the license itself with respect to the time of administration (because the coverage is not immediate), and then the issue of how to manage the disparity that would be created between those who can be vaccinated immediately and who will have to wait months, or maybe - if it snows a lot, the witty would say - even the whole of 2021. We would find ourselves in the situation in which in the long term, once the herd immunity has been achieved, the license would not more sense of existing, and a transition phase during the vaccination campaign in which having a license or not also depends on the order of priority indicated in the vaccination plan. In short, a discreet chaos.

Two possible counter-objections

It must be said however that, compared to other bizarre ideas circulated in recent months, that of the vaccine passport is not the craziest of all . In addition to the issue of incentivizing people, which remains to be demonstrated, there are at least two elements that could in themselves lead to the creation of licenses.

The first is that, however, it is better to gather only people vaccinated than mixed people, vaccinated or not. Fully loaded planes or trains, overflowing theaters and other people gathering points are certainly the last to be rehabilitated. And being able to create a sort of hyper-local herd immunity, always assuming that vaccines prevent transmission, would give the opportunity to open earlier, while limiting access to only certain people.

L another counter-objection, relating to all the evident criticalities of the license idea, is that in any case no rule will ever be perfect. After all, in recent months we have become accustomed to bureaucratic procedures between the brainy and the senseless, between quarantines, double tampons, self-isolation, changing colors and various joints. In short, if we built and even kept the Immuni app, which in fact we never understood how it was used to make it useful, we can now do anything.

A communicative own goal

In addition to technical, scientific and legal issues, the idea of ​​a vaccination passport could possibly create the worst damage from the point of view of communication and public perception.

First of all, granting a license to vaccinated persons would feed one of the most dangerous fake news on vaccines, which even the Higher Institute of Health has kept to deny: the vaccine is not a free all, nor does it give exemption from compliance with anti-contagion precautions such as masks and distancing. One of the reasons, of course, is the aforementioned dubious protection against the transmission of the virus. Giving a paper or digital certificate that certifies vaccination would mean implicitly communicating to people that it is done, that they may feel okay, and could therefore pass a wrong and dangerous message for the management of the epidemic. A bit like the idea that wearing a mask is sufficient to prevent infections.

The other crucial point of a communicative nature concerns the comparison with the compulsory hypothesis. Of course, the license could be presented as a softer version than the establishment of a real obligation, but then it would be necessary to understand how much the lack of a license precludes daily activities. If it limits a little, it would essentially be a useless mini-blackmail. If it limits a lot it would instead become a de facto obligation, because those without a license would find themselves in a substantial prolonged lockdown indefinitely. And finding the right measure would be a challenge by no means trivial: rather, one could say, it is better to provide for the obligation for specific categories. Or perhaps focus on good information and confidence building, even looking beyond Covid-19.

The hypothesis of a vaccination registry

A completely different approach could have another hypothesis of we have been talking about in recent days, namely the establishment of a national register of vaccinated persons. In this sense, just as we tried to do in the spring with national serological screenings, the intention is not to make assessments at an individual level, but at the general population level. Knowing in which areas of the country (but also in which age groups, or professional categories) there are more or less vaccinated can allow us to better understand where it is most urgent to concentrate, as well as to verify how much the protective effect of vaccinations.

The relevance of an initiative of this kind would be at the level of management of the infection and circulation of the virus in our country, and above all of a scientific nature. Also because, as is well known, it is very unlikely that the pandemic will completely resolve itself within a few months, but it will require medium and long-term strategies for the management of infections and containment of the epidemic curve. Understanding what effects the vaccine guarantees on millions of people is fundamental to better calibrate the strategies themselves.

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