tag:theconversation.com,2011:/nz/topics/vaccine-passes-112885/articlesVaccine passes – The Conversation2022-03-22T23:23:45Ztag:theconversation.com,2011:article/1797462022-03-22T23:23:45Z2022-03-22T23:23:45ZAs New Zealand relaxes restrictions, here’s what we can still do to limit COVID infections<figure><img src="https://images.theconversation.com/files/453703/original/file-20220322-21-mfo752.jpg?ixlib=rb-1.1.0&rect=18%2C138%2C4007%2C2879&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Phil Walter/Getty Images</span></span></figcaption></figure><p>New Zealanders are about to enjoy cautiously relaxed COVID restrictions under the country’s <a href="https://covid19.govt.nz/traffic-lights/covid-19-protection-framework/">COVID-19 Protection Framework</a>, starting from this weekend.</p>
<p>Prime Minister Jacinda Ardern announced the relaxations today, signalling the end “for now” of vaccine passes, QR codes and vaccine mandates in the education, police and defence sectors from April 4. </p>
<p>Mandates will still apply for health, aged-care, corrections and border control workers, pending more official advice. Settings within the traffic light system have also been revised, but the country remains at the red level and indoor mask use is still required.</p>
<p>New Zealand’s vaccine pass system was designed when we were in the middle of the vaccine rollout, only about one in 400 New Zealanders had had COVID-19, and nobody had even heard of Omicron. </p>
<p>At that time, unvaccinated people had a <a href="https://theconversation.com/your-unvaccinated-friend-is-roughly-20-times-more-likely-to-give-you-covid-170448">much higher risk</a> of catching the virus and spreading it to others. </p>
<p>For this reason, vaccine passes were an important part of safely relaxing the Auckland lockdown. They helped us enjoy a summer with very low case numbers and minimal restrictions. Crucially, this meant we avoided the dual Delta-Omicron epidemic that significantly added to the health burden in places such as <a href="https://www.stuff.co.nz/national/explained/127440590/covid19-the-nsw-omicron-outbreak-is-not-what-you-think">New South Wales</a>. </p>
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<p>The situation we face today is very different. Vaccines remain highly effective at preventing severe illness but aren’t as good at stopping people catching Omicron. And the protection they do provide against infection wanes fairly quickly. </p>
<p>At the same time, increasing numbers of people have some temporary immunity as a result of having had the virus. This means vaccine passes are far less effective as a public health intervention now than they were a few months ago. </p>
<p>But as vaccine passes are phased out, it is important to consider what measures we can use to reduce transmission.</p>
<h2>Vaccines still work</h2>
<p>Vaccines are still highly effective at preventing severe illness and death from COVID-19. Like New Zealand, Hong Kong is now experiencing a major Omicron wave after initially following an elimination strategy. But in the last two months, Hong Kong has had close to 4,000 deaths per five million people compared to New Zealand’s 130. </p>
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<p>Why such a big difference? Vaccines. Hong Kong has much <a href="https://www.ft.com/content/6e610cac-400b-4843-a07b-7d870e8635a3">lower vaccine coverage in older groups</a> than New Zealand does. </p>
<p>But it’s clear vaccines are less effective at preventing infection with Omicron. The <a href="https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/1061532/Vaccine_surveillance_report_-_week_11.pdf">UK Health Security Agency</a> estimates the effectiveness of two doses of the Pfizer vaccine against symptomatic COVID-19 drops to just 10% after about 25 weeks following the second dose. This jumps to 65% after a booster but also wanes quite quickly to around 40% 15 weeks later.</p>
<p>The proportion of unvaccinated people testing positive is <a href="https://www.newsroom.co.nz/tracking-omicron-in-new-zealand-latest-charts-and-data">not that different</a> from fully vaccinated people. So if you go to a cafe, a hairdressers or a bar, whether or not there are unvaccinated people there makes little difference to your risk of catching the virus.</p>
<p>Other risk factors are more important: are people wearing masks, is it crowded, is the venue well ventilated or outdoors, are people staying away if they have symptoms? </p>
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Read more:
<a href="https://theconversation.com/most-covid-patients-in-nzs-omicron-outbreak-are-vaccinated-but-thats-no-reason-to-doubt-vaccine-benefits-179648">Most COVID patients in NZ's Omicron outbreak are vaccinated, but that's no reason to doubt vaccine benefits</a>
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<h2>We still need public health measures to mitigate COVID</h2>
<p>The <a href="https://theconversation.com/to-be-truly-ethical-vaccine-mandates-must-be-about-more-than-just-lifting-jab-rates-169612">limitations</a> the vaccine pass system has placed on people’s freedoms are much harder to justify now. But that doesn’t mean we can end all vaccination requirements or remove all public health measures.</p>
<p>COVID-19 is an airborne disease but a comparison with diseases spread through contaminated water is useful. The spread of cholera from contaminated water is one of the earliest examples of an <a href="https://www.ph.ucla.edu/epi/snow/snowcricketarticle.html">effective public health response</a> to an infectious disease. </p>
<p>The first response was a “boil water” notice, the equivalent of mask wearing to prevent the spread of infections. Longer-term measures involve systemic changes, such as infrastructure for clean water or, in the case of COVID, infrastructure for <a href="https://www.reuters.com/world/europe/italian-study-shows-ventilation-can-cut-school-covid-cases-by-82-2022-03-22/">clean air</a> through ventilation and filtration. </p>
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Read more:
<a href="https://theconversation.com/no-catching-omicron-is-not-inevitable-heres-why-we-should-all-still-avoid-the-virus-178276">No, catching Omicron is not 'inevitable' – here's why we should all still avoid the virus</a>
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<p>The time to remove boil-water notices is not when case numbers are peaking, or even when they are back at half of their peak level. It is when there are sufficient systemic changes in place to keep people safe.</p>
<p>Similarly, isolation periods are intended to stop people from infecting others. For Omicron, studies suggest half of all cases were still <a href="https://dash.harvard.edu/handle/1/37370587">infectious on day five</a> and the infectious period may be as long as ten days. Given wider availability of rapid antigen tests, we could introduce a test-to-return policy to require a negative test before people leave isolation. </p>
<h2>Some vaccine mandates remain</h2>
<p>People working in specific high-risk situations, like healthcare and aged residential care, will still be required to be up to date with their vaccinations to protect the vulnerable people they work with. </p>
<p>We are currently in the middle of a major Omicron wave, with hospitalisations and deaths at record levels. At least as many people will get infected on the way down from the peak as on the way up. </p>
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Read more:
<a href="https://theconversation.com/evidence-supports-mandatory-covid-vaccination-for-aged-care-workers-but-we-need-to-make-it-easier-too-163569">Evidence supports mandatory COVID vaccination for aged-care workers. But we need to make it easier too</a>
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<p>And even when this wave subsides, COVID-19 isn’t going to go away. It’s likely we will continue to see daily case numbers in the thousands for some time. Added to other respiratory illnesses like influenza and RSV, this could cause significant strain on healthcare over the winter months. </p>
<p>Altogether, this means we still need <a href="https://blogs.otago.ac.nz/pubhealthexpert/covid-19-hospitalisations-now-peaking-in-aotearoa-nz-but-key-covid-19-control-measures-still-need-to-be-maintained/">a set of sustainable mitigations</a> to reduce transmission and the health impacts of the virus. This includes strategies to address <a href="https://www.stuff.co.nz/pou-tiaki/300482666/government-breached-treaty-principles-in-covid19-response-waitangi-tribunal-finds">vaccine inequity</a> and increase booster uptake, mask use when cases are high, better ventilation and adequate financial support for people to take time off work when they are sick. </p>
<p>COVID vaccine passes have outlived their usefulness at least for now. But COVID-19 is going to be with us for the forseeable future.</p><img src="https://counter.theconversation.com/content/179746/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Michael Plank is affiliated with the University of Canterbury and is funded by the New Zealand Government for mathematical modelling of Covid-19.</span></em></p><p class="fine-print"><em><span>Dion O'Neale receives funding from the NZ Department of Prime Minister and Cabinet for providing modelling and analysis related to COVID-19 and from the NZ Health Research Council for research on modeling and equity impacts of COVID-19 in Aotearoa. He is affiliated with COVID Modelling Aotearoa, The University of Auckland, and Te Pūnaha Matatini. </span></em></p><p class="fine-print"><em><span>Emily Harvey receives funding from the NZ Department of Prime Minister and Cabinet for providing modelling and analysis related to COVID-19 and from the NZ Health Research Council for research on modeling and equity impacts of COVID-19 in Aotearoa. She is affiliated with COVID-19 Modelling Aotearoa, ME Research, Te Pūnaha Matatini, and the University of Auckland.</span></em></p>Vaccine passes have outlived their usefulness, at least for now. But as New Zealand’s Omicron wave begins to subside, other public health measures remain vitally important.Michael Plank, Professor in Applied Mathematics, University of CanterburyDion O'Neale, Project Lead - COVID Modeling Aotearoa; Senior Lecturer - Department of Physics, University of Auckland; Principal Investigator - Te Pūnaha Matatini, University of Auckland, Waipapa Taumata RauEmily Harvey, Principal Investigator, Te Pūnaha Matatini, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1729402021-12-01T22:15:38Z2021-12-01T22:15:38ZVerification will be essential as New Zealanders start using vaccine passes – to stop fraud and the spread of COVID<figure><img src="https://images.theconversation.com/files/435158/original/file-20211201-19-1avlpkp.jpg?ixlib=rb-1.1.0&rect=0%2C114%2C5452%2C3509&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Hannah Peters/Getty Images</span></span></figcaption></figure><p>When New Zealand switches to the <a href="https://www.beehive.govt.nz/sites/default/files/2021-11/291121_UAC_CPFSummary_A3.pdf">COVID-19 Protection Framework</a> tomorrow, people will have to present vaccine passes to access many public spaces and venues.</p>
<p>At this point, more than 2.4 million people have downloaded their official vaccine passes, which represents almost 70% of the 3.6 million people who are fully vaccinated. </p>
<p>The transition will likely exacerbate inequities that have already emerged during the vaccine rollout itself, and discriminate against vaccinated but “digitally excluded” people who have limited access to email or phone apps to carry a vaccine pass. People can now get their passes in person at some pharmacies, which helps but does not fully solve the problem.</p>
<p>Another major concern is the integrity of how we use and verify vaccine passes. Businesses and venues have different choices in how strongly they verify the legitimacy of the pass itself and whether or not they request an ID to verify the identity of the vaccine pass holder. This can make all the difference in how effective the system will be in reducing the spread of the virus. </p>
<h2>Verifying vaccine passes</h2>
<p>Last week, the government passed legislation under urgency to enact a “<a href="https://www.beehive.govt.nz/release/traffic-light-levels-announced">traffic light</a>” system, which places regions under certain settings. Under red and orange settings, many venues will only be open to fully vaccinated people who can present proof of vaccination.</p>
<p>The vaccine pass includes a QR code which can be presented on paper or on a smartphone. So far, the government has said the minimum requirement is only to visually check the pass. The next level of verification would be for staff to use the official <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-vaccines/my-covid-record-proof-vaccination-status/nz-pass-verifier">NZ Pass Verifier</a> app to scan the QR code to ensure the pass is legitimate, and that the details printed on the pass match the details encoded in the QR code. </p>
<p>But the highest level of verification is to ask for a photo ID to make sure the person carrying the pass is the person named on it. Taking all three steps provides the highest confidence the person is vaccinated.</p>
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<img alt="Image of someone setting up their vaccine pass on their phone" src="https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/435164/original/file-20211201-18-1ymcwfu.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Almost 70% of fully vaccinated New Zealanders have downloaded their vaccine passes.</span>
<span class="attribution"><span class="source">Phil Walter/Getty Images</span></span>
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<p>Understandably, some venues will consider this too much hassle or impractical. Requiring a photo ID will also discriminate against people who are fully vaccinated but may not have an ID (such as under-18s or people who have no need for one) or those who may not have a photo ID in their preferred name.</p>
<p>In my opinion, venues that are required to check for vaccine passes need to scan the QR code to lift confidence that the pass is legitimate. Otherwise, it is simply too easy to fake a vaccine pass.</p>
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Read more:
<a href="https://theconversation.com/how-far-should-compulsory-proof-of-vaccination-go-and-what-rights-do-new-zealanders-have-165317">How far should compulsory proof of vaccination go — and what rights do New Zealanders have?</a>
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<h2>QR Codes and data privacy</h2>
<p>Another challenge is that individuals also need to continue scanning in with their contact-tracing app (preferably <a href="https://www.health.govt.nz/our-work/diseases-and-conditions/covid-19-novel-coronavirus/covid-19-resources-and-tools/nz-covid-tracer-app">NZ COVID Tracer</a>). These apps are generally designed as anonymous systems and all of the data stays on the user’s device. </p>
<p>The vaccine pass verifier app inherently needs to know the identity of the person, and it operates on the venue’s device, which doesn’t store any of the data and works offline. This is why the two apps and functionalities cannot be combined into one.</p>
<p>Inevitably, people will have to provide a vaccine pass and possibly a photo ID to confirm they are allowed to enter. Then the visitor will also have to scan in to keep their own record for contact tracing. It might be annoying, but that’s what we have to do to keep ourselves safe.</p>
<p>The official pass verifier app does not store any data, but there might be some exceptions in which certain businesses create their own apps. </p>
<p>Examples include ticketing, where a person’s vaccination status may have to be verified at the time of purchase rather than entry to the venue. Businesses with repeat customers, such as gyms, may also want to keep a record of their customers’ vaccination status to avoid having to check their pass each time they enter.</p>
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<p>The COVID-19 protection framework legislation includes privacy protection that ensures information about people’s vaccination status can only be collected, used or disclosed for the purposes of managing COVID-19, with heavy penalties for breaches. </p>
<h2>Are vaccine passes effective?</h2>
<p>One major question is whether the passes actually mitigate the risk to public health. </p>
<p>Evidence from other jurisdictions suggests vaccinated people <a href="https://www.healthline.com/health-news/vaccinated-people-can-transmit-the-coronavirus-but-its-still-more-likely-if-youre-unvaccinated">transmit COVID-19 less than unvaccinated people</a>, hence the effort to prevent unvaccinated people from entering venues to avoid the spread of the virus. But in a New Zealand context, it remains to be seen whether or not the vaccine passes are effective at suppressing the reproduction rate.</p>
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Read more:
<a href="https://theconversation.com/no-vaccinated-people-are-not-just-as-infectious-as-unvaccinated-people-if-they-get-covid-171302">No, vaccinated people are not 'just as infectious' as unvaccinated people if they get COVID</a>
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<p>The government has been using vaccine passes as an incentive for people to get vaccinated by preventing unvaccinated people from accessing venues they might otherwise want to enter. But this motivation expires when we reach a sufficient percentage of people who are vaccinated – and simply aiming for a vaccination percentage raises ethical issues.</p>
<p>We should keep coming back to the public health reasons for why we need people to be vaccinated and why we separate vaccinated and unvaccinated individuals. And to uphold that, we have to make sure vaccine passes are used effectively. </p>
<p>This means, at the very least, scanning the QR code to check the passes are legitimate. And we have to reduce the barriers for people to get their vaccine pass so they aren’t excluded for the wrong reasons. </p>
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Read more:
<a href="https://theconversation.com/to-be-truly-ethical-vaccine-mandates-must-be-about-more-than-just-lifting-jab-rates-169612">To be truly ethical, vaccine mandates must be about more than just lifting jab rates</a>
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<p>Vaccine passes come at a cost. It’s a cost financially to the government and taxpayers in developing the system. But there’s also a cost socially in terms of exacerbating inequities, and a cost ethically in terms of privacy and restrictions on people’s freedom of movement. </p>
<p>If we were to weaken the system to the extent that people can easily fake a vaccine pass, then we aren’t separating vaccinated and unvaccinated individuals effectively and make no progress towards mitigating public health risk. That would mean the existence of vaccine passes is not justified.</p><img src="https://counter.theconversation.com/content/172940/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew has provided independent advice to the Ministry of Health and the Department of Prime Minister and Cabinet as an academic but is not paid by them.</span></em></p>Vaccine passes are easy to fake. Unless venues and businesses make sure to verify them and check the identity of the pass holder, COVID will likely continue to spread.Andrew Chen, Research Fellow at Koi Tū: The Centre for Informed Futures, University of Auckland, Waipapa Taumata RauLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1716412021-11-12T15:23:33Z2021-11-12T15:23:33ZWhy COVID passes are not discriminatory (in the way you think they are)<p>UK health secretary Sajid Javid’s plans for <a href="https://www.telegraph.co.uk/politics/2021/11/09/boris-johnson-nhs-vaccines-sajid-javid-lobbying-article-16/">vaccination requirements for frontline NHS workers</a> has reignited the political and ethical debate over COVID passes. </p>
<p>The requirement constitutes a kind of vaccine pass; without proof of vaccination, healthcare workers are prevented from continuing working in the NHS in a frontline role. Other types of COVID passes have been introduced elsewhere, such as the so-called “<a href="https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-europeans/eu-digital-covid-certificate_en">green pass</a>” used in many European countries.</p>
<p>COVID passes are certificates intended to limit the access to certain spaces – including, in some cases, the workplace – to people who are vaccinated, or who are thought to have immunity from previous COVID infections, or who have had a recent negative COVID test, or some combination thereof (depending on the type of pass). The aim is to minimise the risk that people in those spaces can infect others.</p>
<p>A common objection to COVID passes is that they are <a href="https://bigbrotherwatch.org.uk/2021/11/big-brother-watch-launches-legal-challenge-to-welsh-covid-passes/">discriminatory</a> because they would <a href="https://www.thetimes.co.uk/article/vaccine-passports-will-create-a-two-tier-society-x38dznwrm">create a two-tier society</a> with vaccinated people enjoying more freedom than the unvaccinated.</p>
<p>There are many problems – both practical and ethical – with COVID passes. But discrimination is not one of them if by “discrimination” we merely refer to the differential treatment of people based on their COVID or vaccination status.</p>
<p>The differential treatment is not, in itself, discriminatory. The real ethical issue is about the justifiable limitations of individual freedoms. Discrimination only occurs if the limitations, and the differential treatment that follows, are not justifiable. But that requires addressing a preliminary ethical question on whether such limitations are themselves justifiable. And that question has nothing to do with discrimination.</p>
<h2>Pinning down the discrimination objection</h2>
<p>Discrimination means, simply, treating people differently – it is a neutral concept. We treat different people differently all the time, and often with good reason. However, the term is most often used with an implicit negative moral connotation, to denote the unfair and unequal treatment of different people or groups. For example, stopping people from accessing certain spaces merely based on their gender, race, disability status, appearance, or hair colour is, in most cases, a form of unfair discrimination. When I talk of “discrimination” here, I mean “unfair discrimination”.</p>
<p>COVID status is different from these cases because, in principle, it expresses a morally relevant feature: the level of risk of harming other people by infecting them with COVID. The risk of harm to others is often a valid justification for limiting the freedom of certain people. Sometimes we do that precisely through some form of pass. For example, driving licences are a type of pass intended to minimise the risk drivers pose on others by ensuring that only those who have met some driving safety standards (by passing a driving test) can drive a car.</p>
<p>If the restriction is justified on independent ethical grounds, such as minimisation of harm, then we normally do not think it is discriminatory. For example, we do not think of driving licences as discriminatory against those who did not pass the test (assuming tests are themselves fair) or who freely chose not to take the test. </p>
<p>The question is always whether the restriction of freedom is justified by the kind of good (for instance, minimisation of the risk of harm) it is meant to bring about. If it is justified, then it makes no sense to say that the restriction is discriminatory, no more than it would make sense to say that driving licences or smoking bans in the workplace are (unfairly) discriminatory against those without a licence or against smokers. The only discrimination occurring would be discrimination between those who abide by a justifiable law and those who do not. But that is not unfair discrimination.</p>
<p>So the real question is whether COVID passes are ethically justified. This is a question about (un)justified limitations of freedoms, not about discrimination.</p>
<p>COVID passes obviously entail limitations of individual freedoms. Depending on how they are implemented, they entail the limitation of the freedom to enjoy certain public spaces, to access public transport, workplaces, and so on. If the limitations of freedom are very large, such as prohibition to work in certain settings if one is not vaccinated, then de facto they become severe limitations of the freedom to refuse the vaccine. It would simply become unreasonable for many people to refuse the vaccine if that entails, say, losing their job.</p>
<p>Whether such limitations are justified depends on how we make tradeoffs between individual freedoms and the goods we want to achieve. It also depends on the risks and benefits for certain groups (for example, the risks of vaccines compared with their benefits for different age groups), as well as on how likely it is that we can achieve those goals.</p>
<p>The latter issue turns on factual considerations, for example, on how effective vaccines are at preventing infection or transmission, or how such effects of the vaccines compare to immunity acquired through infection itself. For instance, if there are good reasons to think that natural immunity is at least as good as vaccine-induced immunity, then there seems to be little justification for “vaccine passes”, as opposed to “immunity passes”.</p>
<p>If, based on all these considerations, COVID passes are ethically justified, then their introduction is not discriminatory – or at least no more than any other justified law is. </p>
<p>However, if COVID passes are not ethically justified, then their introduction is discriminatory because it creates a differential treatment among individuals based on characteristics (such as immunity status, or vaccination status) that, by hypothesis, should not be considered relevant. </p>
<p>But the question is precisely whether they should be considered relevant, that is, whether the hypothesis is correct. And that is not a question about discrimination.</p><img src="https://counter.theconversation.com/content/171641/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Alberto Giubilini receives funding from the Wellcome Trust</span></em></p>Differential treatment is not, necessarily, discrimination.Alberto Giubilini, Senior Research Fellow, Oxford Uehiro Centre for Practical Ethics, University of OxfordLicensed as Creative Commons – attribution, no derivatives.