By John Halamka, MD
Twitter: @jhalamka
Vaccine credentials could be a safe and convenient way for people to resume a more normal daily life, but it’s critical that we do it in the right way. Public and private sector collaboration is essential, and we must be driven by science and our best understanding of what vaccines mean for immunity under different conditions. It’s reasonable to expect that some businesses, schools and countries may require it – just like yellow fever vaccine certificates.
So if we are moving toward those uses, we need to create a way patients can share their vaccination status if they wish to do so, with tools designed to be voluntary and not discriminate. But first we need to develop international standards for organizations administering the vaccines to make credentials available in a format that’s accessible, interoperable and digital. We’re working on that with other health care providers, EHR vendors, state immunization systems, pharmacies and tech companies. This work will enable people who have received the COVID-19 vaccine to access, store and share their records in a secure, verifiable and privacy-preserving way.
At this time, patients who have been vaccinated at Mayo Clinic can choose to show their vaccination status on their phones using a health app, if they wish to. The app will say they’ve been vaccinated, which vaccine they received and the date they got it. Over the next several months, the Vaccine Credential Initiative, a collaboration of academia and industry, aims to create a standardized way of proving immunization, using a displayable QR code. Very importantly, that standard format, called the SMART Health Card, has been endorsed by stakeholders throughout the U.S. The vaccine credential will be issued by the doctor’s office, hospital or pharmacy that gives the vaccine, and the data can be uploaded to an app on a phone. Name and birth date are included, but no other medical information is shared, and the vaccine credential is always under the control of the person who received the vaccine. The code sits in a digital wallet, just like a ticket to a sports event that gets scanned when you enter. And also importantly, the vaccine credential will be something that can be printed and shown in paper form, for those who don’t have or use smart phones.
And to be clear, this effort is not about requiring vaccination but offering patients a verifiable way to share their vaccination status if they wish to do so. There is always a choice. Of course, we must address privacy concerns and questions that may arise and always ensure that we have the right protections in place so everybody is comfortable with how their health information is shared and used.
Again, it’s very important to recognize that these tools are designed to be voluntary and must not be used to discriminate. The efforts are well-meaning, but we must follow guidelines for appropriate use and ensure they are not used to limit access to jobs or essential needs like getting groceries or seeking health care.
So, a vaccine credential could help reopen the economy, while not creating another divide as millions of people don’t have smart phones. The digital divide is real, and all our solutions must work on a variety of phones as well as on paper for those without technology. Tech tools may be preferable for many consumers, but we also have to consider how we’re going to handle those who don’t have ready access to a smartphone or other device.
Although we don’t expect that most of the world to be vaccinated until the end of 2021, I wouldn’t be surprised if some businesses require proof of vaccination in the future – either on paper or digitally – just like some countries now require proof of a negative COVID-19 test to enter. Or people may have to agree to on-site testing or proof of recent quarantine. Our work in health care is to ensure that patients have the tools they need to support whatever approach they choose.
John D. Halamka, MD, MS, is President of the Mayo Clinic Platform, where he leads a portfolio of new digital platform businesses focused on transforming health by leveraging artificial intelligence, the internet of things, and an ecosystem of partners for Mayo Clinic. This article was originally published in his blog Dispatch from the Digital Health Frontier and is reprinted here with permission.