By Dan Diamond, Lena H. Sun and Isaac Stanley-Becker
The Biden administration and private companies are working to develop a standard way of handling credentials — often referred to as “vaccine passports” — that would allow Americans to prove they have been vaccinated against Covid-19 as businesses try to reopen.
The effort has gained momentum amid President Biden’s pledge that the nation will start to regain normalcy this summer and with a growing number of companies — from cruise lines to sports teams — saying they will require proof of vaccination before opening their doors again.
The administration’s initiative has been driven largely by arms of the Department of Health and Human Services, including an office devoted to health information technology, said five officials who spoke on the condition of anonymity to discuss the effort. The White House this month took on a bigger role coordinating government agencies involved in the work, led by coronavirus coordinator Jeff Zients, with a goal of announcing updates in coming days, said one official.
The White House declined to answer questions about the passport initiative, instead pointing to public statements that Zients and other officials made this month.
“Our role is to help ensure that any solutions in this area should be simple, free, open source, accessible to people both digitally and on paper, and designed from the start to protect people’s privacy,” Zients said at a March 12 briefing.
The initiative has emerged as an early test of the Biden administration, with officials working to coordinate across dozens of agencies and a variety of experts, including military officials helping administer vaccines and health officials engaging in international vaccine efforts.
While the effort gains momentum it is also facing resistance from some quarters, including a group of Republican governors and Congressmen who oppose a mandatory requirement within the U.S.
The passports are expected to be free and available through applications for smartphones, which could display a scannable code similar to an airline boarding pass. Americans without smartphone access should be able to print out the passports, developers have said.
Other countries are racing ahead with their own passport plans, with the European Union pledging to release digital certificates that would allow for summer travel.
U.S. officials say they are grappling with an array of challenges, including data privacy and health-care equity. They want to make sure all Americans will be able to get credentials that prove they have been vaccinated, but also want to set up systems that are not easily hacked or passports that cannot be counterfeited, given that forgeries are already starting to appear.
One of the most significant hurdles facing federal officials: the sheer number of passport initiatives underway, with the Biden administration this month identifying at least 17, according to slides obtained by The Washington Post.
Those initiatives — such as a World Health Organization-led global effort and a digital pass devised by IBM that is being tested in New York state — are rapidly moving forward, even as the White House deliberates about how best to track the shots and avoid the perception of a government mandate to be vaccinated.
One of the teams working on vaccine passports is the Vaccination Credential Initiative, a coalition endeavoring to standardize how data in vaccination records is tracked.
“The busboy, the janitor, the waiter that works at a restaurant, wants to be surrounded by employees that are going back to work safely — and wants to have the patrons ideally be safe as well,” said Brian Anderson, a physician at Mitre, a nonprofit company that runs federally funded research centers, who is helping lead the initiative. “Creating an environment for those vulnerable populations to get back to work safely — and to know that the people coming back to their business are ‘safe,’ and vaccinated — would be a great scenario.”
Anderson’s team is aiming to release its free software standards in April, hoping developers will use them to help build digital vaccine records that allow people to show they have been inoculated. The Vaccination Credential Initiative includes the Mayo Clinic, Microsoft and more than 225 other organizations, many of which have pledged to use the code when administering shots.
Biden administration officials privately acknowledge the high stakes of the effort.
Proof of vaccination “may be a critical driver for restoring baseline population health and promoting safe return to social, commercial, and leisure activities,” according to the March 2 slides prepared by the Office of the National Coordinator for Health Information Technology and obtained by The Post. But officials at the session — attended by more than 150 staff from the health, defense, homeland security and other departments, and even far-flung agencies such as NASA — warned of the “confusing array” of efforts underway to create credentials.
“A chaotic and ineffective vaccine credential approach could hamper our pandemic response by undercutting health safety measures, slowing economic recovery, and undermining public trust and confidence,” one slide reads.
Micky Tripathi, whom Biden tapped as the national coordinator for health IT, recently said federal officials are concerned with a variety of health-tech challenges, including protecting the credentials against fraud, ensuring data security and making certain that low-income populations aren’t squeezed out.
“How do we make sure that whatever is available is accessible to everyone so no one is left behind or feeling like they can’t participate in the return of their day-to-day activities?” Tripathi asked at a virtual meeting hosted by the Health IT Leadership Roundtable on March 11.
Tripathi told the group he didn’t like the term “vaccine passports,” adding that “passports are something that are issued by governments. … I think of them as vaccine credentials or certificates.” Tripathi did not respond to a request for comment.
The Centers for Disease Control and Prevention, which is participating in the WHO’s effort to create “digital vaccination certificates,” also is preparing to help advise on the passport rollout. The health agency says it is expecting to play a role in determining which organizations will credential and issue the certificates, in addition to informing the public, according to CDC documents reviewed by The Post.
The Biden administration has promised to release more information about its efforts. Asked by Hawaii Gov. David Ige (D) on Tuesday about the state of the passport initiative, Zients told governors he would provide a more detailed briefing this week, according to two people on the call, speaking on the condition of anonymity to describe the private conversation.
Federal officials defended the pace of the project.
Taking time to get the credentialing project right “is very, very important because this has a high likelihood of being either built wrong, used wrong or a bureaucratic mess,” said one official, speaking on the condition of anonymity to discuss the effort. The official said some of the considerations include how to adjust for the spread of variants, how booster shots would be tracked and even questions about how long immunity lasts after getting a shot. There’s “a lot to think through,” the official said.
“Many people see this as a key aspect to getting things closer to normal,” said Kristen McGovern, a partner at health-care consultancy Sirona Strategies and former chief of staff at the Office of the National Coordinator for Health IT. But the technical challenges are significant and given that so many separate efforts are underway, “it would be an almost herculean task to come up with a single standard” for all the vaccine credentials to follow, McGovern said.
There is evidence vaccine passports could motivate skeptical Americans to get shots. Several vaccine-hesitant participants at a recent focus group of Trump voters led by pollster Frank Luntz suggested their desire to see family, go on vacation and resume other aspects of daily life outpaced fear of the shots, particularly if travel companies and others moved to require proof of vaccination.
“We love to travel. We love to take cruises. I would get it to travel,” said Debbie of Georgia, who like others in the focus group was identified only by her first name.
Some attendees dissented and warned that requiring a credential would backfire.
“I would change my travel plans,” said a man identified as Patrick of Tennessee.
Public health and ethics experts agreed that the Biden administration needed to strike a careful balance: Encourage shots and support the private-sector initiatives but don’t put too much federal emphasis on the looming passports.
“If it became a government mandate, it would go down a dark road very quickly,” said Brian C. Castrucci, who leads the Bethesda, Md.-based de Beaumont Foundation, a public health group funding Luntz’s research into why some Americans are balking at the vaccine. “It becomes a credential. It becomes a ‘needing your papers,’ if you will. That could be dangerous — and it could turn off people.”
“It has to be that everyone can get it, and it’s their choice, as it were,” said Ezekiel Emanuel, a University of Pennsylvania bioethics expert who co-authored a Journal of the American Medical Association article last year about the ethics of such certificates and advised Biden’s transition team on the coronavirus. “The one thing I am concerned is that some people won’t be able to get vaccinated for a variety of reasons.”
Emanuel added that the passports will be an element of global travel — not just domestic policy. Key aviation and travel associations on March 22 called on the White House to finalize its vaccine credential plan by May, saying it was essential for the safe resumption of international travel.
Donald Rucker, who led the health IT office during the Trump administration, said myriad technical issues await the rollout of vaccine credentials, including how they are tracked, whether they are enforced and who pulls together the initial records of which Americans have gotten shots.
Rucker said keeping vaccine credentials could help officials better understand coronavirus vaccination, including possible long-term side effects, if the data is connected with the health information exchanges that states maintain.
“The tracking of vaccinations is not just simply for vaccine passports,” Rucker said. “The tracking of vaccinations is a broader issue of ‘we’re giving a novel biologic agent to the entire country,’ more or less.”
Credit: The Washington Post