The backlash against these “passports” has been swift and strong. The World Health Organization quickly advised countries against issuing any such certificates until there is clearer evidence that antibodies protect against reinfection. The American Civil Liberties Union has cautioned that immunity passports could accelerate a trend toward mass surveillance, while the head of Human Rights Watch warns that immunity passports could give rise to a “new form of discrimination.”
Immunity passports are unlikely to be the panacea that their proponents imagine, but nor need they be a one-way ticket to a dystopia in which passport holders roam freely and everyone else is locked indoors. If deployed wisely, they could protect vulnerable individuals from infection and help high-contact businesses reopen; if used carelessly, they could speed the virus’s spread.
A critical issue is that passports could create an incentive for people to expose themselves to the coronavirus so they can develop antibodies and resume work. Concerns about self-infection arise whether it’s the government that mints these passports or the private sector. That’s a key reason federal and state officials — even if they don’t adopt passport programs themselves — need to plan for their arrival.
To be clear, the “passports” that app developers are designing wouldn’t be literal passports. You won’t need one to leave your home, and you probably won’t need one to cross a border either. But immunity passports could help their holders obtain certain jobs for which social distancing is impractical. Think of it as an “immunity diploma,” signifying that you have passed through the infectious stage of covid-19 and graduated with antibodies to the virus.
The worry that antibodies don’t protect against reinfection may be a red herring. The WHO’s caution aside, initial studies suggest that people who have recovered from covid-19 probably aren’t getting reinfected or transmitting the virus. Concerns about test accuracy may be surmountable, too. To reduce the problem of false positives, workers might be tested twice, with different test types, for example.
If the practical obstacles can be overcome, the passports could prove a useful tool. Imagine, for example, that a nursing home declares that it would prefer to hire workers with covid-19 antibodies to care for the most vulnerable residents. This could help lower the frighteningly high mortality rate in nursing homes, which so far have accounted for one-third of all U.S. covid-19 deaths.
The problem is that, with unemployment at historic highs, unemployed health care workers may be motivated to “strategically self-infect” so they can qualify for those nursing-home jobs. And that would be true in any industry that used passports.
Workers often take fatal risks when they think it’s the inevitable price of getting a job. For younger workers, the fatality rate for covid-19 is similar to, or less than, the annual fatal work injury rate in some high-risk industries. One study in the medical journal Lancet estimates that a person in his or her 20s who contracts covid-19 has an 0.031 percent probability of dying. For a logger, the annual risk of death from an on-the-job injury is more than three times that — 0.098 percent. The annual risk of death for fishers, aircraft pilots, and roofers is also above the estimated risk to 20-somethings of covid-19.
People who self-infect would not be risking only their own health, however. If, for instance, younger people join crowds without masks to pick up the novel coronavirus, they may pass it along to others — including older, sicker Americans — before they show symptoms.
While 20-somethings have a relatively low risk of death from covid-19, more than 1 percent of infected members of that cohort end up in the hospital, according to the Lancet estimates. A wave of strategic self-infections could cause a flood of patients into emergency rooms and intensive care units — not unlike what Italy weathered in March. Self-infectors would compete for resources with those who caught the coronavirus involuntarily.
Fortunately, several policy measures would make it less likely that young people take this calculated risk.
First, instead of a private-sector free-for-all, policymakers should prioritize specific sectors for earlier immunity licensing. If positive antibody tests are used to choose workers in only a few corners of select industries, then the risk that waves of younger Americans will strategically self-infect is small. Nursing homes and other health care settings should take the lead. Restaurants, hair salons, and retail stores should not be allowed to make immunity licenses a criterion for employment — at least, not at first. Many state governors have the authority to impose such restrictions on their own, just as they had the authority to determine which industries were “essential.”
The likelihood of strategic self-infection goes down substantially, too, if out-of-work people have a viable alternative that doesn’t involve exposing themselves to the virus. The main coronavirus relief legislation, the Cares Act, passed by Congress in March, helps by guaranteeing a minimum unemployment benefit of $600 per week. In most states, that will last through the end of July; in some states, like Florida, though, those benefits will run dry sooner. Unless those benefits are extended, unemployed people may rationally choose to self-infect if doing so increases the odds they can feed and house their families.
If initial rollouts in high-priority industries don’t set off a self-infection tide, then federal and state officials should consider permitting other sectors to use passports too. But implementation should be staggered. Suddenly allowing every restaurant, hair salon, and retail store to ask that new hires have immunity passports would be a recipe for disaster.
With prudent regulation and a strong safety net, immunity licensing regimes in specific sectors could save lives. But if licensing arrangements are not coordinated and individuals’ incentives are misaligned, then immunity licensing could touch off a disastrous deluge of strategic self-infection. The answer isn’t to reject the idea entirely. The better approach is to proceed with caution and compassion, both for the younger workers who might seek immunity licenses and for the individuals most vulnerable to this dreadful virus.