On Vaccine Passports

This week, NBC reported that “Gov. Charlie Baker said Massachusetts may "soon" deploy a digital COVID-19 vaccine passport similar to those in use in other states, he stressed that he remains opposed to requiring that businesses screen customers for proof of vaccination.

"I've never supported or agreed to any sort of statewide vaccine mandate program," Baker said Tuesday. "We just want to make sure that people have the ability, if they've been vaccinated and want to have proof that they've been vaccinated, that they can easily download it onto their phone and use it whenever they need to."

Vaccination has proven to be extremely effective at preventing serious illness and death from COVID-19. The data show that the mRNA vaccines in particular are among the safest and most effective vaccines in history, but that protection is limited. New variants like Delta and Omicron are able to cause illness in vaccinated people, especially those who have not received vaccines in the last 6-9 months. COVID-19 can also be transmitted through vaccinated people, though not as virulently as through the unvaccinated.

The data also show that prior infection and recovery from COVID-19 is at least as effective as vaccination, although far more risky.

Businesses, especially health-related ones, like hospitals, physical and massage therapists, etc., or schools, and performance or conference venues that bring large numbers of people together in a central indoor location, have a right to protect themselves and their customers with measures like a requirement of vaccination. States overstep their bounds and hurt us when they substitute their judgement for the decision making of countless people making their own individualized risk/benefit assessments, whether it be through a vaccine mandate, or through a mandate not to allow vaccine requirements.

It is up to each individual and business owner to decide if vaccination and vaccination requirements are right for their goals and values.

A vaccine passport system that allows people to certify their vaccination status to those who choose to require it, so long as it is voluntary, should not be considered a violation of anyone’s rights. But, that does not mean it is a good idea.

The most obvious problem is that people who have recovered from a COVID-19 infection are at least as “vaccinated” as those who have had two mRNA vaccinations. A widespread vaccine passport system that makes second-class citizens of people recovered from infections is irrational and socially corrosive.

The second most obvious problem is that both vaccination and prior infection have a “shelf-life” that decays over time. This is both because the immunity itself wanes, and because new variants have emerged that break through the partial immunity conferred by both vaccination and prior infection.

A ham-fisted vaccine passport system that depends only on vaccine status, and doesn't fully account for both the immunity conferred by prior infection, and for waning immunity over time in the face of new variants, is likely to do more harm than good. It will both provide a false sense of security that lets new variants run rampant through waning immunity, and unfairly exclude people with recovered infections from full social participation.

The lesson of masks should have taught us something. Masks work very well at preventing the spread of COVID-19 (and other respiratory viruses), but mask mandates do not. The reason for this is that mask mandates create an incentive to comply in the least effective way possible, with flimsy pieces of cloth improperly worn, rather than a properly worn surgical mask. We can expect a vaccine passport to suffer the same problem. If someone with a single J&J vaccine in February is cleared by the passport system, and an unvaccinated person who recovered from a Delta infection in October is not, then it is worthless.

Remembering 9/11/2001, twenty years later.

The morning of September 11, 2001 was one of those crystal clear, cool, dry, early September days that let you know Autumn in coming. It was my second day of classes in medical school at Boston University. As a 41 year old first-month medical student, it represented a new beginning for me. After 20 years as a computer programmer, engineer, and mathematician, I was starting a new career in medicine, with a rough plan to become an oncologist. The front of the main medical school entrance faces southeast, on the flight path of the planes departing from Logan Airport. They roared past, high over Albany Street, left to right. I remember regarding the weather with the term pilots sometimes use, “Severe Clear.”

September 2001 was a time of both personal and general optimism. The Cold War was over. The markets were booming, near all-time highs. I was aware of what Francis Fukuyama had called, “the end of history,” to describe the ascendancy of liberal democracy across the globe, and the waning of the ideologies and conflicts that had described much of history through the Twentieth Century. Into this unprecedented time of optimism, prosperity, and peace, I was starting a new career in medicine. Liberty, civil rights, international cooperation, and free markets, were advancing across the globe. Poverty, war, and nationalism were in rapid retreat. The internet was connecting people everywhere with a promise of unlimited access to knowledge, connection, and mutual understanding.

Nowhere was this more evident than in medicine, which has always been a very international community, with an ethos that transcended national, cultural, and linguistic borders. My new friends in medical school were from everywhere, Libya, Lebanon, Romania, Afghanistan, Jamaica, Puerto Rico, India, Taiwan, and more. My chosen field of oncology seemed poised in particular for rapid advancement. A rough draft of the complete human genome had recently been announced, and could be accessed almost instantly by researchers globally.

I was in the cafe in the basement of the medical school when the television in the corner of the room showed a live broadcast of a smoking World Trade Center in New York, after a passenger jet from Boston had hit one of the towers. Had I just watched that jet roar by earlier in the morning? A crowd had gathered in the room. There was much discussion about how such a thing could happen. We were watching the live broadcast when the second passenger jet hit the South tower. My breakfast rose in my throat, realizing I had just watched hundreds of lives instantly and horribly snuffed out in a ball of fire. This was a terrorist attack. Everything had changed. It did not seem important to go to the next class, which was Psychiatry.

When the South Tower collapsed, about an hour later, the basement of the medical school suddenly felt suffocating. I went out into the courtyard, under that cool, blue sky. I sat on a bench, covered my face, and sobbed into my hands. At that moment, I saw the end of all that optimism. I saw our opening up to the world being coming to and end, and being replaced by a new war. I saw civil rights being curtailed, and a return of all the ugliness that Fukuyama’s “history” had to offer. I sat there for a long time under that deep blue sky, thinking about how the world had just changed, and thinking about thousands of lives so violently and malevolently taken.

I would later learn that my sister's husband, a Manhattan real estate broker, had an early morning meeting in the WTC rescheduled to later in the day at the last minute. This probably saved his life. My stepsister's husband was also called away at the last minute, after organizing a conference for dozens of his colleagues in finance at the Windows on the World restaurant on top of the North Tower. None of them survived.

Now, twenty years later, I am an oncologist at Boston Medical Center, and on the faculty of BU. The scientific optimism of 2001 has proven to be justified, and continues to be, with advances in oncology coming so fast that it is a struggle to keep up. It continues to be a privilege for me to work with colleagues from a huge diversity of backgrounds.

However, we are still digging ourselves out of the cultural rubble that has given us several wars, a surveillance state, a closing of international doors, poisonous political polarization, legislative and executive branches of government both run amok, an opioid epidemic, and civil liberties in retreat. Much healing remains to be done.

It still hurts to see those pictures.