How to reopen society: Issue vaccine ‘passports’

It is impossible to overstate the disruptive impact of the COVID-19 pandemic on all aspects of human endeavor. As we suffer through these difficult days, we have cause for hope and optimism with the near-miraculous creation of effective vaccines to combat this virus in a staggeringly short time. This, along with increasing knowledge of how we can test for its presence among us, prevents infection through public health measures such as masks, increasingly effectively treats patients with the most severe and life-threatening disease, and gives further cause for a sense of a better future.

While the ultimate goal of “herd immunity” is sought in countries around the world, this will be a challenge to achieve in our highly interconnected world and may not be achievable even in most advanced nations (and be an even longer-term goal in resource-poor regions). In the interim, the prescriptive hygiene of masking and social distancing remains necessary to attenuate spread and mitigate against critical illness and death. Sadly, the consequences of these necessary actions have proven to be devastating to many businesses, our education system, and the mental health of so many, including the most vulnerable. It is clear that the prolonged need to limit our social interactions will have an even deeper, more profound negative impact on our people and our economy.

In the face of all this, I propose a partial solution that will both mitigate some of these human consequences and give a lifeline to many businesses at near-extinction. I call this the “Vaccine Vanguard.” The basic premise is that vaccinated individuals, or those who have recovered from COVID-19 infection, constitute a natural “bubble” that gradually can expand into a new but more normal society, as more people are immunized or are infected and recover.

The foundation of this proposal is based on the key observation that the currently approved vaccines (and others, hopefully, to be approved soon) have been shown to virtually eliminate the individual’s risk of severe disease leading to hospitalization or death. Thus, if one is only interacting with other vaccinated or recovered (10 days post-infection) individuals, the risk of infection is probably much less than with influenza. So a social gathering made up exclusively of the immunized could interact normally; after all, we don’t social-distance or shut down venues during flu season. This means the possibility of opening bars, theaters, sporting venues and so on, without putting attendees at risk for major illness and with little risk of stress on hospital beds. 

Now, mind you ,when interacting outside such a “Vanguard,” standard mask/distance precautions would be maintained. After all, if an immunized person had the virus, while not posing a risk to other vaccinated individuals, the rest of the population would still be vulnerable.

Thus, a system of official certification of vaccination — a so-called passport — would allow these now-shuttered venues to open exclusively to the immunized, thereby kickstarting these businesses after almost a year of dormancy in many areas. As the vaccinated and the recovered populations grow by the millions, so would these venues’ clientele. In addition to the economic boost, the benefit to overall mental health of these “islands” of sanctioned “new normalcy” would be incalculable.

This would have other positive consequences. A key one would be that it would incentivize many vaccine hesitators to clamor to join the “Vanguard.” This likely would be a demographic that might otherwise be resistant to the needle, thus spurring us closer to herd immunity. Another is that cheating would only have consequences for the cheater — after all, if you fake your health “passport” and wade unprotected into a sea of the vaccinated, you are only putting yourself at risk.

Naturally, there may be outcries of “privilege” and “inequity.” But remember that the vaccines are free, and if we actively, intentionally manage the equitable distribution to all of society (including the most vulnerable), then any privilege will be determined primarily by one’s risk from the virus (those first in line to receive it) and one’s willingness to be vaccinated — certainly a fair exchange. This endeavor, one might imagine, could be coupled with emerging rapid and ultra-rapid testing for the unvaccinated at the entry to these reopened venues, which could expand the clientele even further while enhancing safety.

But, first, let us contemplate the science- and data-driven steps with a “Vaccine Vanguard.” As I am merely a cardiologist, I leave it to the public health experts and our political leaders to contemplate this proposal’s value in helping our long-suffering community.

Jeffrey W. Moses, M.D., is the John and Myrna Daniels Professor of Cardiology at Columbia Irving University Medical Center and an interventional cardiologist recognized internationally for his pioneering work as a lead investigator in a 2002 clinical trial of the first drug-eluting stent, as part of the clinical trial of the first transcatheter aortic heart valve, and many other cardiovascular procedures. He is director of interventional cardiovascular therapeutics at Columbia Irving University Medical Center and director of advanced cardiac interventions at St. Francis Hospital and Heart Center, Roslyn, N.Y. The opinions expressed here are his own and not those of Columbia University.