Imagine a dystopian future where proof that you have been vaccinated against Covid-19 could dictate your freedom, access to public spaces, employment, and other activities that entail coming into contact with other people.

This dystopia may not be so far-fetched and could become a reality as the world tries to regain a sense of normality. It would not be the first time freedom for certain groups of people was determined by societal stratifications and deeply embedded structural inequality.  Inequality and social stratification played a huge role in the way countries were challenged by and addressed the pandemic. 2021 has ushered in the vaccination phase with a host of new concerns regarding the management of the global pandemic, one being the inequality of access to vaccinations. 

The Covid-19 pandemic has shed a harsh light on global structural inequalities. Many countries have been forced to confront underlying social, political, and economic problems which are largely rooted in historical inequality, exclusion, and injustice that have not been adequately addressed. The pandemic has highlighted that although the virus does not discriminate, the same cannot be said for prevention and care. This can have catastrophic consequences.

 VACCINATED: TICK YES OR NO

It is not an unfamiliar concept to require proof of vaccinations to enter countries or to participate in certain activities. In fact, many African and South American countries have Yellow Fever Vaccination requirements before arrival. Increasingly, schools and workplaces are asking for proof of certain vaccinations or flu shots. However, there are a few things that make introducing proof of Covid-19 vaccination very different from having a yellow booklet that shows that you've had a yellow fever vaccine. 

Proof of being vaccinated is essentially classifying people on the basis of their Covid-19 status and creating a new measure to divide the haves and the have-nots, or, the "immunoprivileged" and the "immunodeprived".

This new reality proposes a system in which those who choose not to be vaccinated or have no access to vaccines will have their freedom curtailed in the name of public health. Even though the introduction of vaccination verification has been debated since 2020, it looks as if 2021 may be the year that makes the Covid-19 passport or proof of vaccination a reality. But how do countries intend to address the risk of dividing people into vaccinated and not vaccinated, and ensure that this does not contribute to existing patterns of privilege, disadvantage and discrimination? How can society ensure that another binary division will not perpetuate existing institutionally-established inequality by reinforcing discrimination based on a person’s health status. 

When the World Health Organisation (WHO) declared Covid-19 a global pandemic, research institutes and companies rushed to start finding a vaccine. Since the beginning bioethicists have warned about the danger of creating systems of immunity certification. Before vaccines were even approved, the WHO warned that the introduction of immunity passports risked stratifying societies based on immunological status resulting in unjust and unequal Covid management. However, it was not long before the rush to create digital health certificates or passport systems for countries to integrate into Covid-19 management strategies started. Covid or PCR tests began to be required to prove a negative Covid-19 status for travelling and other activities, as part of a short-term solution to allow individuals more freedom than others, albeit a temporary one. Across the globe countries are now pushing to vaccinate their citizens and hoping that vaccination passports are the safe solutions to reopen borders, unfreeze economies, and restore a semblance of normality.

THE PRIVILEGE OF HAVING A PASSPORT

The proposed Covid-19 passport focuses on the vaccination status where vaccinated equals safe, and unvaccinated equals unsafe. This binary indicator provides the foundation for dividing populations and controlling what they can and cannot do – essentially providing a new basis for discrimination and inequality. Dividing people and countries into the dos and the don’ts, the wills or the won’t’s presents a risk in its potential to establish even greater polarisation and deeper social divisions.

Coronavirus is disproportionately affecting black, ethnic, and minority communities. The disproportionate and unequal Covid-19 landscape is playing out on an international and societal level. The challenges associated with racial health gaps, poor public health systems, and social distancing in townships and overcrowded refugee camps, are a few examples of how the pandemic has disproportionately affected vulnerable groups and how vaccination plans could continue to do so.   

There is undoubtedly a realistic element to the pro-vaccine passport argument; people are pushing to return to a life of normality in everyday existence. But we need to ask what this semblance of normality is and who it is intended to serve. Is proof of vaccination a means to reopen schools, attend sports events and allow people to return to offices? Or is it meant to allow international travel, eating in restaurants, visiting public spaces, or as a condition of employment? Could the distinction between vaccinated and not vaccinated people provide yet another basis that perpetuates injustice, justifies discrimination, and controls the freedom of individuals? 

The WHO cautioned against issuing immunity passports because their accuracy could not be guaranteed stating that “there is currently no evidence that people who have recovered from COVID-19 and have antibodies are protected from a second infection”. Vaccines are temporary, explains Sarah Chan, a bioethicist at Edinburgh University,;the vaccination may provide some protection from catching Covid-19, but it is not 100% effective in 100% of individuals. More so, there is insufficient evidence to suggest that the approved vaccines significantly reduce transmission. Dave Archard, Chair of the Nuffield Council on Bioethics, explains that little is known about the length of immunity or resistance to new variants. The promise of vaccinations as an effective way to manage the pandemic and prevent transmission is debatable, which leads to the following question: is the risk of using divisive and potentially discriminatory means to verify a vaccination worth it? Or is it about providing permission slips and opportunities to those with access to the limited stock of vaccines available, regardless of the lack of certainty?

The impacts of vaccination passports are far-reaching and could deepen societal divides. Issues of race, occupation, criminal records, immigrant status and other divisions in society could be exacerbated by the need to prove your immunisation. People in South Africa are already questioning this proposed system as being reminiscent of the apartheid era “dompas” and the return to verifying an individual’s status and therefore their movement and opportunities. 

ALL ABOUT GEOGRAPHY AND WEALTH

Although many countries have been outspoken against the use of Covid-19 vaccination passports, the promise of resuming travel, social activities, and life without the restrictions imposed by Covid-19 regulations makes it easy for people to disregard the potential negative consequences. The voices advocating to reopen travel and help economies recover through mass immunisation and certification have drawn out many other voices that are opposed to the idea. Yet many other economies are suffering from a significant decrease in tourism revenue too. Countries like South Africa and Brazil, to name a few, are in a similar situation – with one major difference – their access to vaccines is limited. 

Wealth and geography are the current determinants for access to vaccination stocks, not public health or human need. So far, wealthier countries have bought more vaccines than poorer countries. By December 2020, these wealthier nations, representing 14% of the world’s population, had procured more than half (53%) of all the most promising vaccines. It is estimated that poorer economies will only be able to mass immunise by 2023, if at all. Mid-income countries like South Africa may be able to achieve mass immunisation by mid-2022. But these are all optimistic figures which will depend on the effectiveness of the vaccine against new variants and buying power of wealthier countries. 

Hoarding vaccines is just another identifier of the advantage wealthier nations have in vaccinating their population, another dimension to the divide. There is a stark contrast between the way rich and poorer countries responded to the pandemic. It highlighted the different challenges countries face in their management of public health and exposed societal stratifications on varying levels. The response and future of Covid-19 management pose the risk of increasing these stratifications if not adding another dimension to the global inequality landscape. 

THE START OF WHAT IS TO COME

The way forward is still blurry, though the European Union announced plans to launch a Covid-19 passport, and some countries like Israel and Denmark already have forms of vaccination certification, whilst Covid-19 vaccine verification is a reality in Asia. Whether referred to as a passport, or bill of health, the main argument posed by a majority of “wealthier nations” is that Covid-19 vaccination passports are a way to return to a life of normality. A system for people to prove that they have been vaccinated raises concerns around the effects of such divisive measure and whether making this a universal system will be adding another basis for discrimination and societal stratification.

Tasneem is a human rights activist and filmmaker. She is currently working with an INGO in a South Sudan on issues of civilian protection and finding nonviolent approaches to achieve sustainable peace. She has a masters degree in Human Rights Law from the University of Cape Town focusing on women’s rights, international criminal law and refugee law.

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