On 24 March SICCAR hosted a roundtable on covid vaccine passports with panellists Maarja-Liis Ferry (SICCAR), Edgar Whitley (LSE), Ain Aaviksoo (Guardtime) and Anthony Day (IBM). Representing a wide breadth of stakeholders, the panellists offered unique insights on health status credentials, digital passports, innovation, and privacy.
Below we have summarised some of the key points that were made during the discussion.
What is COVID status certification the answer to, and how can it be used in society?
Dr Edgar Whitley: This comes down to gaining a deep understanding of what the technology is trying to achieve.
WHO offers guidance around proof of vaccination. Although that is important, effectively this just confirms that you’ve had the vaccine, and what type of vaccine, which batch etc. Getting the vaccine is ultimately something for personal benefit: it reduces the likelihood you’ll end up hospitalised.
At this point in time, the scientific evidence is less clear about what effect vaccination has on transmissibility of the disease. Even after you’ve been vaccinated in the UK, NHS guidance still says to do social distancing and wear a face mask.
If you are thinking about using vaccine status for reopening a domestic economy as opposed to international travel, it is unclear as to what additional benefits you are getting. As everyone has to adhere to the same rules, what difference will it make if a vaccinated person is visiting a pub? Are they allowed to sit more closely to their friends than people who are not vaccinated?
A useful starting point would be to understand what the ‘normality’ is that we are aiming for.
Beyond vaccination—what is the broader context of COVID and other pathogen health status verification and its role in the reopening the economy?
Maarja-Liis Ferry: There is a rush at the moment to get solutions in place. But COVID and other pathogens are the long haul, and when you start thinking that way, it is not necessarily how are we all going to go on holiday this summer – but rather how are we all going to continue to move and interact safely for the next 10-15 years and into the future.
We don’t know what the impact of vaccines is on transmission and when we look at testing there is a variety of tests available with different levels of effectiveness, so it’s going to be about managing levels of risk – what’s acceptable for a large-scale outdoor event vs indoors at a cinema or a wedding.
Going forward we need to focus on avoiding forgery and preserving privacy for the individual, and making it simple for the end user, because at the end of the day nothing is going to work on a global or national scale unless it is simple to use.
Ain Aaviksoo: From a public health point of view, if a newly infected individual doesn’t pose that much of a public health risk anymore, what is the added value of trying to organise and build an enormously complex system to manage the privacy of a value proposition that has been defined so narrowly?
We should try to make the best use of the technologies that enable security and privacy through collaboration across the entire public health ecosystem.
Anthony Day: There is a high likelihood that a solution should be digitised as much as possible because that will enable a streamlined and scalable process. It is also important to manage the issuance of credentials that goes beyond vaccination status: we are looking at health credentials. Integrations are important, for instance airline or cruise liners or employers will be looking at different private and public sector wallets being issued for multiple jurisdictions, and how they can be integrated with digital experiences, ticketing solutions and access management.
Is there a need for guidelines from Governments to guide innovation in the private sector?
Maarja-Liis Ferry: Yes, Government should be involved in setting guidelines and not shy away from the issue, to protect the best interests of the citizen.
There is a need for collaboration between public health and the private sector and I think this is an opportunity to foster new relationships between these sectors. If we include SMEs in this process, this will lead to ongoing economic benefit.
There is an opportunity for public health to be involved in creating distributed trust networks between public health, private testing and industry, where the citizen has oversight of what data is shared.
What is the ‘picture of perfection’ for the future role of technology in public health in the COVID pandemic, and beyond?
Edgar Whitley: Rather than focusing on a picture of perfection, there is an interesting innovation question that is going to come out. In the UK, the NHS is the source of truth of vaccination status. If we are relying on that proof of vaccination as a standard activity, then the role of interoperability and standards for the relying parties — the bars, restaurants, and theatres — is going to be incredibly important. If all apps are equally as good, we are going to get a homogenised service without real competition, and there won’t be an opportunity for companies to differentiate themselves. Or, one app provider perhaps with a slicker UX or probably a better advertising campaign, dominates the market. Talking about innovation and SMEs and rebuilding the economy perhaps goes to waste because of the nature of that standardised requirement for the technical exchange of data.
Ain Aaviksoo: There will be lessons learned both positively and negatively. Contract tracing apps were one example where everyone had great hopes and built secure systems, and the public health benefit was limited. I do think that tech companies have learned a lot during the crisis, and the solutions that will come out of this will be more considerate of the complexity in healthcare.
Using your health data more freely will be one of the outcomes. We might not know exactly how it will materialise, but there will certainly be more freedom for people to use their data in a secure manner so that they can trust that their privacy will not be compromised.
Anthony Day: There are two things for me. First, we need to level up the infrastructure for data sharing and verification between member states. There are several protocols out there, Trust over IP, several Self-Sovereign Identity, W3C Verifiable Credential Standards, that have been worked on for many years prior to the pandemic. Let’s level up that capability around SSI and credentials management at a national level.
Two is building on that trust layer to enable open health to transform the experience for citizens in the same as open banking did for financial literacy.
Maarja-Liis Ferry: COVID has rapidly accelerated the adoption of new technologies by large-scale health organisations. As the NHS has been traditionally quite slow to adopt innovation, we need to ensure that this isn’t limited to the basics.
Things like rapid adoption of video consultations are great, but there is an opportunity now to deploy more innovative and impactful technologies in healthcare data management to bring healthcare in line with other industries and into the 21st Century.
It is up to Government and public health to grasp the opportunity to innovate with industry and set the standards for easy, secure citizen-led sharing and verification of health status, even beyond COVID.
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