Immunity card

from Wikipedia, the free encyclopedia

An immunity card , also known as an immunity pass , is an identity card that classifies people who have previously been infected with a contagious disease as immune and is intended to impose fewer restrictions on them to fight infection. Use during the COVID-19 pandemic is being discussed but is controversial for both practical and ethical reasons. With regard to COVID-19, it was also referred to as Corona-Pass , Corona-ID , COVID-19-ID , COVID-19-Pass and COVID-Pass .

In contrast to a vaccination card , it does not document immunity achieved through vaccination , but infection. However, in the case of measles, not only the vaccination, which is different from COVID-19, but also immunity due to illness can be entered in the vaccination card.

HEALTH AND ACCLIMATION CERTIFICATE. HAVANA, CUBA, ⸺ ⸺, 189—. This is to certify, that ⸺ ⸺, a native of ⸺, and a resident of ⸺, color ⸺, years of age, ⸺, sex ⸺, has produced satisfactory proof to me that ⸺ has had yellow fever or is acclimated to it by long residence in towns and cities where it has prevailed in recent years, that ⸺ is protected from smallpox by successful vaccination or a previous attack of the disease, and that ⸺ is in good health at the present time. And I further declare my belief that sufficiently acclimated to the diseases of the tropics, so that ⸺ presence threatens no danger from yellow fever, cholera. or smallpox. [SEAL.] ⸺ ⸺ MD, MHS
Sample of a certificate which, among other things, should show immunity to yellow fever caused by illness. It was used for immigration to the United States in the late 19th century .
Translation of an excerpt: “This is to certify that ⸺ ⸺, born in ⸺, and a resident of ⸺, skin color ⸺, age in years, ⸺, gender ⸺, has provided me with sufficient evidence that ⸺ had yellow fever or through a long stay in towns and cities where it has been widespread in recent years, is used to "

history

Something comparable with an immunity card was already practiced in the 19th century for yellow fever . Back then, the mosquito- borne disease often killed 8% of the population in some endemic areas . At that time it was common to apply for a job as “acclimated”, i.e. immune. For this reason, proof of staying in a place where yellow fever was widespread or a medical certificate was required to ensure that workers did not simply die after completing their training. A survived infection was worth money, so that some even deliberately set out to get sick. The exact verification was difficult because there were no blood tests . For example, the admission of people in cities with the spread of yellow fever in some life insurance companies was based on the length of stay in them, while others rely on medical verification.

Concepts

With the SIR method , a concept was modeled in which “shield immunity” is used. Workers (e.g. in critical infrastructure ) without recovery are to be replaced by those who have recovered. This is intended to work together with the general protective measures that are to be gradually reduced. This would work more effectively the longer the immunity lasts. Due to the possible false positives , the infection-reducing effect also depends on whether a high number was infected at all. In addition, there are differences depending on the actual base reproduction number that has only been determined approximately so far .

Solutions with digital signature have been proposed for a secure implementation .

discussion

course

As early as the end of March 2020, in the course of antibody studies, there were reports from Germany about a possible immunity passport. The media quoted one epidemiologist as saying, "The immune system could be issued with a kind of vaccination certificate that would allow them, for example, to be exempt from restrictions on their activities". The British government had been planning to issue such passports since the beginning of April. Other states followed, which is why the WHO warned against such on April 24 due to the unclear to what extent antibodies would guarantee immunity. In Chile , the plans became more specific in mid-May, so that despite warnings from Chilean medical societies, a “release certificate” was planned, which was supposed to certify that the person carrying it had a lower risk of infection for three months. These were then withdrawn as these certificates could create "a fairly serious problem of discrimination". In mid-August, the El Salvador Ministry of Health announced plans for an immunity card to be issued after a positive PCR test and recovery with a validity of eight months. In the meat packaging industry and in the distribution of medicines and food, ID card holders should be given preference.

In Germany, the Federal Minister of Health Jens Spahn ( CDU ) suggested introducing the Second Act to protect the population in an epidemic of national importance . He justified this with the fact that “it cannot be that our citizens can no longer travel to countries that are planning such regulations”. However, this failed for the time being due to resistance from coalition partner SPD . Spahn then asked the Ethics Council for an opinion. In mid-June, a private provider with false promises offered PDF documents for sale as alleged "Covid 19 immunity passports" in Germany . The Hamburg Medical Association warned against such offers at the end of June. The advertising would presume a lack of security, since long-term studies on immunity would be lacking due to the novelty of the virus. The President of the Medical Association of Lower Saxony Martina Wenker also declared her rejection of an identity card with "An antibody test is not worth much", he could not say whether infections are still possible. She also gave ethical reasons. The Ethics Council had meanwhile stated that it wanted to devote more time to the topic due to the complexity.

Arguments

Legal scholar Volker Boehme-Neßler and virologist Christian Drosten also took part in the discussion in Germany . While Drosten at the end of April "completely assumed that there was immunity" that would last for a certain time, he feared a "social stigmatization " in various areas, even in private, since it could be used to show off people or people could be unloaded from celebrations without ID. So did Boehme-Neßler at the beginning of May, who warned of a division in society and also considered an introduction to be unconstitutional :

“[…] The idea of ​​the constitution is: In the beginning there is freedom. Everything is basically allowed. Unless it is exceptionally prohibited. Freedom is the norm, its restriction the exception.

The planned Corona Pass would turn that around. At the moment, the restriction of freedom is the norm. Everyone is locked down. In exceptional cases, the freedoms would be possible again - but only for those who can show an immunity card. Only those who meet the health requirements could exercise basic freedoms. Freedom as an exception for the healthy - that completely contradicts the spirit of the constitution. [...] "

- Boehme-Neßler

In early May held it Anika Klafki contrast in Verfassungsblog for from a constitutional point of view for concern in the case of a detectable immunity to ignore this. The application of general preventive measures to people who do not pose a risk of infection could only be justified in exceptional cases “as a last resort in very limited exceptional cases” . The difference to the measures for non-disruptors provided for in the Infection Protection Act , based on a general risk, is that "in the case of demonstrably immune persons, there is the certainty under infection protection law that control measures directed against them have no direct benefit in combating the risk of infection". The consideration of a proven immunity already results from the principle of proportionality , which is why a concrete legal introduction is unnecessary and rushed with regard to the difficulties of proof.

In the United States , the legal scholar Govind Persad and the medical ethicist Ezekiel J. Emanuel argued for an immunity card with the “principle of the 'least restrictive alternative'”, that so much should be allowed as possible. Accordingly, if there is demonstrably a lower risk of infection, people should be allowed to be free from restrictions. That would be like " driving license and pilot's license " ( "Driver's and pilot's licenses"), which is why they "immunity based license" rather than "immunity Pass" suggested as a name ( "The term 'immunity-based licenses' is better than 'immunity passports.'" ):

"[...] just as the work of licensed truckers benefits those unable to drive, the increased safety and economic activity enabled by immunity licenses would benefit the unlicensed. For instance, preferentially hiring immune individuals in nursing homes or as home health workers could reduce the spread of the virus in those facilities and better protect the people most vulnerable to COVID-19. Friends, relatives, and clergy who are immune could visit patients in hospitals and nursing homes. "

"[...] just as the work of licensed truck drivers helps those who cannot drive, the greater safety and economic activity afforded by immunity licenses would help the unlicensed. For example, hiring immune individuals preferentially in nursing homes or as home health workers could contain the spread of the virus in these facilities and better protect vulnerable populations from COVID-19. Friends, relatives, and clergy who are immune could visit patients in hospitals and nursing homes. "

- Persad & Emanuel

Opening restaurants to licensed customers could bring tax revenues to invest in fighting the pandemic. To speak of a split in society, as in the case of the Yellow Star , would not be appropriate, since classification is not based on irrelevant factors such as religion, but on immunity. No regulated introduction of licenses could lead to companies introducing less secure evidence themselves.

For immunity cards, it was also stated elsewhere that they would be used for yellow fever . On the other hand, it was found that these were actually vaccination cards. While these would encourage vaccinations, the proposed concept would encourage people to become infected with the disease. The well-known historical use of actual immunity cards during the 19th century in New Orleans is an example of discrimination . Whether someone with yellow fever was "acclimatized" (translated from "acclimated") would have decided about the possibility of marriage or the value of slaves . “Something similar” saw a Nature comment by molecular biologist Natalie Kofler and bioethicist Françoise Baylis from the end of May as a possible “ dystopian future if governments were to introduce 'immunity passports' in efforts to reverse the economic catastrophe of the COVID-19 pandemic ” (“ Something similar could be our dystopian future if governments introduce 'immunity passports' in efforts to reverse the economic catastrophe of the COVID-19 pandemic ").

From a practical point of view, the Nature commentary also objected that there would not yet be any reliable knowledge about the duration of an alleged immunity in humans, in addition, antibody tests that were discussed for subsequent immunity certification would give many false positives and thus false certainty. From the figures it is only possible in Germany to test 6% per month with such a test and offset against the small proportion of those who have recovered in the total population, it would only be possible in the United States (as of the end of May 2020), for example 0, 43% issue an ID. That would not result in any economic improvements. In order to be able to control movements efficiently at all, which is the intention behind the immunity card, the paper form is not suitable. Therefore, digital ID cards are likely to be used, which would pose a threat to data protection . In China, for example, in addition to the COVID-19, the further health status would also be recorded in such apps, which, as announced in China, could also be used after the COVID-19 pandemic. “The immunity passports of today could become the all-encompassing biological passports of tomorrow”.

Wealthy people may find it easier to get tests, as has been shown by professional sports teams, and thus cause inequality. Unequal treatment is also to be expected between residents of different countries, those who introduce an identity card and those who cannot or do not want to do so. Ultimately causing loud various comments (Here Nature quoted) immunity certificates "threats to public health " ( "Threats to public health"). They “could create perverse incentives” to infect themselves in order to obtain evidence, or illegally obtain evidence.

As a solution to these incentives, proponents suggested limiting spending to specific groups, such as hospital workers, who would be vigilant about infection prevention. Another argument is that properly adapted laws can prevent discrimination. A Lancet commentator argued that this contradicts the purpose of immunity cards, which should be classified according to the criterion of the immune status and thus enable participation.

Trivia

A concept of immunity passports in the form of a bracelet was thematized in the 2011 film Contagion . They are needed in the film, for example, for shopping.

In social media , according to anthropologist Heidi Larson, “Most conversations about the concept of the immunity passport [...] range from skepticism to passionate rejection” (“On the notion of immunity passports, most conversations ranged from skeptical to ardently opposed”).

literature

  • Natalie Kofler, Françoise Baylis : Ten reasons why immunity passports are a bad idea . In: Nature . Volume 581, May 28, 2020, 379 ff., Online May 21, 2020, doi: 10.1038 / d41586-020-01451-0 . Comment in the respected and well-respected journal listing problems with the proposal.
  • Ole F. Norheim: Protecting the Population with Immune Individuals . In: Nature Medicine . Volume 26, June 2020, online May 7, 2020, p. 823 f., Doi: 10.1038 / s41591-020-0896-2 . Presentation of a study that modeled a possible impact during the COVID-19 pandemic.
  • Govind Persad, Ezekiel J. Emanuel : The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”) In: JAMA . Volume 323, No. 22, June 9, 2020, pp. 2241 f., Online May 6, 2020, doi: 10.1001 / jama.2020.8102 . Opinion in the widely read medical journal that sees great potential.
  • Alexandra L. Phelan : COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges . In: The Lancet . Volume 395, No. 10237, May 23, 2020, pp. 1595–1598, online May 4, 2020, doi: 10.1016 / S0140-6736 (20) 31034-5 . Comment in the old medical journal portraying the introduction of immunity passports during the COVID-19 pandemic as a worsening of the situation.
  • Kathryn Olivarius: Immunity, Capital, and Power in Antebellum New Orleans . In: The American Historical Review . Volume 124, No. 2, April 2019, pp. 425–455, doi: 10.1093 / ahr / rhz176 . Contribution to the economic importance of immunity in 19th century American New Orleans, severely affected by yellow fever.

Web links

supporting documents

  1. ↑ Larissa Rhyn: Interview with Daniel Koch: Risk groups should soon lead a normal life again - without special measures . In: nzz.ch . May 7, 2020, accessed June 8, 2020.
  2. ↑ a b Volker Boehme-Neßler: The Corona Pass is inhuman and unconstitutional . In: zeit.de . May 5, 2020, accessed June 8, 2020.
  3. ↑ Italy is considering its own Corona ID card for immune citizens . In: wienerzeitung.at . April 7, 2020, accessed June 4, 2020.
  4. ↑ Controversial Corona ID card - patient protectors are clearly positioning themselves . In: ruhrnachrichten.de . May 5, 2020, accessed June 4, 2020.
  5. ↑ Kristiana Ludwig: Immune to good arguments . In: sueddeutsche.de . May 14, 2020, accessed June 4, 2020.
  6. ↑ Do Covid-19 Immune receive an extra ID? In: tagesanzeiger.ch . May 4, 2020, accessed June 4, 2020.
  7. ↑ Heike Schmoll : On vacation with the “Covid-19 Pass”? In: faz.net . May 7, 2020, accessed June 4, 2020.
  8. ↑ Pia Heinemann : What you need to know about “Covid 19 passports” . In: welt.de . April 30, 2020, accessed June 4, 2020.
  9. ↑ WHO warns of "immunity passports" . In: spiegel.de . April 25, 2020, accessed June 4, 2020.
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  11. ↑ a b c d Phelan: COVID-19 immunity passports and vaccination certificates . 2020, p. 1597.
  12. ↑ What are the benefits of an immunity card? In: deutschlandfunk.de . June 26, 2020, accessed on July 10, 2020, What is an immunity card and what should it do?
  13. ↑ Olivarius: Immunity, Capital, and Power in Antebellum New Orleans . 2019, p. 440, footnote 88.
  14. ↑ Olivarius: Immunity, Capital, and Power in Antebellum New Orleans . 2019, p. 440.
  15. ↑ Olivarius: Immunity, Capital, and Power in Antebellum New Orleans . 2019, p. 429.
  16. ↑ Olivarius: Immunity, Capital, and Power in Antebellum New Orleans . 2019, p. 428.
  17. ↑ Olivarius: Immunity, Capital, and Power in Antebellum New Orleans . 2019, p. 437.
  18. ^ Norheim: Protecting the population with immune individuals . 2020, p. 384.
  19. ↑ Daniel B. Larremore, Kate M. Bubar, Yonatan H. Grad: Implications of test characteristics and population seroprevalence on 'immune passport' strategies . In: Clinical Infectious Diseases . online July 20, 2020, doi: 10.1093 / cid / ciaa1019 .
  20. ↑ Mark A. Hall , David M. Studdert : Privileges and Immunity Certification During the COVID-19 Pandemic In: Journal of the American Medical Association . May 6, 2020, doi: 10.1001 / jama.2020.7712 .
  21. ↑ Antibody study to demonstrate population immunity . In: aerzteblatt.de . March 27, 2020, accessed June 8, 2020.
  22. ↑ Kate Proctor, Ian Sample, Philip Oltermann: 'Immunity passports' could speed up return to work after Covid-19 . In: theguardian.com . March 30, 2020, accessed June 8, 2020.
  23. ↑ Jason Horowitz: In Italy, Going Back to Work May Depend on Having the Right Antibodies . In: nytimes.com . April 4, 2020, accessed June 8, 2020.
  24. ↑ Barbara Fraser: Chile plans controversial COVID-19 certificates . In: The Lancet . Volume 395, No. 10235, May 9, 2020, p. 1473, doi: 10.1016 / S0140-6736 (20) 31096-5 .
  25. ↑ Liseth Alas: Infectólogo Jorge Panameño: “No hay base científica que avale el tema de la inmunidad por COVID-19 ″ . In: elsalvador.com . August 11, 2020, accessed August 16, 2020.
  26. ↑ Las razones por las que Chile dio marcha atrás a la entrega de un carné de inmunidad . In: elsalvador.com . August 10, 2020, accessed on August 16, 2020.
  27. ↑ a b Spahn still believes that an immunity card is required . In: aerzteblatt.de . May 14, 2020, accessed May 24, 2020.
  28. ↑ What is behind the first Corona immunity pass . In: tagesspiegel.de . June 20, 2020, accessed June 25, 2020.
  29. ↑ Hamburg Chamber warns against commercial immunity cards . In: aerzteblatt.de . June 30, 2020, accessed July 1, 2020.
  30. ↑ Debate about immunity card continues . In: aerzteblatt.de . June 26, 2020, accessed July 1, 2020.
  31. ↑ (36) Coronavirus update . In: ndr.de . April 28, 2020, accessed June 11, 2020.
  32. ↑ Anika Klafki: The immunity card and the way back to a free life . In: verfassungsblog.de . May 4, 2020, doi: 10.17176 / 20200505-013642-0 .
  33. ↑ a b Persad, Emanuel: The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”) . 2020, p. 2241.
  34. ↑ a b c Persad, Emanuel: The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”) . 2020, p. 2242.
  35. ↑ a b Kofler, Baylis: Ten reasons why immunity passports are a bad idea . 2020, p. 379.
  36. ↑ Kofler, Baylis: Ten reasons why immunity passports are a bad idea . 2020, p. 380.
  37. ↑ a b c Kofler, Baylis: Ten reasons why immunity passports are a bad idea . 2020, p. 381.
  38. ↑ COVID-19 'immunity passports' pose range of issues . In: upi.com . June 1, 2020, accessed June 8, 2020.
  39. ↑ Heidi J. Larson: A call to arms: helping family, friends and communities navigate the COVID-19 infodemic . In: Nature Reviews Immunology . July 2, 2020, doi: 10.1038 / s41577-020-0380-8 .