
Why immunity passports are a bad idea - bcaulfield
https://www.nature.com/articles/d41586-020-01451-0
======
avancemos
“There is currently no evidence that people who have recovered from COVID-19
and have antibodies are protected from a second infection”(see
go.nature.com/3cutjqz).

As of 3 days ago there is:

[https://science.sciencemag.org/content/early/2020/05/19/scie...](https://science.sciencemag.org/content/early/2020/05/19/science.abc4776?fbclid=IwAR0crCPeMEZ1Zwzsq8BuONaajH_EOSG4hPNl5OHaMVJi8cqJVvhqR1rAB94)

~~~
godelski
From my understanding, it should be the other way around that's proved.
Because that's kinda how the immunity system works. AFAIK the viruses that you
don't get immunity from (assuming you get it and recover) are the odd ones.
Like HIV, and from what I know there can be hundreds or thousands of
variations of the virus inside a single person.

~~~
jpollock
Chickenpox is another one, it can re-erupt as shingles when older.

My googling also turns up herpes, Epstein-Barr, measles(!), HPV, Hep-B [1]...

It looks like there are many diseases which can find a host reservoir in our
body to hide out for a while.

[1]
[https://www.ncbi.nlm.nih.gov/books/NBK8538/](https://www.ncbi.nlm.nih.gov/books/NBK8538/)

~~~
godelski
So there's nuance to this that's important. Let's look at measles[0] because
we get vaccinated for it (which shows that we can get immunity) but the report
says that 9% of cases were people who had been vaccinated.

The crux of this is that immunity doesn't last forever but does last for
awhile. In measles it looks like 15 years after your two standard MMR vaccines
you get from a kid. We have to recognize too that vaccines aren't perfect.
Your immune system might not make as strong of an antibody response as another
person. You may lose immunity sooner than others. Etc. But the whole premise
of the vaccine is that you can get immunity. And if we look at this study,
this worked out for most people. Not many people got measles, and of those
that did only 9% were vaccinated, which shows that there is a substantial bias
for those that weren't vaccinated.

So when I'm saying that people get get immunity I don't mean forever and to
every strain, but that they generally get some protection. In fact, this is an
essential component to vaccine theory. If you gain __NO__ immunity (for any
period of time) from covid, then a vaccine isn't going to do anything because
you can't build an immunity. If you get immunity for a year (like with the
flu), I think that's a pretty acceptable risk for many and shows that we could
build substantial herd immunity just with the younger populations (like with
the flu, which the vaccine there isn't even that great, but better than
nothing).

And as another note on Shingles, I don't know about you, but chickenpox
parties (because it is A LOT worse when you're older) were a thing when I was
a kid (I'm not even 30!) and less than 1% of people get shingles. The main
factors are being old, immunocompromised, and getting chickenpox before you're
18 months old. Saying you can get reinfected and will get reinfected are
different statements with different risk values.

[0]
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979181/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4979181/)

------
oxfordmale
It will also result in illegal Corona rave parties, with the young, that are
at very low risk, preferring to contract it and get on with their lifes.

~~~
JulianMorrison
Except that they'll contract it, spread it to their family, some of them will
actually die of it, and a lot more will suffer long term side effects that may
be subtle but still dangerous. For example, this disease seems to cause blood
clots. You could be fully recovered and drop dead half a year later from a
clot breaking loose and getting lodged in your heart.

~~~
gruez
>For example, this disease seems to cause blood clots. You could be fully
recovered and drop dead half a year later from a clot breaking loose and
getting lodged in your heart.

Isn't blood clots a side effect from lying in hospital beds all day, rather
than the disease itself?

~~~
JulianMorrison
It seems to be an endothelial disease. And it causes blood to clot in small
vessels all over the body. This may be a mechanism by which is damages the
lungs (as well as broken off clots lodging there).

------
m3kw9
Is bad because of the incentives to cheat to get one, fake one, could create
false sense of security when Covid mutate, and dangerous behaviour seeking to
get infected to chance immunity because of advantages offered of having one

------
Animats
That article makes a good argument _for_ immunity passports.

\- People don't seem to be getting this disease twice in three months, even if
exposed again. So there's clearly some level of immunity. In a month, we'll
know if it's good for four months. It doesn't have to be lifetime. A year or
two would be enough. By then there will be either a vaccine or herd immunity.

\- The first batch of rushed antibody tests were not very good, but there are
reliable antibody tests now. Above 99%, anyway. That's good enough.

\- If huge numbers of tests will fix the problem, that just takes money. Far
cheaper than a 3 trillion dollar "stimulus". Cost goes down with volume, too.

\- Too few survivors - right now, yes; over time, no. New York City is
somewhere in the 15% - 20% range now. By the time the plan is in place, there
will be more.

\- As for "marginalized groups", this seems to hit Asians and blacks worse. So
those groups will have more survivors, more immunity passports, and better
access to jobs.

~~~
buboard
> right now, yes; over time, no.

the rate of infection (and immunity development) is going down everywhere. it
seems high immunity level will take too many months to arrive even in the most
affected cities. By that time the virus will have mutated, like other
coronaviruses

~~~
Animats
_the rate of infection (and immunity development) is going down everywhere._

No, it's not.[1] Some places it's up, some places it's down. The US as a whole
is flat right now.

[1] [https://ig.ft.com/coronavirus-
chart/?areas=usa&areas=gbr&are...](https://ig.ft.com/coronavirus-
chart/?areas=usa&areas=gbr&areasRegional=usny&areasRegional=usnj&cumulative=0&logScale=0&perMillion=1&values=cases)

~~~
buboard
the graph shows new cases are down from the peak and decreasing. this means
immunity development is going to be a lot slower than it has been until now

------
davisskola200
About two years ago, I learnt about a successful HEPATITIS B Virus treatment
from Herbal Health Point (ww w. herbalhealthpoint. c om), I was on the
treatment for over 7 months and tested negative after I completed the
treatment. Its almost unbelievable how the treatment alleviated the virus. I
completed the treatment two years ago and still negative!

------
JumpCrisscross
Whether antibody tests are made official or not, their results will begin
being requested before their efficacy has been proven. I’ve already started
seeing it in New York, if only as a polite request.

Focus should be on improving test quality, understanding joe immunity works
and increasing availability.

This article reads as a perfect is the enemy of the good piece. Limiting
something potentially beneficial because not everyone can have it is a nice
thought, but it backfires.

------
brownbat
I'm surprised those who have survived covid haven't found a way to self-
identify, like green wristbands or something that say "immune" or "survivor,"
and wear those in place of masks.

Not recommending this, it would still create some of the same problems, but
I'm surprised it just hasn't naturally emerged from individual incentives.

~~~
Slartie
What would that change?

If you're legally required to make people wear masks when they enter your
store you can't just say "oh, but there are these peeps who said that they
already had the virus, they said they could be identified by their green
wristbands, I will let those in without a mask". Local law enforcement will
first laugh at you, then threaten to close your store if you don't comply with
the law which does not exactly include a paragraph about exempting people due
to whatever kind of self-chosen fancy "survivor IDs".

------
jariel
I'm resigned to the fact that our leaders are fools, living in intellectual
bubble candy-lands, totally unaware of human nature.

The article presents neat, philosophical arguments.

But the _real_ reason we can't have 'immunity passports' is that large swaths
of young people will be swarming to get infected on purpose.

Massive numbers of people will either think 'there is no risk' or 'are willing
to take the risk' or 'feel the need to take the risk' (i.e. for income).

Bragging about their 'freedom passports' on Instagram, egging others on.

I can see low-grade Instagram celebs doing 'team infections' on social media,
going into a house together and getting infected.

I can see poorly raised teens making pacts. Semi lawless young people just
going out and getting it.

Other young people taking bad cues for influencers.

Think of the problems FB and YouTube will have. Will they have to censor
anyone promoting 'getting infected'?

The mere thought of 'immunity passports' is DOA for that reason alone, and of
all the articles I've seen on the subject, they've never bothered to address
this most obvious issue.

~~~
Animats
Since very few people under 25 die of this, that's probably OK. And then we
have a workforce.

This is actually an argument for giant 3-week rave parties in isolated areas.
Everybody gets tested on the way out. Ones with antibodies and no virus get a
passport. Then they get job offers. Extreme, but better than the current
"open, stay open, and keep dying" plan.

~~~
jariel
"Since very few people under 25 die of this, that's probably OK. And then we
have a workforce."

Wow - absolutely not - the notion of people - anyone - purposely infecting
themselves with a deadly disease that actually does kill quite a number of
people - is absurd.

The notion that the government may indirectly encourage it is very
irresponsible.

This is aside from even the fact that quite a lot of those people will still
need hospitalization, and of course, they become carriers and will infect
others.

A 'wave of young people getting infected' would cause the hospitals to spike
again, get more healthcare workers and 'all the other people' in the hospitals
infected as well.

We're going to have to aggressively socially distance and change a lot of our
habits for the next 18 months or so as vaccines, cures, therapies etc. are
developed - all of these things combine to bring R0R/R1 the numbers down.

~~~
SpicyLemonZest
We won't be able to aggressively socially distance for the next 18 months,
whether or not we have to.

------
naringas
but, alas, they are a great idea if you are sufficiently scared...

------
jedberg
On the one hand I agree with the gist of this article -- that those with less
privilege will be worse off because it will be harder for them to get the
certificate.

On the other hand, we already have this in California. You can't attend school
without your vaccinations. Although the state will provide the vaccinations
for free if you can't afford them.

The problem is it actually is a good idea _right now_ to operate under the
assumption that antibodies provide immunity, but in the future it may not be.

But if you allow a program that gives certificates for having antibodies, it
will be really hard to put that genie back in the bottle.

~~~
SiempreViernes
""" If universal, timely, free access to a vaccination becomes possible,
_then_ it could be ethically permissible to require vaccine certification for
participation in certain activities. But if access to a vaccine is _limited in
any way_ , then some of the inequities we highlight could still apply, as the
literature on uptake of other vaccines attests """

------
buboard
is any country actually issuing those "passports"? afaik none of the countries
that opened up do that

a more pertinent question is how to monitor the quarantine of infected people
for the following months. asian countries used quite harsh measures for that

~~~
SpicyLemonZest
A lot of countries have publicly floated the idea, but as far as I know none
have ended up implementing it.

------
darawk
These arguments are uniformly terrible. Let's go over them point by point.

> COVID-19 immunity is a mystery

No. It's not. Recovered people are almost certainly immune. There's evidence
that's come out recently to actually empirically confirm this, but it's also
how almost all diseases work, and so it's a _super reasonable_ prior in the
absence of evidence. This whole "we haven't positively proved it, therefore we
have no idea" position that's being taken in some corners of the healthcare
community is ridiculous, dangerous, and wrong.

> Serological tests are unreliable. The volume of testing needed is
> unfeasible. Tens to hundreds of millions of serological tests would be
> needed for a national immunity certification programme.

 _Some_ serological tests are unreliable. So use the reliable ones, problem
solved. The US is doing hundreds of thousands of tests a day. That's enough
for this program to work.

> Too few survivors to boost the economy.

This may be true in some areas, but it's certainly not true in NYC, where 20%
of the population has been infected already. Even if it doesn't boost the
economy, it'd allow freedom of movement to people who have recovered - that
seems like a valuable thing to me on its own.

> Monitoring erodes privacy.

No it doesn't. Give someone an immunity certificate. If they get stopped
outside when they're not supposed to be, they present it to the police and go
on their way. Just like a drivers license or any form of identification now.

> Marginalized groups will face more scrutiny.

No. We do not need any extra monitoring to do this. Just take the current
system with its current restrictions, and lift the restrictions for people
with a certificate of immunity.

> Unfair access. With a shortage of testing, many will not have access.

First of all, unfair access is a choice. Design the system so it's fair, if
you're worried about that. Second of all, unfair access is not a reason to
deny access to everyone.

> Societal stratification.

This is literally the point. To stratify by recovered/immune. If you actually
want to get into this, traditionally marginalized groups have been
disproportionately infected by this virus, which means they will be
disproportionately granted immunity certificates. If anything, this will
stratify in the opposite way from 'traditional' stratification, and that seems
like a fine thing to me.

> New forms of discrimination

This is just a restatement of the last two points.

> Threats to public health. Immunity passports could create perverse
> incentives. If access to certain social and economic liberties is given only
> to people who have recovered from COVID-19, then immunity passports could
> incentivize healthy, non-immune individuals to wilfully seek out infection —
> putting themselves and others at risk

Driver's licenses create perverse incentives. That's not a reason not to issue
them. If someone infects themselves with covid to get an immunity passport,
that's fine, we'll just get to herd immunity that much faster.

Remember, immunity passports aren't putting _more_ restrictions on anyone.
They're just lifting extant restrictions on those who have recovered. This
idea that it's going to erode privacy or rights is such a crazy false choice I
don't even know where to begin. The reasoning in this article is just so, so
bad.

------
trhway
so, immunity passports are bad while vaccination certificates are good? What
is the difference?

~~~
SpicyLemonZest
Vaccination certificates can be easily obtained through a quick, safe,
procedure, and are waived in the rare cases where the procedure wouldn't be
safe.

------
zimpenfish
Title is currently "Ten reasons why immunity passports are a bad idea"

~~~
dang
Fixed now.

------
dvt
> Strategies that focus on the individual — using conceptions of ethics rooted
> in libertarianism — contradict the mission of public health.

This is _quite_ the claim. Unfortunately, it's not really backed up by much.
Not to mention that the idea of an "immunity passport" is pretty anti-
libertarian to begin with, so it just seems like odd shade-throwing.

> because of structural inequities, people of colour are dying from COVID-19
> at much higher rates than are white people..

I was under the impression that people of color are more impacted by COVID-19
due to certain health profiles (e.g. diabetes being more common in black
communities than, say, Asian communities). I'm not really sure how the jump is
made here to "structural inequities." COVID-19 is just _one_ co-morbidity and
claiming otherwise is just agenda-waving.

~~~
ceejayoz
> I was under the impression that people of color are more impacted by
> COVID-19 due to certain health profiles (e.g. diabetes being more common in
> black communities than, say, Asian communities).

That's one factor, but there are many. Hospitals in low income areas are not
as well funded and supplied. Access to primary care may be more limited.
Heavier concentrations of jobs with less ability to work from home. etc.

~~~
hutzlibu
But that does not explain the same effect in sweden, where also the people of
color were much more affected. And sweden is very homogenized, compared to US.

~~~
SiempreViernes
> And sweden is very homogenized

[Citation needed]

~~~
hutzlibu
"The Income inequality in Sweden ranks low in the Gini coefficient, being 25.2
as of 2015 which is one of the lowest in the world"

[https://en.wikipedia.org/wiki/Income_inequality_in_Sweden](https://en.wikipedia.org/wiki/Income_inequality_in_Sweden)

~~~
ceejayoz
That’s not a great measurement for homogeneity.

~~~
hutzlibu
But it's the one that matters in that context.

Which was poor US areas are really poor and so are their hospitals.

In sweden there are no really poor areas and no underpayed hospitals.

(they are also not perfect, though)

------
stared
> Strategies that focus on the individual — using conceptions of ethics rooted
> in libertarianism — contradict the mission of public health.

Immunity passport (or any other pandemic-prevention tools) focus on the
population, not an individual. (It is not if you can or cannot get infected,
it is if you are likely to infect others!)

I am disappointed by the populistic vibe of this article, endorsed by Nature.
Sure, there are problems with the idea of the immunity passport. But the
question is - what are the alternatives?

They gave much less scrutiny to the idea of a vaccine (that no-one knows if
and when it is going to be available) and tracking (which works in Singapore,
Taiwan and South Korea, but in other countries it fails miserably). They both
suffer from many similar issues as the passport (tracking: regarding privacy,
vaccine: access to less privileged groups, etc).

~~~
SiempreViernes
Uh, how is a _personal document_ something that focus on the overall
population?

Population level solutions of this type would universally grant rights to (at
least) entire blocks of a city.

~~~
stared
Not infecting the population?

If we can make the whole population immune - it is the best. If there are some
people immune - it makes no sense restricting their traveling rights if they
are not increasing risk of infecting others.

------
remote_phone
Immunity Passports are a great idea because it decreases fear. This is
assuming that people aren’t forging these certificates. But if I know that the
delivery person is verifiably immune and won’t transmit the disease, or if the
cook at a restaurant and the servers are immune, I’m more likely to go there.
I would even pay extra.

Decreasing fear is what is going to save this economy otherwise we are looking
at another 2-3 years of economic paralysis.

~~~
deegles
What happens when workplaces start demanding immunity in order to come back to
work? Does that not punish those who keep themselves safe?

~~~
smnrchrds
This is my biggest fear. That the government support for people rendered
jobless or furloughed due to covid would end, businesses would start
reopening, but they require immunity passports. This would cause many people,
especially those in poverty, to purposefully contract corona so they can get a
job.

