Tackling the immunity certificate conundrum: What does it take?

Ever since the World Health Organisation officially declared Covid-19 a pandemic more than a year ago, the handling of health data has increasingly gained importance, especially with the global rollout of vaccination campaigns. Whether we call it a digital vaccination passport, immunity certificate or green pass, in the end it all comes down to the way people’s data related to their immunity status is collected, stored, accessed and used. 

Together with distinguished experts Garrett Mehl (Head of Unit, Digital Health Technology, WHO), Elli Androulaki (Research Manager, IBM Research) and Alessandro Blasimme (Senior Scientist, Health Ethics and Policy Lab, ETH Zurich), the necessary framework conditions for a responsible immunity certification were discussed. 

As part of three open ideation breakout sessions, the concrete questions around the requirements for a trustworthy, interoperable and sustainable digital immunity certification system were evaluated. Also, the potential involvement and role of International Geneva and its institutions were part of the discussion. The three breakout sessions were split into ethical, technological and scientific focus. 

Why does the issue around the certificate conundrum matter?

As the workshop revealed, the topic is a highly complex and multifaceted issue. Everyone has different concerns and opinions. People are insecure about the next developments around the vaccine passports, whether they are being issued electronically or not and with what consequences to it. During the panel discussions of the three experts, the complexity of designing a global framework to securely storing and processing the collected data became evident. The pandemic was also described as a catalyst for a strong push around the health space with numerous ethical issues around personal, sensitive data involved and human lives at stake. 

What issues do we see around the certificate conundrum discussion?

The first part of the breakout sessions was about listing issues connected to the immunity certificate conundrum. Although the breakouts had different focus areas, the overlap of ethical, technological and scientific issues became apparent as the presentations of the collected issues revealed: 

• Challenges for an inclusive approach to those who do not have access to electronic devices, cannot be vaccinated or where governments are too slow to vaccinate the population 
• Unclear involvement of technologies and what it entails, such as the storage, interpretations and accessibility of data 
• Unclear benefits of the e-vaccine pass over traditional paper-based passes
• Lack of communication why certain data is collected, why certain regulatory frameworks are applied and with what impact for the population 
• Lack of aligned strategy between governments with a standardized approach people can adjust to
• Slowness of politicians vs. speed of the disease and scientific development 

Overarching issue clustering of the three focus groups: 

• Ethical: Justice, governance, consequences, trust
• Technological: Information security, data processing, data sharing 
• Scientific: Lack of communication, lack of interoperability across countries, speed vs. slowness 

How can we tackle this problem?

In the second part of the breakout sessions, potential solutions on how to address the most pressing issues were presented. The results again concluded similar and intertwined approaches on what it takes to create a trustworthy, interoperable and sustainable digital immunity certification system.

• Better international coordination and agreements between health organizations and governmental bodies to provide clarity on regulative framework

• Clear communication around the data usage, accessibility and storage 
• Context to why e-vaccine passports are potentially regarded as more beneficial over traditional paper based passes
• Provide proof of concept that the advantages by being more “accessible/traceable” currently outweigh the disadvantages as we can move more freely 
• Multi-stakeholder approach by governments, public health organizations and tech companies to cover all required complexity areas 
• Usage of secure and modern technologies such as blockchain for maximum protection of data including forming cooperation with, for example, academic institutions 
• Inclusive approach by bringing the technology to the people, identifying mechanisms for those who do not have access to latest technologies or non-discriminative ways for those who cannot be vaccinated / are the last ones to receive the vaccine 

Ethical: 

• Consequences: Framework on what will happen with the collected data once the pandemic is over and what criteria defines the pandemic to be over
• Governance: Proof of concept for successful regulations and evidence-based assessment that measurements are working
• Trust: Transparent sharing of which information are collected, how, the accessibility and interpretation thereof 
• Justice: Robust anti-discrimination laws to those who cannot afford latest technology, cannot be vaccinated or are the last ones to receive the vaccination 

Technological: 

• Information security: Secure usage of blockchain technologies; Public-key-infrastructure (PKI); Cooperation with academics / open source 
• Data processing: Cooperation with computer emergency response teams (CERTS); transparency on processes, data quality (trust)
• Data sharing: Inclusive process to bring the technology to the people

Scientific: 

• Communication: Single source of official communication that is aligned with all health authorities
• Lack of common approach: Standardized framework across different countries 
• Speed vs. slowness: Better interoperability between science and governments as evidence evolves and politicians take time to form decisions 

The role of International Geneva 

The role of International Geneva was described as promising due to its strong ecosystem and connections to tech, public, health and ethical organizations which fulfil the multi-stakeholder requirement to solve the immunity certification issue. Also, International Geneva benefits from its strong ties to ethical practices as well as its long-standing neutral image and experience in the geo-political space.

Conclusion

As the global pandemic has seemingly hit us overnight and has ever since been the controlling factor of our lives, it is fair to say that the great solutions to some of the most complex questions do not come easily. It will take continuous efforts and a multi-stakeholder dialogue to tackle the immunity certificate conundrum not only effectively but also in a sustainable way. Key aspects for this to happen is the collaboration between governments, public health organizations and data management governance by modern technology providers, all paired with an open and transparent communication to the public. 

What it means for the Swiss Digital Initiative: 

The Swiss Digital Initiative (SDI) is headquartered in International Geneva, hence, the heart of multilateralism. The sharing of health data raises several ethical challenges and requires a strong governance thereof. With a focus on bringing ethical standards to the digital world, the SDI sees a potential to be involved in supporting the formation of an ethical framework around health data. With the current development of the first, globally leading Digital Trust Label, the SDI is potentially working on a first tool to support this development. The workshop proved that the SDI is not only well-positioned in terms of its location but also within the respective ecosystem of having strong connections, collaborations and partnerships to a variety of stakeholders from public and public organizations that serve as a key element to successfully fostering a trustworthy framework to operate in.