As we transition into the beginning phases of deconfinement, we are seeing countries incorporate different variations of tech-based solutions to help assist in these delicate endeavors. Digital contract tracing (DCT) applications have taken the main stage in conversations for proposed solutions, however this is not the only tech being offered as an answer to our current crisis. Although on a much smaller scale in comparison to DCT, discussions on immunity passports have begun to appear on our timelines as another potential tech solution to expedite the exit from quarantine for certain individuals. However, just as we asked with DCT, so we must ask again with immunity passports: what are the ethics behind this technology, and, with human values in mind, is this worth pursuing?
Defining Immunity Passports
An immunity passport is essentially a digital certificate attached to a person’s identity indicating whether or not an individual has previously contracted the coronavirus and is subsequently immune to a second infection. The purpose of such technology would be to begin allowing individuals who are immune, and therefore risk-free in respect to contracting COVID-19, to begin returning to ‘normal life’ activities and liberties.
Currently, the application of immunity passports has been put on hold due to the fact of insufficient evidence of the necessary antibodies that would declare an individual immune. In fact, the World Health Organization advised against governments adopting any form of immunity passport, at this point in time, due to lack of evidence and therefore risk of potential for re-infection. Although this is a significant barrier to the immediate use of immunity passports, it does not mean that it is an absolute end to the discussion.
If sufficient evidence in effective antibodies does arise, then the idea of an immunity passport will very likely come back into the conversation. Furthermore, as the world now understands the importance of preparation for a pandemic, immunity passports may be viable in future cases. So, even though we are not utilizing them at this very moment in time, it does not imply that we never will, and instead affords us the time to properly consider the ethical angles to this technology prior to technical implementation.
Breaking down the tech - what are we really working with here?
In order to properly consider the ethics of this technology, let’s take a step back from any technical, medical, or le gal barrier to immunity passports that may currently exist. These are of course vital components to the success of such passports, but can often cause distractions, confusing the debate and pulling us away from our original goal of unpacking the core ethical principles at work. So, for just a moment, let’s step into a thought experiment in which the required antibodies exist and immunity passports are technically feasible.
At its very core, immunity passports are simply digital markers indicating whether or not a person has previously contracted coronavirus and so now has the antibodies required to prevent a second infection. Fundamentally speaking, the act of indicating whether or not an individual is immune is ethically neutral. As it is neither ethically good nor bad to have previously contracted coronavirus, the marker is not ethically laden, it’s merely a descriptor indicative of reality.
It is important to consider, however, that such a digital marker should be classified as health data as it is essentially an indicator of an individual’s medical history. Just as a medical record of whether or not a person has had the chickenpox is kept securely as health data, so should a record of whether or not they have had coronavirus. Under normal circumstances, broadcasting information about individuals’ medical histories to the public would be immediately rejected as we have come to respect health information as something private between an individual and their doctor. However, there are times in which individuals are willing to share health data if it means they gain some sort of benefit in return. In the case of the coronavirus, information regarding prior infection results in the gain of an immunity passport.
Again, the act of indicating prior infection is ethically neutral. Sharing this information, on the other hand, starts to bring this ethical neutrality into question. However, the real complications start to arise when we begin assigning economic and social value to this immunity marker.
What happens when our medical histories affect our economic abilities?
Although an immunity passport may be a simple digital marker at its core, this is not its only layer. The differentiating factor between an immunity passport and, say, a digital marker indicating whether a person has a strawberry allergy or not, is the value that we assign to the immunity marker. Normally, a digital marker indicating some detail or another about an individual’s medical history remains securely in the medical field. However, this is where an immunity passport would differ, as the digital marker for immunity is created with the purpose of allowing an individual with the marker access to certain economic and social liberties. It is this crossover that we now need to take a closer critical eye to.
Our medical histories are often out of our control. So, we try to keep them as separate as possible from our economic and social standing, as conversely these are aspects of our lives we try to maintain high amounts of control over. It is not unheard of for medical conditions to crossover into influencing economic and social factors of our lives, however these crossovers are what we term as disabilities or handicaps. For example, a person born without legs is physically handicapped and may face economic and social setbacks because of this. The important thing though, is we work as a society to combat any challenge or disadvantage caused by medical handicaps to the best of our abilities.
Returning back to immunity passports, we see that such a marker would be a crossover from individuals’ medical histories into the economic and social aspects of their lives. However, in this case we would not term this crossover as a handicap, but rather an advantage, while those without the passport would be the ones put at a disadvantage. This means that an immunity passport would essentially be creating socially-imposed economic handicaps that were not previously there. Except in this case the handicap would not grant the individual access to additional aid, rather it would instead restrict the individual further.
Currently, the tech industry does not possess any overarching code of ethics, so I’m going to fall back on the principles in medical ethics here for a moment to help illustrate what is going on ethically in this situation. Medical ethics has four main principles, one of which is the principle of justice that essentially states there must be an element of fairness in all medical decisions. Although immunity passports are issued to make economic and social decisions, these decisions are based on medical data, so in this case it is fair to apply the principle of justice to this technology.
As currently proposed, immunity passports would be violating the ethical principle of justice due to the fact that the possession of an immunity passport would disproportionately either benefit or burden an individual based on circumstances beyond their own control. The action of assigning access to economic and social liberties to the digital marker of immunity is what makes the originally neutral technology into an ethically laden one, and not in a good way.
Respecting Ethical Limitations Leads to Stronger Solutions
As we now see, the ethical principle of justice calls immunity passports into question. When justice is put at risk in this context, we are looking at substantial consequences such as people voluntarily infecting themselves out of desperation, discrimination in access to proper testing, and a disproportionate effect on people whose professions require them to work onsite, to name a few. This is why it is so essential to break down technology proposals to the point of ethical analysis as it helps uncover, what we hope were, unintended consequences and allows us to tackle the issues before they arise.
In the case of immunity passports, we see that although the technology is ethically neutral, the proposed application of it is not. It is important to note now that this does not mean we should give up on the technology itself. Instead, this implies that we have not found the best possible application for the technology according to our ethical limitations.
In fact, it is quite possible to use the concept of a digital marker to help us fight COVID-19. For example, it could be beneficial for high-risk individuals to voluntarily apply for a digital marker that grants them certain aids, such as access to grocery stores the hour after they have been disinfected, or priority for access to masks. These are of course only examples that need to be further examined to see if they are viable, but the point here is that there are other applications of this technology that are better suited both technically and ethically to our end goal of the fight against coronavirus.