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Resolving the Challenges Around Vaccination Status Authentication

"We need to do some serious transformative work to our social paradigm. Instead of a 'me' culture, this needs to be a 'we' culture-that's when we'll be able to work together to put an end to these global crises of famine, climate change, and so forth." Shenita Etwaroo

The 30th of September 2021 has come to pass. This was the date when the World Health Organisation (WHO) was expecting that all member countries would have fully vaccinated at least 10% of their population against SARS-COV-2. After the passing of this deadline the WHO reported that 56 out of the 194 (28.86%) members had failed to meet the target. Of the countries that did not meet this deadline, 41 (73.21%) were situated on the African continent.

These findings come at a time when some countries that have vaccinated over 60% of their population have indicated that they intend to offer booster doses of vaccines to their at-risk populations as winter approaches, to minimise the chances of a spike in hospitalisation and mortality. These two contrasting developments have brought the ethics of vaccine equity into the spotlight.

This ethical dilemma revolves around the quest to attain herd immunity in order to contain the pandemic. The moral question here is, will the world exit this pandemic together or on a country-by-country basis? As at the time of writing, it was known that in certain countries e.g., the United Kingdom, the pandemic was slowly coming to an end with COVID-19 evolving into an endemic disease. However, the managers of the global pandemic are quick to point out that this country first position is untenable. They hold this view because it only takes the emergence of a more contagious strain of this virus, with a potential to evade vaccines, for the gains of the few countries with a high percentage of the population vaccinated to be eroded.

This view is supported by the alteration that occurred in the trajectory of this pandemic when the delta variant emerged. Let's have a bit of context. The original strain of this virus that was isolated at the start of the pandemic had a reproductive number between 2 and 3. This means a country will have had to vaccinate approximately 75% of its population in order to reach herd immunity. Factoring in the reproductive number of the delta variant (5-8) which now seems to be the predominant strain in most countries, the herd immunity threshold shifts to approximately 87.5% of a country's population. Such a high herd immunity threshold and the fact that vaccination has not been able to entirely stop the transmission of the virus within vaccinated populations has led the head of the Oxford Vaccine Group Prof Sir Andrew Pollard to suggest that "reaching the threshold for overall immunity in the population was mythical."

However, there is general acceptance that humans can live with this virus if vaccination rates are high. This view is supported by the fact that in many Western European countries where vaccination rates are high, public restrictions have been eased with sporting activities and other public events restarted. However, in many of these countries, such activities are allowed for people who can prove their vaccination status or provide evidence that they have returned a negative COVID-19 test before attending these public events. Monitoring of viral transmission in attendees at such events suggests that infection rates amongst attendees have been negligible.

Based on this information, the United Kingdom has moved a step further with this model and has indicated that from the 5th of October, travellers who are fully vaccinated will not require a negative pre-arrival polymerase chain reaction (PCR) test result before enplaning. Rather, they would have to book for a test on day two, following arrival. This change is aimed at restarting global economic activity and kick start the tourism industry. It must be stated that similar reciprocal arrangements are available in the United States and the European Union.

However, this announcement has been criticised by many countries whose vaccination programs have been underpinned by the COVAX program. Many of these countries, Ghana included, have argued that the UK's policy is discriminatory because it does not accept the vaccination status of people vaccinated using vaccines manufactured by the Serum Institute of India (SII). This feud has led to the government of India imposing mandatory quarantine requirements for all UK nationals arriving in the country; even if they are fully vaccinated against COVID-19 commencing on the same day the new policy comes into force. According to their release, "the change brought 'reciprocity' to its rules."

It is important that clarity is brought to the issue of vaccine status acceptance before it complicates the ethical dilemma around the equitable distribution of vaccines. A careful read of the UK guidance makes it clear that the inability to accept the fully vaccinated status of people from certain countries has little to do with a suspicion of the inferiority of the vaccination programs or vaccine quality in those countries. It is on record that the UK has used vaccines manufactured by SII in its vaccination program.

The issue has more to do with the ability to digitally ascertain the authenticity of a travellers' vaccination status upon arrival in the UK. It is on record that the majority of the countries excluded from the UK policy have failed to digitalise their COVID-19 vaccination records. We are aware that the Quick Response (QR) codes for fully vaccinated Ghanaians are dysfunctional and give an error message. We are of the view that emphasis should be placed on ensuring that vaccination records are digitalised and are securely accessible globally.

It will be disingenuous for anyone to play ostrich and expect that manual handwritten vaccination cards for COVID-19 will be accepted as evidence of one's vaccination status. To do so will be to ignore the likelihood of these cards being cloned and faked. Anyone who has followed the evolution of travel post -global shutdown will know that some fit-for-travel PCR test certificates have been faked. In the end, it took digitalisation of the authentication process to minimise the public health risk associated with fake fit-for-travel PCR test certificates.

The world will be worse off if the tools required to aid the exit from this pandemic i.e., vaccines and vaccination status are weaponised. Countries such as India may have the clout to retaliate against what they deem as discriminatory, but we dare say most countries caught up in this rumpus lack that ability. On the other hand, if those with access to vaccines do not ensure that vaccination coverage in deprived countries is high, they may never be able to fully open up, and global economic activity will fail to quickly return to pre-pandemic levels. This will not benefit all parties.

This time calls for cool heads and not finger-pointing. The world has another target that all countries should have fully vaccinated 40% of their population by the 31st of December 2021. This is where the focus should be. As it stands the global vaccine supply chain can ensure that this is achieved. That is if the haves are willing to slow down on booster shots and the have-nots speed up vaccination rollout and resolve their vaccination records digital challenges.

Featured Image Courtesy of The Focal Project

Edited by Winifred Awa