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We can finally foresee the end of the novel coronavirus pandemic. Global pharmaceutical companies are developing vaccines for COVID-19. Soon, there will be widespread COVAX that can produce immunization – lasting protection against deadly COVID-19 infections.

Most likely, the COVID-19 vaccination processes will follow conventional immunization pathways. It will utilize health systems that already administer vaccinations for other communicable diseases, like chickenpox, hepatitis, influenza, etc.

This existing administration and reporting infrastructure can and should be leveraged for COVAX. Yet how can we confirm vaccination in the near term – before herd immunity reduces COVID-19 to a rarity or better, a bad memory?

Global COVID-19 vaccination requires detailed information on personal inoculation.

Everyone – governments, healthcare providers, private companies, local schools, religious organizations, even our friends and neighbours – will want to know who is (or isn’t) immunized against COVID-19.

Immunization identification becomes even more complex with multiple vaccines on the market at the same time; each with their own set of immunization protocols. Those that require multiple doses, which might be given at multiple health sites, exponentially compound the patient identity problem.

We will need a variety of “immunization passports” that work at the local, national, and international level that is widely usable, secure from forgery, and protects individual privacy. Digital health solutions are uniquely suited to this challenge.

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Imagine a Digital Yellow Card

Many people are familiar with the paper-based Yellow Card, the International Certificate of Vaccination. This early health passport is widely used to show vaccination against Yellow Fever, the only disease for which countries can require proof of vaccination from travellers as a condition of entry into a country. The Yellow Card is simple, easy to use, and widely accepted by governments and healthcare organizations.

However, Yellow Cards are laughably simple to fake. I can see the global anti-vaxx community selling forged paper-based COVID-19 vaccination cards hours after official versions are unveiled by the World Health Organization or any national government.

We must have a digital option. A digital vaccination certificate that can support COVAX delivery, monitoring, and crucially, a trusted framework that we can all use to know who is or isn’t inoculated against the novel coronavirus. This eVax Certificate should also be applicable to other vaccines too.

What COVAX Solutions Can Countries Adopt?

Governments around the world are getting ready to vaccinate their populations. Russia, China began already, the United Kingdom is about to start, and the United States is not far behind. However, countries like Nepal, India, and Uzbekistan have also pre-ordered millions of COVID-19 vaccine inoculations and will be following shortly.

As countries vaccinate their populations, they will need systems to track inoculations. Those inoculated will want to show their status to their communities. If countries can have a trusted means to show iccoulation status, this signaling will stimulate demand for more immunizations, creating a vicious cycle that should confer herd immunity for many societies by mid-2021.

Key here are COVAX immunization registries that governments can adopt and manage as their own systems and can be used by their citizens in everyday non-government mediated activities.

Government ownership is paramount. Look at what happened when Apple and Google developed high-tech contact tracing applications. Both methodologies were very sophisticated and could be used on the vast majority of the world’s mobile phones. However, since they didn’t get government buyin, both systems were poorly adopted and fell into disuse.

That’s a lesson learned from the world’s most powerful, wealthy, and skilled companies. Without government ownership, even the most advanced and well-funded digital development solution will fail.

Leveraging Existing Digital Identity Systems

India is considering using their existing Aadhaar digital identity system to create a massive vaccination programme – administering and tracking 3-5 million COVID-19 vaccinations per day. The Kenyan government can use its Huduma Namba national IDs in a similar fashion, as can other countries with national digital identity systems. These systems could be linked to government-issued passports to allow international travel for their citizens.

In China, where the novel coronavirus started, President Xi Jinping proposed using QR codes to identify those with COVID-19 immunity based on nucleic acid test results. This builds on the widespread use of QR codes there for most everyday activities, including retail purchases, government services, and social interactions.

Worryingly, these QR codes are also used to assign Chinese citizens a personal score based on their medical history, health check-ups and lifestyle habits. That’s an intrusion into personal privacy that’s most likely unpalatable for Western-style democracies.

The CANImmune system in Canada offers an interesting idea. It is a free, bilingual digital immunization record for Canadians, and can be used by patients, their families, and pharmacists to manage immunization records. However, the CANImmune system doesn’t seem to be widely adopted – it has only 100,000 users across Canada.

Developing New Immunization Passport Solutions

Obviously, digital solutions are way more effective if they are tested and operational before they are needed, especially in emergency situations. COVID-19 digital response is no different. We need to be quick if we are going to design and deploy any new digital Yellow Card systems.

There are multiple organizations promoting biometric data linked to smart cards, physical tokens, or mobile phone software as a way to track COVAX recipients. One challenge to using biometrics: the need to clean fingerprint readers after each use.

WHO and Estonia recently announced a smart Yellow Card collaboration to strengthen equitable access to COVID-19 vaccines. Their technology approach is based on blockchain technology, which makes sense. Tracking activities on a public, immutable record is the one realistic use case for distributed ledger technology.

However, using blockchain systems present many ethical challenges. For example, a blockchain immunity passport would give people the impression that one needed a digital token to participate in daily activities, and that others could discriminate based on the lack of a digital token.

WHO Digital Vaccine Certificate Working Group

Thankfully, the WHO has launched a Smart Yellow Card Working Group to develop common standards and governance for security, authentication, privacy, and data exchange to guide member states use cases, standards, and best practice​.

UNICEF, GAVI, ITU, and EC DG SANTE have joined WHO in a multi-sectoral consortium. They will use Smart Yellow Card specifications and standards for digital vaccination certificates, architected to link national and cross-border digital systems.

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You too can join the Smart Yellow Card Working Group! WHO is seeking digital health experts like you to help them develop the following for electronic vaccination certificates:

• A governance framework and common architecture
• Interoperability standards with a common taxonomy
• Defined certification specifications
• Vetted digital solutions that incorporate all three items above

Since there is no singular solution that can fulfill every use case, the working group will aim for electronic vaccination certificate frameworks that deliver a minimum set of requirements. Member states then can choose from multiple digital COVAX certificate solutions.

Join Us to Discuss Digital COVAX Certificate Ideas

Join us at the Global Digital Health Forum for a lively discussion on how we can use digital identity technologies to track and prove COVAX immunizations. We’ll explore answers to questions like these with your learned peers:

• What should we be thinking about when designing immunization passports?
• Which solutions exist today, and how can we leverage them?
• What new innovations could make solutions faster to deploy and use?
• How can we ensure privacy while still maintaining accuracy and verification?
• Where will equity be an issue, and how to reduce vaccine or digital divides?

This discussion will help you understand the future of digital vaccination records and can position you to participate in the WHO Smart Yellow Card Working Group. We will be debating how digital solutions can help countries and communities issue, certify, and verify a COVAX event that also enhances data privacy, security, and patient confidentiality.

Digital COVID-19 Yellow Cards
December 8, 2020
10:30am – 11:45am EST
Global Digital Health Forum
Advanced Registration Required