Coming Soon: Immunity Passports…..!
By: Ameer Shahul
Tags: Covid 19, Health, Coronavirus, Virus, Medicine

The Deep South is a subregion in the Southern United States.

Otherwise known as Cotton States, this includes the present day regions of Georgia, Alabama, South Carolina, Mississippi, and Louisiana.

Travelling back in time, one could trace the region as most dependent on plantations. Slave societies thrived there during the pre-Civil War period where white masters could buy and sell slaves on their fancy. It turned into one of the poorest areas by the end of Civil War in 1865, but continued to be a major site of racial tension, white supremacy, lynching and so on. Only silver lining is that it also played as the cradle of American civil rights movement later on.

Within Deep South was Antebellum New Orleans, the abode of thriving cotton industry. A place whites dominated blacks and enslaved them through legally sanctioned means of violence during those days. At the peak of Slavery, came another evil social order named “Acclimated citizens.” In no time, this class climbed atop the social pyramid, placing “Unacclimated strangers” next and everyone else thereafter.

This social order was created by a pandemic. Yellow Fever….!

With no vaccination and no known treatment available for long, surviving Yellow Fever was otherwise described as the “baptism of citizenship.” It is believed that only a person chosen by God would survive the deadly virus, and such a survival would establish him as a legitimate and permanent player in the Cotton Kingdom.

Mosquito-borne flavivirus that caused the deadly Yellow Fever was a frequent visitor to the region during the period and unleashed terror among the communities in every possible manner, killing 150,000 people in one go and more in the nearby cities.

Mortality was very high to the extent that it killed about half of those infected with the virus, and most succumbing to violent end like vomiting thick black blood. But in the end, the other half who survived the viral attack became immune for life and are known as “Acclimated.”

In the decades that followed, it would lead to a widespread new social order in the region. As the order raged, “Unacclimated” whites were considered unemployable because they could get the infection anytime and can spread it to others before it is detected.

With no access to health care, Blacks were so scared of the virus too. The top gainers were the master of “Acclimated” slaves. Those enslaved blacks with immunity could command a premium of 50 percent and above of the value.

And this was the beginning of Yellow Fever Capitalism.

In those communities, the “Acclimated” status was certified by issuing a card which used to be the ultimate passport of life. The practice continued for very long time since then.

The remnants of that Yellow Fever card is still active in many parts of the world. There are countries which still insist on Yellow Fever Vaccination Certificate named “Carte Jaune” to allow people cross into their borders. The Yellow Card today is the International Certificate of Vaccination issued by the World Health Organization and recognised globally.

Corona Pass sans Immunity Card

As the larger world moves into month 3 of COVID19 spread, indications are that nation states have begun seriously considering an “Acclimated” status for people with Corona immunity, and thinking about issuing an “Immunity Passport” to people who acquired immunity against the virus.

The ‘passport’ will certify that the holder is immune to SARS-CoV-2 after performing an antibody test and a virus test. The antibody test is to verity an infection and the consequent development of the antibodies that remains in the body for long. The virus test will look for any active infection in the body. The ‘passport’ can be granted if the antibody test is positive and the virus test is negative.

The document would entitle the person to go back to work, travel and participate in society without restrictions like face masks and social distancing which are otherwise the norms of the day.

Apparently, policymakers in Germany, Italy, the US and UK have been toying with the idea of “Immunity Passport” at least for the people who have contracted the virus, recovered, and has since developed immunity. The idea stems from the fact that an infected person cannot get infected again because of the acquired immunity and, therefore, will not pose a public health risk. Once introduced, such a passport could be lapped up by corporations, airlines and communities.

Remember, UAE carrier Emirates had conducted rapid Covid-19 blood tests on its airline passengers three weeks ago to fly them to Tunisia, and asserted that they are working to scale up testing capabilities to extend it to more flights. The airline went one step further to conduct on-site tests and provide immediate confirmation to passengers traveling to countries which require COVID-19 test certificates.

Seeing this as an opportunity for an emerging business, many are jumping into the fray. Among them “CoronaPass” by a start-up named Bizagi in UK is making headlines. It is an app that stores the user’s immune status data obtained from an official healthcare authority, and presents a QR code that scan to check the user’s immunity status. The company claims that it is HIPAA-compliant and only stores the immunity status of people in encrypted databases. It also promises that the data will only be accessible to governments or companies with approved access to the “requesting” side of the app.

Technology to Help Immunity Passport

There has also been reports of using blockchain technology for adding value to the “passport” from multiple points, track the points of verification and offer seamless access to verification parties. It can help update every time a test is done by the holder of the ‘passport,’ give legitimate access to entities to check the status and record every verification in real-time. Blockchain would also help remove issues of transparency and forgery and make it more acceptable across the board.

Vottun, a company specializing in the certification and traceability of data on the blockchain, has entered the space and explained that its “Immunity Passport” can be verified at any time anywhere using cryptography by any mobile phone that can read a QR code. It is rumoured that PwC in Spain is an early user of the company’s solution.

This would open space and opportunity for large and reputed corporations with enormous experience and patents in blockchain technology. Such trusted corporations with high level of reputation would be able to offer an across the border solution, should they decide to get into the space and should the nations and corporations embrace it as a legitimate verification document.

As the technology interface begin to unroll, many countries would attempt to integrate an “Immunity Passport” initiative with their COVID19 Track and Trace app since this would be a natural progression of the existing capabilities of the app.

Apps like ArogyaSetu of India, CovidSafe of Australia, SMS of South Korea, PEPP-PT of Germany and the Chinese and Italian government sponsored apps can easily move to the next level by capturing the testing data from their national medical servers.

And then, the Track and Trace apps are ready to issue the “Immunity Passport”…………..!

Re-infections and Validity of Immunity

“Mystery In Wuhan: Recovered Coronavirus Patients Test Negative … Then Positive” — so screamed a headline by the NPR on March 27.

Soon thereafter similar reports have begun coming from China and South Korea, challenging the age-old theory of developing immunity after an infection.

World Health Organisation jumped into the forefront and stuck its neck out, “As of 24 April 2020, no study has evaluated whether the presence of antibodies to SARS-CoV-2 confers immunity to subsequent infection by this virus in humans”.

Taking on the “Immunity Passport” lobby head on, the world health body concluded by suggesting that “at this point in the pandemic, there is not enough evidence about the effectiveness of antibody-mediated immunity to guarantee the accuracy of an “immunity passport” or “risk-free certificate.”

Before dwelling into the details, let’s understand how the immunity development in human body works.

As soon as you are attacked by a colony of virus, your body responds with an innate reaction. Under this first line of counter-attack, various constituents of your body cells force the virus to slow down its progression. In the second phase, the cell makes antibodies that goes and specifically bind to the virus and destroy it. These antibodies are nothing but proteins otherwise called immunoglobulins. As this happens, the body also produces another set of cells called T-cells that identify and eliminate body cells already infected with the virus. Collectively known as cellular immunity, this process can take up to two weeks in healthy individuals.

This combined response may clear the virus from the body. In strong enough response, it eliminate the virus from the body, prevent progression to severe illness or re-infection by the same virus later on. This process of immunity development can be measured by the presence of antibodies in blood therafter.

The argument of WHO went like this: Most of the studies show that people who have recovered from infection have antibodies to the virus. However, some people have very low levels of neutralizing antibodies suggesting that cellular immunity may also be critical for recovery.

The main argument of WHO against “Immunity Passport” was that it felt people who assume they are immune to a second infection because they have received a positive test result may ignore public health advice. “The use of such certificates may therefore increase the risks of continued transmission,” it concluded.

However, the global health body couldn’t hold on for long. Evidence emerged from different quarters that cases of re-infections could be rightly attributed to testing errors. Body of scientific studies, lab reports and opinions of medical experts were brought to the notice of the global health watchdog. Let’s dive into the details:

PCR tests generally look for the genetic material of the virus and not for active virus. As the body began recovering from an infection, it clears out inactive debris of viral cells from the lungs which can be coughed up into the throat, from where clinicians take a sample swab. A sensitive diagnostic test might mistake such viral debris for an active infection.

So, within 48 hours of issuing the first statement WHO retreated by issuing another tweet, “We expect that most people who are infected with #COVID19 will develop an antibody response that will provide some level of protection”.

And it was put to rest.

Other questions linger around include as to how long the acquired immunity can last. Insights from studying on other members of the coronavirus family like SARS shows that it can average two years.

Additionally, the first serology test authorized by the FDA only boasts of 94 per cent accuracy for positive and 96 per cent for negative results, leaving six out of 100 false results who can go back to work and society with an “Immunity Passport”. Besides, FDA has allowed number of companies to market their serology test kits without authorisation.

Will one miss the “Immunity Passport,” if s/he is infected but hasn’t developed the antibodies at the time of testing? Is it possible to have antibodies without sickness, but not protect from an another infection with a larger viral load? Scientific community does not have answers to most of these immune response questions because of insufficient data at this early stage.

Above all these, the deafening challenges are the sociological implications….!

Immunocapital and Immunoprivilaged, the New World Order

History reminds us that the sociological consequences of Yellow Fever Capitalism ranges from extreme to wild. Life insurers rejected “Unacclimated” applicants or charged them huge premium, none offered them credit, no girls agreed to marry them. New immigrants, therefore, sought Yellow Fever, by cramping in unhygienic dwellings, using the beds where infected died and so on.

In brief, it widened the gap between rich and poor in the Cotton Kingdom.

High mortality in such situations is beneficial to the rich because it would make the migrant workers insecure and make them available at low wages. Politicians and administrators will not spend money for improving the living conditions of underprivileged sections because they would want the disease to spread and the nations develop herd immunity.

Recall that in the last two months of COVID spread, unemployment rose across nations. Health care workers, drivers, cleaners, delivery boys, cooks and caretakers are getting into the streets facing the heat of the police high handedness at many places to oil the engines of economy to keep it moving. Ministers, bureaucrats, corporate executives, lawyers, professors, stock traders and tech managers sit in the comforts of home, work online, take huge benefits and fatty pay checks, and enjoy health insurance. Hasn’t it clearly divided the society and benefitting one section?

Beyond all these, “Immunity Passports” can be found to be challenging the established good behaviours against discrimination and lack of equity.

In one straight move, “Immunity Passports” would create an artificial roadblock as to who cannot participate in social, civic, and economic activities, thereby force uninfected citizens to seek out infection. More so from among sections of the society who cannot afford long absence from work. Most incentivised to seek out infection would be those who cannot afford healthcare, especially in countries where there is no universal healthcare access.

This will complicate with business lobbies working overtime to ensure governments send workforce back to workplace to benefit from the immuno-capital of the workforce. It can compound the existing gender, race, ethnicity, religious and nationality inequities.

In addition to it, this has the potential to become yet another platform for lack of transparency and implicit bias. Socio-economic, racial, religious and ethnic inequities might be reflected in its administration as to who can access antibody testing, and who get preference in the queue and the lengthy and complicated process that would become burdensome for underprivileged sections of the society.

In the immediate future, all institutions including the judiciary would overlook such concerns as everyone would be inclined to look at the gains of immuno-capital and its benefits to the nation states.

And ignore the immuno-privileges being enjoyed by the rich and the mighty……!

Recommended for Further Reading:

1. NPR.org March 27, 2020 Mystery In Wuhan: Recovered Coronavirus Patients Test Negative … Then Positive

2. Quartz, qz.com, April 15, 2020 Why some Covid-19 patients might have tested positive twice

3. The Medical Futurist, April 30, 2020 An Immunity Passport After COVID-19 And How Digital Health Can Support It

4. Quartz, qz.com, April 16, 2020 Is it too soon for a “CoronaPass” immunity app?

5. The New York Times, April 12, 2020 The Dangerous History of Immunoprivilege

6. The Federalist, March 25, 2020 How Medical ‘Chickenpox Parties’ Could Turn The Tide Of The Wuhan Virus

7. Corona Pass https://www.coronapass.org/home

8. Indian Journal of Medical Research April 28, 2020 Time to revisit national response to pandemics

9. World Health Oganisation 24 April 2020 “Immunity passports” in the context of COVID-19

10. World Health Organisation on Twitter April 26, 2020 https://twitter.com/who/status/1254160937805926405?lang=en

11. The Lancet May 4, 2020 COVID-19 immunity passports and vaccination certificates: scientific, equitable, and legal challenges