In the wake of CDC’s error, we will need vaccine passports

Almost a week ago, the Centers for Disease Control and Prevention published a guidance on what vaccinated people can and cannot do. Among other things, the guidance said, "fully vaccinated people no longer need to wear a mask or physically distance in any setting, except where required by federal, state, local, tribal, or territorial laws, rules, and regulations, including local business and workplace guidance." Experts criticized the guidance, not because of the scientific basis behind it -- COVID-19 vaccines are extremely effective, and vaccinated people pose a small risk to themselves and others -- but because with low rates of full vaccination, enforcing such a guidance raises challenging implementation questions. The CDC just made it more challenging for business and local governments -- especially in sensitive political environments -- to enforce mask mandates.

In the majority of the United States, most of the population is not fully vaccinated and teens are only now starting to get vaccinated. In an environment of low vaccine rates, removing mask requirements increases the risk of outbreaks.

But selective enforcement is extremely challenging, especially since we know anti-vaccine activists have been openly faking vaccine card. Just this month, a California man was arrested for selling fake vaccine cards. Therefore, a customer carrying a card, or without a mask, may or may not be vaccinated. There is every reason to expect that anti-maskers will continue to engage in chicanery.

How can business owners keep their business safe? How can people know whether those they interact with are vaccinated or not, and set their level of risk? Even if the CDC reconsiders the guidance, it's hard to put back a mask requirement once removed, or support it in light of changes.

Vaccine passports would be one way to handle it, though they raise their own issues. Vaccine passports are an acknowledged, accredited confirmation of vaccination status. Those of us who travel will likely have to, at some point, provide evidence of vaccine status. For example, Europe has reopened itself to vaccinated travelers from some countries, and when it reopens to United States travel, vaccination status would likely make a large difference in entry. In other countries, too, vaccination status may be a way to avoid being quarantined for two weeks.

In Israel, a government-issued "green pass" -- an approved app -- allows people who are vaccinated or recovered from COVID-19 to do things they could not do pre-pandemic, like go to restaurants or vacation in hotels.

But they can be of use for private businesses, too.

An approved electronic confirmation that someone was vaccinated -- perhaps with the alternative of having a negative COVID-19 test within a set period -- could solve the problem for businesses that want to reduce their risk, or market themselves as a safe business. It's also a way to allow us to resume large events. If there was a quick way to scan an app, you could hold a large indoors event in relative safety.

But is it feasible? One challenge is access. Not everyone has access to a cellphone, so even a free, government-created app may not be available to everyone. This can exacerbate existing inequalities. We know vaccine distribution tended to favor those of relative privilege -- those with online access; with time to take off work and go to vaccine clinics with potentially long waits, and who can drive to where the vaccines were given. One potential solution is for the government to make available, as an alternative, the new electronic vaccine-status wristbands. Although this raises questions, such as how do we avoid uploading a fake vaccine card on it?

Another challenge is what to do with the rare few with real medical reasons not to vaccinate. The good news is that there should not be many such people. Right now, contraindications appear limited to allergic reactions, and those are not the same across the mRNA vaccines and the J&J vaccine.

People who cannot medically vaccinate should, ethically, not be discriminated against because of that, and should get a special medical exemption. Herd immunity -- or community immunity -- means that if enough people are vaccinated, the germs cannot reach the few who cannot, medically, be vaccinated. If we can limit medical exemptions to only the few with real contraindications, those people should not pose a serious risk. Herd immunity should protect them, just as it protects people with transplants, who cannot get live virus vaccines, from measles or chicken pox.

A final question is how to balance the need to know vaccine status -- and distinctions based on it -- with the autonomy of people who just do not want to vaccinate. This question has led to some strange developments in our country, with Republican politicians -- who traditionally support freedom of business from regulation -- regulating to prohibit private business from requiring vaccines from employees or customers.

There are two things to keep in mind here. First, non-vaccination is not just a private decision. It also affects those you may come in contact with and those you may infect, in this case, with COVID-19. Second, and conversely, use of vaccine passports does not necessarily mean denying access to the unvaccinated. It can just mean imposing less restrictions on those who are vaccinated.

In the wake of CDC's tricky guidance, vaccine passports can help business protect their customers, without keeping out the unvaccinated -- by having targeted rules, with or without the vaccine. 