Digital Health Passes: Ready for Take-off?

The aviation industry continues to face uncharted territory as it grapples with the COVID-19 global pandemic. In light of the release of COVID-19 vaccines and mass vaccination efforts, industries and governments are evaluating how to facilitate air travel without risking public health. There is an increasing need for a touchless travel experience coupled with a way to verify and link a traveler’s identity with their relevant health statistics. A digital health credential (sometimes referred to as an immunity passport, vaccination passport, or vaccination certificate, and referred to as a digital health pass throughout this blog) could meet these needs.

Several countries have already implemented varying degrees of digital health passes, with many others contemplating their use. Israel introduced a digital health pass, known as the “Green Pass” this February. Vaccinated people and certain recovered COVID-19 patients can download an app (or print a certificate with a QR code) which certifies their health status to gain entry into various facilities and venues throughout the country. On March 17th, 2021, the European Commission proposed a Digital Green Certificate, similar to Israel’s to facilitate movement throughout the European Union. China recently launched its version of a digital health pass for its citizens traveling across borders. Canada’s Prime Minister acknowledged on March 12th that Canada is one of many countries exploring COVID-19 vaccination requirements for international travelers, but is reluctant to introduce digital health passes within Canada. Canada has not made any commitments. Other countries including Denmark, Sweden, Greece, Malaysia and Bahrain have signaled their intention to introduce digital health passes.

As momentum builds, it will be critical to stay up-to-date with the development and use of digital health passes. If digital health passes are to facilitate international travel, governments will likely turn to standard-setting bodies such as the World Health Organization (the “WHO”) for guidance. There will need to be global standards to ensure that health data is:

  • secure;

  • private;

  • from a trusted government-authorized source; and

  • linked to a traveler’s identification through biometrics.

In the air travel sector, it is envisioned that a digital identity will use biometrics to confirm a person’s identity and certify their health status (for example, that the identified individual has been adequately vaccinated against COVID-19). Digital identification brings its own host of issues, which have to be satisfactorily resolved in order for digital health passes to be utilized as intended. However, the air travel industry has laid the groundwork for the use of digital identification, which may in turn predicate the integration of digital health passes with travel identification.

Digital identity and air travel

The use of biometrics to confirm identity is not a new concept to the air travel industry. The U.S. Customs and Border Protection (CBP) Simplified Arrival process is a touchless, streamlined, pre-clearance procedure that uses biometric facial recognition to automate the customs procedure at the border. Originally introduced in certain U.S. airports, in December 2020, Simplified Arrival expanded to L.F. Wade International Airport in Bermuda and to the Lynden Pindling International Airport in Nassau, Bahamas. In February of this year, CBP announced that Simplified Arrival would come to eight locations throughout Canada, beginning with Toronto Pearson International Airport. While Simplified Arrival is aimed at enhancing national security, its touchless approach to more efficient security screening may be an asset to air travel during COVID-19. It will be interesting to see how Simplified Arrival informs the digital health pass framework.

The air travel experience has become increasingly digitized, even prior to the COVID-19 pandemic. Physical documents are easily lost, damaged, misplaced and even forged. Increased digitization is aimed at improving the commercial disadvantages of paper travel documents as it is generally more efficient and less labour intensive. A digital identity that eliminates the need for physical travel documents could be the next logical step if the appropriate technology and regulations are in place. COVID-19 is simply accelerating the demand for this type of product.

The Known Traveller Digital Identity (KTDI) is a World Economic Forum initiative first conceptualized in 2015. It is a traveler-managed decentralized digital identity that provides screening and risk assessment prior to a traveler’s arrival at a border. Although the KTDI was not developed with COVID-19 in mind, it is currently piloting components of the concept in the cross-border context between Canada and the Netherlands.

Digital health pass products and air travel

There are several digital health pass products at various stages of development. Many are the result of public-private collaboration. Technology such as blockchain, cryptography and mobile devices support apps that can verify health information, keep it secure, and share it through a QR code. Unlike KTDI, these have been developed specifically to address COVID-19 and therefore focus on verifying health status. However, there is the potential for these products to be integrated into a digital identity in the future. Some examples of current digital health pass products include:

CommonPass: an app that aims to provide a “trusted, globally-interoperable platform for people to document their COVID-19 status to satisfy country entry requirements, while protecting their health data privacy”. CommonPass has been trialed on flights between Hong Kong and Singapore, and London and New York. Even more recently, Qantas Airlines (the flag-carrier of Australia) used CommonPass on a flight from Frankfurt to Darwin.

IBM Digital Health Pass: an app and digital wallet that will allow individuals to maintain and share their personal health information. In addition to air travel, it is also aimed towards employees, customers and visitors entering physical locations such as workplaces and stadiums. It is currently in a pilot program with the State of New York and was used in February and at the beginning of March this year to facilitate entry into arenas for sporting events.

IATA Travel Pass: an initiative led by the International Air Transport Association (IATA) which aims to offer four main components:

1) a global registry of health requirements for entry into different countries;

2) a global registry of testing and vaccination centers;

3) an app that enables authorized labs and test centers to securely share results with passengers; and

4) a contactless travel app that passengers can use to share their health results and verify that they meet the necessary health requirements for entry to their destination.

IATA Travel Pass, like CommonPass, is currently in trial use by several airlines.

Technical considerations

Countries and product developers are taking varying approaches to digital health passes and it is unlikely that one product will be used globally. To facilitate seamless air travel, product developers recognize that rapidly developing technology must be interoperable. Systems must be able to work together across geographic, organizational, and technical boundaries to exchange and process data in a secure, efficient and accurate way. There are a number of initiatives, such as Good Health Pass, spearheaded by the technology industry to address the need for interoperability.

Privacy considerations

Digital health passes will involve the collection, use, storage and disclosure of personal information. In recent years, there has been a trend toward more stringent privacy legislation with data protection laws such as the European Union’s General Data Protection Regulation (GDPR) leading the way, and other jurisdictions, including California and Virginia, following suit. In addition, various proposed amendments to privacy laws, including at the federal level in Canada, provincially in Quebec and in the United States, are further complicating the existing patchwork of inconsistent obligations. Consensus must be reached on the extent that personal health information (and potentially other information such as travel itinerary for contact tracing) can be used to ensure safe travel while adhering to privacy legislation which will vary between countries and regions.

Other legal, scientific and ethical considerations

Digital health passes will permit or restrict freedom based on whether a person poses a biological risk to themselves or others. This risk is mitigated once that person is vaccinated. However, there is unequal access to vaccination, and certain individuals may not be able to receive the vaccination for health, religious, or other reasons. This may increase discrimination, inequality, and restrict human rights.

Also, there remain scientific unknowns on the efficacy of the current COVID-19 vaccines in preventing transmission (including COVID-19 variants), and how long and how well the vaccines protect different population groups.

Standardization and regulatory framework

While proof of vaccination poses legal and ethical considerations, it is not an entirely new concept to international travel. There is an existing paper-based International Certificate of Vaccination or Prophylaxis, known as the “yellow card” that is official proof of vaccination against a disease. Governed by the WHO’s International Health Regulations (2005) (IHR), yellow fever is currently the only disease specified in the IHR for which countries may require proof of vaccination as a condition of entry. This may change in the future.

The IHR “provide an overarching legal framework that defines countries’ rights and obligations in handling public health events and emergencies that have the potential to cross borders”. An IHR Emergency Committee was formed to address COVID-19 (the “IHR Committee”) and at the IHR Committee’s sixth meeting in January 2021, it undertook to:

  • lead the development of international standards and guidance for reducing COVID-19 transmission related to international travel;

  • work to rapidly develop and disseminate the WHO policy position on the legal, ethical, scientific, and technological considerations related to requirements for proof of COVID-19 vaccination for international travelers, in accordance with relevant IHR provisions;

  • coordinate with relevant stakeholders the development of standards for digital documentation of COVID-19 travel-related risk reduction measures, that can be implemented on interoperable digital platforms; and

  • encourage States Parties to implement coordinated, time-limited, risk-based, and evidence-based approaches for health measures in relation to international travel.

However, in its interim position paper released February 5, 2021, the WHO reiterated its position that:

National authorities and conveyance operators should not introduce requirements of proof of COVID-19 vaccination for international travel as a condition for departure or entry, given that there are still critical unknowns regarding the efficacy of vaccination in reducing transmission. In addition, considering that there is limited availability of vaccines, preferential vaccination of travelers could result in inadequate supplies of vaccines for priority populations considered at high risk of severe COVID-19 disease. WHO also recommends that people who are vaccinated should not be exempt from complying with other travel risk-reduction measures.

This position was reconfirmed at a WHO COVID-19 press conference on March 8, 2021.

While the WHO does not currently support digital health passes to facilitate air travel, it has initiated the Smart Vaccination Certificate Working Group to establish a multi-sectoral consortium (the “Consortium”) to:

1) facilitate monitoring of national COVID-19 vaccination programs; and

2) support cross-border uses architected for a potential future in which the COVID-19 vaccine would be included in an updated version of the IHR.

The Consortium is working towards establishing a framework of key specifications and standards to guide digital vaccination certificates linked to national and cross-border digital systems. As the Consortium works towards achieving consensus on common standards and governance for security, authentication, privacy, and data exchange, it will be publishing recommended standards and guidance. So, while the WHO currently opposes requiring a digital health pass for travel, it is actively working to lead the way in setting global standards for the verification, sharing, and use of COVID-19 digital heath records for other uses.

Key takeaways

Prior to the COVID-19 pandemic, the air travel industry had already been moving towards a touchless, digital identification-based experience. COVID-19 and the subsequent vaccine campaign has accelerated this innovation. Industry groups and travel providers may have valuable insights to contribute to the development of a digital health pass framework.

Ultimately, the global use of digital health passes to facilitate air travel is contingent on government co-operation and buy-in. Although it is yet to be determined, this may be secured if an organization such as the WHO leads the way by providing oversight and developing trusted standards.

The subject of digital health passes is rapidly evolving. More developments are expected at the time of this blog posting. Stay tuned.

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