Woman and child walking in scenic Costa Rica

Bioethics Forum Essay

Instead of Vaccine Passports, Let’s Push for Global Justice in Vaccine Access

While Covid-19 vaccine passports raise many ethical and scientific questions, those in favor of them make the following argument: vaccine passports are not a new idea, some  are required for traveling to countries where tropical infectious diseases are endemic, and vaccine passports or certificates for Covid-19 will help speed the return to business as usual and to a normal life.

What is  normal life? For whom?  

The progression of the Covid-19 pandemic hasn’t been determined only by the nature of the SARS-CoV-2 virus, but also by the social, environmental, economic, and political conditions of our era, which are the legacy of and continue to be embedded in colonialist and imperialist economic power relations. Like so much else about the pandemic, vaccine certificates would underscore global inequities. Disadvantages and harms would not be limited to international travel; they might also extend to employment, returning to school, and accessing a range of services.

The advantages would go mainly to wealthy countries—primarily in the global north–and to individuals in other countries who are able to get vaccinated. The disadvantages would be felt mainly by people in low- and middle-income countries—primarily in the global south–where vaccines are scarce or unavailable and by people in wealthy countries who, for various reasons, have  difficulty accessing vaccines. Not everyone who lives in the global north can easily get vaccinated if they want to. Many undocumented immigrants in the U.S. and Europe avoid vaccination because they believe they might be at risk of deportation if they become visible to the government.

To critically analyze vaccine certificates from a global health justice perspective, it’s indispensable to have this background in mind. The pressure to go back to business as usual is at odds with the often-repeated slogan build back better.

While the idea of implementing vaccine certificates is gaining support in many wealthy countries, millions of people around the world don’t have access to health care, financial support for keeping quarantine or isolation, oxygen, medicines, and hospital’s beds. Though the vaccination rate is increasing rapidly in the U.S. and many European countries, for millions in the global south, the probability of getting vaccinated this year is almost zero. In many countries in the global south, including India, Brazil, Perú, and Mexico, Covid infections and fatalities are skyrocketing.

With global inequities in vaccine access, why would a bioethicist or health professional consider vaccine certificates ethical? Covid-19 vaccine production and distribution have been devastatingly unfair. To quote the WHO director,  it is a “catastrophic moral failure.”

In Costa Rica, where I live, only 24% of the population has received at least one vaccine dose, not because we lack the health care infrastructure to make vaccines available for every person in the country but because we have received very small amounts of vaccines, despite the negotiation efforts made by the government during the last several months. The National Vaccination and Epidemiology Committee decided to use the vaccines developed by Pfizer/BioNTech (through direct contract) and Astra-Zeneca (through Covax), but it is considering the Sinopharm vaccine now that the WHO has listed it for emergency use.

However, many Costa Ricans who have passports and U.S. visas, are considering traveling to the U.S. to get vaccinated, instead of waiting their turn here, where the number of cases and the mortality rate are rapidly increasing. Vaccine tourism is another example of how inequality and injustice are determining the course of this pandemic. The Costa Rican government debt crisis has worsened due to this pandemic and the economic crisis is so acute that for many people risking contagion is not the worst case scenario. But those who have, at least, the capacity to pay for an air ticket with a credit card, who have a passport and a valid visa, might feel forced to go to the U.S. to access what should be available to every person in the world, regardless of their economic or social status. Even the Costa Rican president suggested that every person who can travel to the U.S. to get the jab, should do it. Vaccine tourism, then, seems to be another promising business opportunity for the powerful countries that have accumulated vaccines instead of redistributing them soon and fairly.

Given this state of affairs, I think that the decolonized ethical position is to reject Covid-19 vaccine certificates and, most importantly, to put all efforts–political, intellectual, and social–to the task of scaling up global vaccine production as soon as possible and allocating vaccines globally. The underlying principle should be interdependence and taking into account the duty of reparation of structural injustices.

Gabriela Arguedas-Ramírez is an associate professor in the school of philosophy at the University of Costa Rica, @gaby_arguedas. 

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