Editorial

Global health & digital identity: a complex but critical journey

With travel delays, cancellations, and a rise in forged COVID vaccination certificates, there may be no better time than now (or perhaps before the pandemic, if anyone could have predicted it) to have a discussion around a global, digital health passporting system

Posted 3 August 2021 by Christine Horton


As the summer holiday season hits full swing and the world recalibrates to post-pandemic activity, the prospect of serious delays loom as international travellers must navigate a plethora of new restrictions; a situation made worse as there is no universally recognised documentation to verify vaccination status.

Summer season

According to the latest data from the World Tourism Organisation (UNWTO), a UN agency, global tourism suffered its worst year ever during 2020, with international arrivals dropping by 74 percent, equating to a billion fewer international arrivals than in the previous year.

Although vaccinations are accelerating in many nations, the complexity of restrictions are still largely set by individual nations. The rules change depending on a traveller’s nationality, embarkation point, most recent Covid test and underlying vaccination status. The situation is a quagmire of rules and sometimes even contradictions.  As of late June, people travelling from the UK to Greece, Spain and Portugal are not required to quarantine. Those going to Italy must self-isolate for five days then take a test, while fully vaccinated UK visitors to France can enter without quarantining. However, many of these same countries require quarantine on arrival for UK visitors that have not been vaccinated, due to the spread of the Delta variant. While an EU citizen arriving from the UK, disembarking in France, then travelling on to Spain would have an entirely different set of restrictions!

EU agreement

At present, each nation has its own method of allowing its citizens to prove their vaccination status. For example, French citizens can use the TousAntiCovid app to show vaccination status – while the UK’s NHS App offers a similar function. Both apps provide confirmation as a QR code that can be scanned for venues and travel destinations that require vaccination confirmation.  The French version, and similar health service apps across other EU states will form part of The EU Digital COVID Certificate initiative that, it claims, will facilitate safe free movement of citizens in the EU during the COVID-19 pandemic.

Countries can start issuing and using it already and it will be available in all EU Member States as of July 1, 2021. However, it is still unclear whether the UK NHS app will be integrated into the platform due to its post Brexit limbo state. Although not a replacement for a passport, the EU Digital COVID Certificate contains necessary key information such as name, date of birth, date of issuance, relevant information about vaccine/test/recovery and a unique identifier.  This data remains on the certificate and is not stored or retained when a certificate is verified in another Member State.

The certificates will only include a limited set of information that is necessary. This cannot be retained by visited countries. For verification purposes, only the validity and authenticity of the certificate is checked by verifying who issued and signed it. All health data remains with the Member State that issued an EU Digital COVID Certificate.

Unfortunately, the EU system that may eventually span around 500 million citizens has no equivalent within the US, where vaccination records are kept by states rather than the federal government. In the US that has witnessed a surge in anti-federal sentiment during the previous election cycle, the Biden administration has so far stated that it has no plans for a federal COVID-19 health certificate. The result is that US travellers heading abroad, or international visitors to the US, have no guaranteed way of ensuring that they will be admitted into a country – other than if they hold a US passport.

Private and public initiatives

The US situation where healthcare is decentralised is not unique.  India, China, and others have similar ‘federal versus state’ issues where creating a single healthcare registry is incredibly difficult. As a result, there is a growing private sector industry that is trying to tackle the issue using technology and interoperable standards.

One such innovator is Change Healthcare, an independent healthcare technology company that is a participant within the Vaccination Credential Initiative (VCI), a voluntary coalition of largely US public and private organisations committed to empowering individuals with access to verifiable clinical information, including a trustworthy and verifiable copy of their vaccination records in digital or paper form using open, interoperable standards.  VCI participants range from tech giants such as Google and Apple all the way through to regional health authorities, health insurance providers and hospitals. To date, the platform has been freely adopted by over 2,000 community, regional, and national pharmacy locations that have been at the forefront of US vaccination efforts.

Although solutions like VCI are working well today, they are still limited in scope due to the lack of recognition at an international level. The longer-term solution would be to include health data within e-passports but there are still major hurdles – largely due to politicking.

The International Civil Aviation Organisation (ICAO), an agency of the United Nations, the World Health Organisation (WHO) and the International Air Transport Association (IATA) are currently working on a project to standardise vaccination and testing certificates, thereby promoting mutual recognition leading to the possible reduction of quarantine measures.  The IATA has also launched its own IATA Travel Pass app – that has been adopted by nearly 50 airlines that – enables authorised labs and test centres to securely send test results or vaccination certificates to passengers for display via the secure app. However, again, not all national border agencies accept this app as valid proof and the ICAO has no mandate to enforce a standard, which means it must convince its 193 funding nations to accept its proposals.

Smarter passports

Ultimately, the best method would be to embed health data within passports. And nearly all modern passports support Visible Digital Seals (VDS), a Machine Readable Travel Documents (MRTDs) standard already approved by the ICAO. However, updating potentially billions of passports is not a short-term option – which means the rise of national health service apps, private party apps like VCI and IATA Travel App, plus paper-based certificates will continue to co-exist for the foreseeable future.

At this point in time, a globally agreed and universally implemented digital health passporting system looks unlikely. However, with the UK border control already reporting over 100 cases of fake Covid test documents each day, it is likely that other nations are experiencing similar issues. As citizens everywhere anxiously await a return to normality, the pressure on national governments to co-operate and come to a global agreement will intensify – hopefully before the next global pandemic surfaces.

Rob Otto is Field CTO/principal architect, Ping Identity.