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The Ethics of COVID-19 Immunity-Based Licenses (“Immunity Passports”)

Educational Objective
To understand the ethical dilemmas of COVID-19 Immunity-Based Licenses (“Immunity Passports”)
1 Credit CME

Chile, Germany, and the UK, among others, have indicated they will implement certifications that a person has contracted and recovered from coronavirus disease 2019 (COVID-19) or, in the future, has received a COVID-19 vaccine. Such policies have been discussed, but not implemented, in the US. However, if other countries require these certifications for entrance, the US may adopt them to enable travel, generating calls to use them more broadly.

Certifications of immunity are sometimes called “immunity passports” but are better conceptualized as immunity-based licenses. Such policies raise important questions about fairness, stigma, and counterproductive incentives but could also further individual freedom and improve public health.

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Article Information

Corresponding Author: Ezekiel J. Emanuel, MD, PhD, Department Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, 423 Guardian Dr, Blockley Hall, Ste 1412, Philadelphia, PA 19104 (MEHPchair@upenn.edu).

Published Online: May 6, 2020. doi:10.1001/jama.2020.8102

Conflict of Interest Disclosures: Dr Persad reported receiving grants from The Greenwall Foundation. Dr Emanuel reported receiving speaking fees from numerous entities, stock ownership in Nuna, investment partnership in Oak HC/FT, and receipt of grants from Hawaii Medical Service Association and Oscar Health.

References
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Childress  JF , Faden  RR , Gaare  RD ,  et al.  Public health ethics: mapping the terrain.   J Law Med Ethics. 2002;30(2):170-178.PubMedGoogle ScholarCrossref
2.
Mullin  E . “Immunity passports” could create a new category of privilege: being infected with the virus could come with more freedom. OneZero. Published April 23, 2020. Accessed April 30, 2020. https://onezero.medium.com/immunity-passports-could-create-a-new-category-of-privilege-2f70ce1b905
3.
Emanuel  EJ , Persad  G , Upshur  R ,  et al.  Fair allocation of scarce medical resources in the time of Covid-19.   N Engl J Med. Published online March 23, 2020. doi:10.1056/NEJMsb2005114PubMedGoogle Scholar
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Parfit  D .  Equality and priority.   Ratio. 1997;10(3):202-221. doi:10.1111/1467-9329.00041Google ScholarCrossref
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Hawkins  JS , Emanuel  EJ .  Clarifying confusions about coercion.   Hastings Cent Rep. 2005;35(5):16-19. PubMedGoogle Scholar
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