Many countries on all continents have closed their borders to foreign visitors due to the coronavirus pandemic. Such indiscriminate border closures are a wasteful aberration which the world can’t afford.
There is an alternative: serological tests can allow us to identify people who have coronavirus immunity and who therefore present reduced to no risk when they travel. An international health passport issued to these people would help to eliminate or limit the damage caused by freedom of movement restrictions.
I have argued for serological testing to enable those with immunity to return to work in The Geopolitics here. The idea has since been taken up by European governments including the UK, Germany, Luxembourg, the Netherlands and Italy. But serological testing also needs to be used to allow international mobility.
Even in countries which don’t close their borders, quarantine restrictions of at least 14 days, including on their own nationals, make most short-duration travel impractical. China is imposing such quarantines in a bid to prevent coronavirus from being re-imported into the country. The economic damage from international travel restrictions grows by the day. The World Travel and Tourism Council has estimated that 75 million jobs in the industry are at risk worldwide.
Immunity passports are just one of the tools made possible by serological tests. They can help to save the international travel industry and avoid the bankruptcy of air carriers. The impact of the pandemic on the global economy would be reduced: many industrial and commercial agreements depend upon face to face talks which are currently impossible.
The prospect of any kind of meeting between health experts from different countries is currently remote: this would require the end of confinement in both the countries concerned, as well as the easing of international travel restrictions. Travel between some states in the US is also now restricted – making it hard for medical professionals to go where they are needed most. In my own country, Cambodia, Prime Minister Hun Sen has forbidden 150 Cambodian Muslims from returning home from Malaysia, suspecting them of carrying coronavirus. This is a violation of our constitution: a state should not turn its back on its own citizens for any reason.
The logjam can be eased by creating international health passports. These passports could be underpinned by a bilateral agreement between two countries, a multilateral accord between a group of states, or an international agreement under the aegis of the World Health Organization (WHO). The tests used to determine immunity need to be agreed and standardised by participating countries. People who have the needed antibodies and so test positive for immunity would be given the health passport, which would include their regular passport number. This document would then be checked by border control police, along with the passport and any needed visa.
The model for such a passport already exists in the form of the Carte Jaune, or Yellow Card, which is an international certificate of vaccination. The card, which is endorsed by the WHO, is normally kept with the holder’s passport and is demanded on entry to countries with specific health risks. The card provides the dates when the needed vaccinations were administered.
The cost savings from such an approach would be considerable. For the cost of a serological test, which might be just a few dollars, the expensive quarantine process could in many cases be avoided, as well as the waste of the professional time and opportunities of the person concerned.
It’s important to realise that we don’t know how quickly immunity is established for those who have been confronted with coronavirus, or for how long that immunity lasts. Regular testing for the most crucial frontline workers will be needed to ensure that their immunity is still in place. Some experts, such as Paul Hunter, professor in medicine at the University of East Anglia in the UK, have argued that there is a danger that people will seek to deliberately get infected with coronavirus so as to (hopefully) survive without infecting their families, obtain immunity and so be allowed to return to work. Stronger communication of the fact that coronavirus can kill anyone, regardless of their age or medical history, can help to reduce that risk.
It seems unlikely that a person who would deliberately contract coronavirus will be willing to observe current confinement restrictions: such people are probably out there creating risk already. Deliberate contraction seems especially unlikely in the case of health workers who may need to be redeployed. But the global response to coronavirus cannot be held hostage to possible selfish and reckless behaviour of these kinds. The risk that a black market in health passports could develop has also been raised. But such fraud would be impossible if the “immunity passport” was electronically linked to the standard passport.
We have never needed international cooperation between medical experts and frontline professionals as badly as we do now. But international mobility has never been so restricted in any of our lifetimes. This will become a matter of grave urgency in poor developing countries and fragile states which lack established central authority or strong public health systems. Qualified experts need to be able to travel to coordinate responses, and to deploy protective equipment where it is most needed. An international health passport is the most practical tool to enable them to do so.
The immunity passport will have an important economic impact on tourism, air transport and many other industries. Rather than staying paralysed in the face of general, indiscriminate confinement, businesses and organisations can regain operational status by sending personnel who have been identified as immune through serological testing back to their posts. Technical and medical progress will be needed to allow us to establish with precision and certainty that immunity has been acquired. In the meantime, one immediate solution is for health authorities to possibly establish a protocol allowing for two serological tests to be carried out at intervals to confirm that immunity exists and that it can be relied on for an acceptable and workable period.
The views and opinions expressed in this article are those of the author.
Sam Rainsy, Cambodia’s finance minister from 1993 to 1994, is the co-founder and acting leader of the opposition Cambodia National Rescue Party (CNRP).