Emanuel: 'Immunity passports' could help open economy, but science still needed

The ethics of immunity certificates were the subject of a recent viewpoint published in the Journal of the American Medical Association by Govind Persad from the Sturm College of Law at the University of Denver and Ezekiel Emanuel, M.D., vice provost for global initiatives at the University of Pennsylvania. (Getty/filadendron)(JAMA)

As countries around the world have begun their push to reopen amid pandemic concerns, interest around the concept of "immunity passports" has begun to grow in recent weeks. 

The idea, proponents say, is to identify and allow those who've already recovered from COVID-19 to have a certificate of sorts showing they've likely developed immunity to the virus and can move more freely in society even as others shelter in place.

Is that a good idea? 

"At the moment, there's no good science," Emanuel told Howard Bauchner, M.D., who is editor in chief of JAMA, in a recent interview. "The presumption is the following: Someone who gets infected with COVID-19 will have an immune response, raise antibodies and other immune cells that can fight COVID-19 and be immune from reinfection and they also won't be shedding virus particles themselves." 

It was a topic Senator Rand Paul, R-Kentucky, pressed National Institutes of Allergy and Infectious Diseases Director Anthony Fauci, M.D., to discuss Tuesday. 

They were speaking during a Senate committee hearing on the subject of safety reopening schools and workplaces Tuesday when Rand questioned Fauci on the likelihood science would ultimately show recovered COVID-19 patients developed immunity. 

"The question of immunity is linked to health policy in that workers who have gained immunity can be a strong part of our economic recovery. The silver lining to so many infections the meat processing industry is that a large portion of these workers now have immunity. Those workers should be reassured that they likely won’t get it again instead of being alarmed by media reports there is no evidence of immunity,” Paul said. “Can you help set the record straight that the scientific evidence, as it's being accumulated, supports that the coronavirus likely leads to some form of immunity?” 

Fauci said immunity was likely, but not certain.

“Given what we know about the recovery from viruses such as coronaviruses in general, or even any infectious disease with very few exceptions, that when you have antibody present, it likely indicates a degree of protection,” Fauci said. However, long-term studies are needed to prove whether having antibodies is protective and, if so, for how long. "As I’ve often said, and I will repeat, you can make a reasonable assumption that it would be protective, but natural history studies over a period of months to years will then tell you definitely if that is the case."

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"I think that would make them able to do things other people might not. They might be people that say, 'Well, they can come into the country because they're not going to be carrying COVID into Britain or New Zealand or other countries that may become COVID-free," Emanuel said. "You might actually want them for doing certain jobs where the risk of infection could have very devastating consequences like working in nursing homes or working in the supply chain of food production."

However, he warned, the medical community should move carefully in supporting such certificates as the science has not yet confirmed.