Vaccine Passports are unlikely to counter vaccine hesitancy

Welcome to Plugging the Gap (my email newsletter about Covid-19 and its economics). In case you don’t know me, I’m an economist and professor at the University of Toronto. I have written lots of books including, most recently, on Covid-19. You can follow me on Twitter (@joshgans) or subscribe to this email newsletter here. (I am also part of the CDL Rapid Screening Consortium. The views expressed here are my own and should not be taken as representing organisations I work for.)

---

Vaccine passports are in the news because (a) lots of people have been vaccinated and (b) lots of people have not been vaccinated. We would like (a) to continue and (b) to go away so governments are looking for any instrument that will do that. Persuading people is hard. Offering people a carrot (such as a lottery only works a little). Hence, the desire to use a stick. That’s what a passport is. It is a prohibition on doing certain things if you are unvaccinated. It is the same as when I tell my kid the Wifi is only for people who have done their homework. You make life worse for those who haven’t done what you want.

As an economist, I’m all for punishments as a motivator. On the kid front, I wrote a whole book about how that might work (and more critically showing how it often failed). Read the book and you may well end up considering my children as heroically well-adjusted. But we have to be careful about them. They have to do their job and for vaccine passports, precisely because they are being imposed on a system rather than individuals, I have my doubts.

Passports versus credentials

Before considering the issue of vaccine hesitancy, let me focus on a good aspect of passports: they provide information regarding peoples’ risk when they go places. As I wrote some time ago, a credential is information that can be used to communicate riskiness to others. By contrast, a passport is that plus a right to pass. The information aspect is important and I wrote another book about how that is The Most Important Thing in managing pandemics.

Suppose you have a place, say a retirement home, where not everyone can be vaccinated or is vaccinated for various reasons. If you manage such a place, you want people who are coming in to be safe — that is, not likely to carry the virus. You can do this in two ways. First, you can test or screen them to ensure they are not infectious. Second, you can see if they are vaccinated. Neither is perfect but the probabilities fall so low that they can class as safe.

That rationale for credentials is important for any place where there are people who might be vulnerable. Similarly, it is not important for places where there aren’t people who might be vulnerable. (This last part is important and I’ll come back to it).

Europe and other places are offering apps that provide that information.

One good aspect is that you can offer this credential even if you choose not to be vaccinated. That means that it is more privacy-compliant than a pure vaccine passport if you care about such things.

Vaccine Theatre

What this means is that vaccine passports are not about keeping people safe or protecting people. And many are getting confused.

For instance, there are many people organising events that require people to show proof of vaccination. Leaving aside, for the moment, that with hundreds of different systems, there aren’t great ways of verifying that you are vaccinated, this is pure vaccine theatre. If you organise a wedding and require everyone attending to be vaccinated, who are you protecting. First of all, anyone who is vulnerable or cannot be vaccinated is being precluded from attending. That means that there will be vaccinated which …. obviates the need to mandate vaccinations. Second, suppose you didn’t mandate this? What could happen? Some people who aren’t vaccinated may attend. OK. But who will that harm? Not the vaccinated. Only the unvaccinated. The unvaccinated are taking the risk. And if the risk is very high then they won’t come anyway. The mandate is just precluding those who want to take the risk and aren’t vaccinated. (Again, if someone special who is unvaccinated needs to be there, there is a rationale for credentials). But the point is a mandate doesn’t actually do anything extra. It will just end up being a pain in the neck for those who are vaccinated and now need to cobble together proof.

Once you think about it for two seconds, when people proclaim that you need vaccinations to attend their event, they are likely more virtue signalling than doing something real.

The Right to Pass

Surely, you may ask, if we deny the unvaccinated a normal social life, this will widen the value between being vaccinated and not being vaccinated by making it more painful to be not vaccinated? Won’t that drive more to get vaccinated?

I think that can have a short-term effect. Lots of people might not be vaccinated because they haven’t got around to it and this can get them off their butts as it did in France this week. But I predict that, like lotteries that encouraged vaccinations, this will be a short-lived effect.

The real issue we face is vaccine hesitancy that is long-term. Most countries seem to be capping out at 70 to 80 percent of their adult population vaccinated. This is below what we now need for herd immunity which is likely in excess of 95% of the entire population (not just adults) given the Delta variant.

Vaccine hesitancy is a complex issue and, as I have written about elsewhere, is likely driven by health concerns — both real and perceived — that are not necessarily crazy or irrational. Yes, there is misinformation. Yes, there are people who are worried about magnetic microchips or something. But to lump them together is not a good idea. Moreover, conflate them and you create stigmas that are never good for public health.

If hesitancy is about health risks then that also means that countering hesitancy will likely depend on the prevalence of the virus. If the virus is prevalent in a region, people are more likely to be vaccinated. If it is waning, they are less likely to be vaccinated. This is why, when there was an outbreak in Sydney, people rushed to be vaccinated.

If we institute a passport that restricts unvaccinated people’s activities, that will actually reduce prevalence. Basically, we are keeping them in lockdown. But herein lies the paradox. Reduced prevalence means that the unvaccinated are better off. If they are better off, then the passport is less of a punishment. Hence, there is reduced demand for vaccination.

In other words, without a vaccine passport, there is more prevalence but people adjust and get vaccinated because of that which is a long-term investment in pandemic management. With a vaccine passport, there is less prevalence and so unvaccinated people are more likely to be satisfied with continuing not to be vaccinated. (I have a paper I am writing that shows this in a behavioural epidemiological model that I will release in the coming weeks). The point is that prevalence drives vaccine demand and vaccine passports counter that. That’s not a bad thing but it means that it really is a lockdown by another name. That makes it a band-aid and not a solution.

More experiments

All that said, we will see what happens. There are many experiments going on. Europe has credentials. So does New York. France is mandating those credentials as part of a passport (with tests and vaccines). So is Manitoba. They will likely be used for border crossings. Ontario is ruling them out for government with the Premier saying, “We aren’t going to have a split society” but private companies can have their own vaccine policies.

My preferred way

My preferred way to deal with this issue and the frustrations regarding returning to normalcy is this. Once you have assured yourself you have hit limits on vaccine demand (that is, supply shifts from being below to being above demand), you set a timeline for full reopening. You provide a means by which people can show that they are safe (with either a vaccine or negative test done recently) that gives people the tools to manage their safe interactions with others. And then you open at that time. In anticipation of increased prevalence — worrisome though that is — hopefully, more of the hesitant will become vaccinated.

Things are very different where you have vulnerable people. In that case, you may have to mandate vaccinations as a workable system just as we do for schoolchildren for other diseases. But a return to normal really means not having to show a passport for every place you go. We need to keep our eyes on that prize.