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Evaluating the effectiveness of vaccine passes

Example of a digital vaccine passport using QR code (Source: NY Governor's Press Office)
Example of a digital vaccine passport using QR code (Source: NY Governor's Press Office)

A year ago, Israel was the first country to issue a strict vaccine passport. Israelis needed a “Green Pass” to go to restaurants, clubs and other crowded venues.

Now, some health officials say the Green Pass did not stop the omicron variant, and is no ‘longer relevant.’

“If it doesn’t have the purpose of allowing the safe reopening of the economy, then using it only as measure for vaccine compliance is not legitimate because there are other metric measures that are less intrusive and maybe even more effective.”

Today, On Point: Why are U.S. cities issuing strict vaccine passport programs now? And will they work?

Guests

Miquel Oliu-Barton, associate professor at the University Paris-Dauphine who’s expertise is health and economic policy, and the interface between science and decisions. (@OliuBarton)

Maya Peled-Raz, head of the community health program at the University of Haifa. (@UofHaifa)

Dr. Jennifer Avegno, director of New Orleans Health Department. (@AvegnoJennifer)

Seema Mohapatra, visiting professor of law at SMU Dedman School of Law. Author of “Passports of Privilege.” (@profmohapatra)

Transcript: The Future Of Israel’s Green Pass Program

Several countries have implemented vaccine passes. France, Germany, Italy, China, Canada, to name a few. And here in the United States, major cities have done the same.

New York, San Francisco and New Orleans last year. And more recently, Chicago, Philadelphia, Washington, D.C., Boston, all imposing vaccine pass policies just last month.

MEGHNA CHAKRABARTI: Something else also happened just last month. Israel, the first country to launch vaccine passes last year, has moved towards eliminating the Green Pass program. And why? A governmental health advisory panel determine that the Green Pass is not effective. So Israeli policymakers will be deciding whether or not to end the program in the coming weeks.

So we’re going to talk about vaccine passes now a year later, what they hope to achieve in various countries and cities here in the United States, what they could cost, what they could gain. And we’ll start with Maya Peled-Raz. She’s head of community health programs at the University of Haifa in Israel. She also coauthored the paper Lessons from Israel’s COVID-19 Green Pass Program. It was published in the Israel Journal of Health Policy Research. Maya Peled-Raz, welcome to you.

MAYA PELED-RAZ: Hello, Meghna.

CHAKRABARTI: So first of all, I’d love to start with some definitions so that we’re operating from a place of knowledge, rather than supposition. What was the original intention of the Green Pass program when it was created last year in Israel?

PELED-RAZ: So the Green Pass, the original Green Pass program, coincided with the third wave that we experienced. And it’s important to realize that Israel, in a way, was coming into the waves before everyone else. So we were like two months ahead of everybody else. So everybody else had a chance to learn from us, but we had no one else to learn from. We just had to make the decisions on our own. And another thing that’s really important to understand is that Israel, the whole country, was under lockdown in the first and the second wave.

So when the third wave arrived and vaccines started rolling in — and in Israel, they started rolling in and being available much faster and sooner than in everywhere else, for different reasons. Then the Green Pass or badge, as we called it, was implemented first. And the idea behind it was definitely — no debate about that — to really allow for the opening of the spheres, the economic sphere, the educational sphere, instead of going into a third lockdown. So it started as a purely preemptive measure that was actually aimed at infringing less, allowing for less infringement on human rights.

CHAKRABARTI: So because of the severity of the lockdown that Israel was experiencing at the time.

PELED-RAZ: Exactly.

CHAKRABARTI: OK, so that’s really important context here. So then ostensibly it allowed Israelis who had been vaccinated access to those parts of society that we just talked about. I presume it was successful in doing that. So what has changed from that time until just last month when we started reading an Israeli health advisory panel is saying that the Green Pass is no longer effective?

PELED-RAZ: First of all, it was an extremely successful story. And it really changed the face of the way that Israel managed the COVID pandemic up to that point. And it allowed us to come out of the third wave much faster with quite fewer negative impacts on on our lives. And what changed from then to now? The variant, definitely the variant.

CHAKRABARTI: The omicron [variant].

PELED-RAZ: Yes, definitely. So we started with the Alpha. The third wave was Delta. They were substantially different than this variant, the omicron. And now we have a variant that infects everybody, regardless of being vaccinated. The major difference in between those vaccinated and those who are not is the severity of the disease. And what we see right now is that despite the really huge, unprecedented numbers of people being infected, the burden on the medical system, on the health system is no greater than it was in the previous wave. So we know we can handle it.

CHAKRABARTI: In Israel.

PELED-RAZ: In Israel, yeah.

CHAKRABARTI: Here in the United States, we’ve seen a whole variety of reasons being put forth by policymakers to implement vaccine passes now. Which include the opening up of society, as you’ve talked about, but that’s just a different cup of tea here in the United States. But what about increasing vaccination rates? Did the Green Pass make a difference on that front in Israel?

PELED-RAZ: Well, objectively and empirically, it definitely did. There were peaks of vaccination every time that we reenacted the Green badge. Because we had intermissions between waves, we relaxed the Green badge requirements and coming into the fourth and then, now the fifth wave. Once the requirements were heightened, re-heightened. We kept every time seeing a peak in vaccination compliance.

CHAKRABARTI: So I’ll let you get to your qualification there in a moment. But when the pass was relaxed between waves, how was it determined when to relax? Were Israelis told, Well, if infection rates get below a certain level, we will pull back on the Green Pass? How did that work?

PELED-RAZ: Well, it wasn’t preplanned. So there wasn’t a goal that was set in advance, which I’m criticizing, you know, looking back at it. And many people criticized at the time, as well, not having this specific goal to reach. But it was known that when we get to a low level of infection, it will be alleviated. And it has been. So that’s exactly what happened. So every time we reached really low numbers of people who are no longer flooding the emergency rooms, the Green Pass was retracted.

CHAKRABARTI: OK, so in your paper, one of the lessons, though, that you put forth is that while the Green Pass was essential at the times that you’re talking about, it also imposed the sorts of restrictions that in the abstract, you write, were not consonant with solidarity and trust-building. So can you talk about what the downsides were then?

PELED-RAZ: Well when we’re talking solidarity, you need to ask yourself is solidarity really a value appreciated in your own country? So I will not answer that question for the United States.

CHAKRABARTI: No, this is for the Israeli context.

PELED-RAZ: Yeah, exactly. So it definitely is a value appreciated in a communitarian state as Israel. And we really, you know, we want people to feel as part of a group, as being part of a mission that we are all striving to achieve. And it’s really clear that when you are telling certain people you are excluded, this does not help that in any way.


PELED-RAZ: So we discussed solidarity, which is an issue. But I think that the bigger issue that we experienced in Israel was the trust or distrust problem. Because research shows that in Israel, the major reason for people being vaccine hesitant is actually the fact that they’re thinking people who want to actively exercise their discretion. And when the state comes and tells them, OK,  If you don’t vaccinate, you cannot do this and that, it really creates a backlash. And that was combined with the sort of sporadic, if not a little bit erratic, erratic decision making processes in the government. So that had definitely a negative impact. But we did not experience other side effects that should be considered in other countries, especially in the United States. As such as, for example, inequality. Or, you know, a lack of access issues, because vaccines are available to everybody in Israel.

CHAKRABARTI: Can I just jump in here for a second? Because I recall from last year, there was some concern about, for example, Arab-Israelis having a more difficult time accessing vaccines. Or members of ultra-Orthodox groups showing high percentages of vaccine hesitancy. Has that changed?

PELED-RAZ: Well, those are two different issues. … So we did have a problem, not of access to the vaccines, but of access to good clean data that would really bring them into the fold. And that was recognized pretty early on. And then I think it was that gap was closed in a two months period. So that definitely is an issue that should be monitored and really worked towards in order to prevent those problems.

CHAKRABARTI: I have one last question for you, Maya, if I could. Given what your analysis of Israel’s experience with the Green Pass over the past year. As I said at the top of the show, the Israeli government now has been advised by a health panel to perhaps eliminate the program. Would you advise the government to completely eliminate the Green Pass program?

PELED-RAZ: In Israel, yes, at this point. Because now at this point, it only serves as an incentive tool. And I really don’t like it as an incentive tool. Not because I don’t think we need to use incentives. I think we should, but that’s a bad tool for that purpose. It’s masked as a preemptive tool, while actually trying to be an incentive. And I’d much rather people know when they’re pushed or when they are protected. And if you want to push them, just say so. So fine them, or even put them in jail. I’m exaggerating the point, but don’t act as if it’s it’s a preemptive tool and then just try to push them.

From The Reading List

Research Square: “The effect of COVID certificates on vaccine uptake, health outcomes, and the economy” — “In the COVID-19 pandemic, governments have, among other measures, mandated the use of COVID certificates to prove vaccination, recovery, or a recent negative test, and have required them to access shops, restaurants, schools, universities, or workplaces.”

SSRN: “Passports of Privilege” — “All Americans sixteen and older are now eligible to receive a COVID-19 vaccination. However, many will not be able to access such vaccinations due to their work situation, health status, and inaccessible vaccinates sites.”

This article was originally published on WBUR.org.

Copyright 2022 NPR. To see more, visit https://www.npr.org.