Ethical concerns over vaccine “passports” are emerging. Some concerns revolve around potential violation of liberty. “Everyone has a right to make decisions about their own health, but we don’t have the right to expose others to a dangerous infectious disease,” says Lawrence O. Gostin, JD, faculty director at the Georgetown O’Neill Institute for National and Global Health Law in Washington, DC.

Another central ethical concern is equity. “Vaccine passports are unethical as long as they leave people behind. We must first ensure that anyone who wants a vaccine can get one,” Gostin argues.

Gostin says ethicists should “speak out strongly in favor of vaccine equity and the ethical importance of reaching disadvantaged populations.”

In addition, there are ethical concerns on who would enforce vaccine passports. “Enforcement could lead to profiling certain groups based on their membership in a racial, religious, or social group that has lower rates of vaccination,” says Nancy S. Jecker, PhD, a professor of bioethics and humanities at the University of Washington School of Medicine.

Using vaccine passports for international travel is ethically problematic, says Jecker, “due to inequalities in access to vaccines between rich and poor nations. Testing and masking are fairer because they are more widely available.”

Vaccines should not be mandated, argues Jecker, “until vaccines are widely and equitably available to all segments of a population, privacy is protected, allowance is made for conscientious objectors, and mandates flex or are rescinded in the face of new evidence, such as waning immunity due to new virus variants.”

Mark A. Hall, JD, director of the health law and policy program at Wake Forest University, says there are two core concerns on vaccine passports. “From the left, there is concern about undermining social solidarity in coping with the COVID-19 pandemic if vaccine passports were seen or felt to create or accentuate inequitable divisions in society. From the right, the concern is more about privacy and freedom, the idea that government or corporate actors would be forcing vaccinations, limiting our freedoms, or tracking our movement and health data,” Hall says.

According to Hall, there are developments presenting ethical issues. For instance, private actors are starting to use vaccine certification to determine whether people can engage in certain activities, such as large gatherings, employment, or school. Some states have banned private actors from using proof of vaccination as the basis to lift restrictions.

“Ethicists can engage in this debate and consider what uses of vaccine certification appear to be more acceptable than others so that appropriate guardrails can be maintained to prevent the truly unacceptable uses,” Hall offers.

As for the hospital setting, Gostin says healthcare professionals owe a special duty to keep patients safe. “Thus, COVID-19 vaccines are just as, if not more, important than flu vaccines,” he says.

Mandatory vaccination is accepted in a wide range of circumstances, including healthcare. “Because COVID-19 currently is a greater threat than most others, and because the vaccines have proven to be as safe and effective as they are, I do not see a serious ethical concern about requiring vaccination to work with patients,” Hall says.

The bigger ethical concern, according to Hall, is healthcare providers insisting they have a right to expose patients to either unnecessary risk “or even simply unnecessary worry.”

All these ethical concerns are under debate in the midst of uncertainty regarding duration of vaccine protection along with emerging virus variants. “Vaccine passports could backfire, posing a risk to public health if they create a false sense of protection and people mingle as usual,” Jecker cautions. Ethicists should “join the public conversation” about vaccine passports, says Jecker. “During a global pandemic, it is a social responsibility to reach beyond the ivory tower,” she says.