Search Results
A total of 742 articles were identified for screening (Google n=641, academic literature n=101). Based on the title and headline screening, 551 articles were eliminated including 24 duplicates identified with the same heading or near similar content. One hundred and ninety-one articles remained for full text review, of which 70 were included in the final analysis (Figure 1).
Characteristics of included articles
Of the 70 relevant articles, nearly half were opinion/editorials (n=29, 41.4%), followed by news articles (n=25, 35.7%), research articles (n=7, 28.7%), company websites (n=3, 4.3%), and blogs (n=2, 2.9%). N=4, 5.7% were considered other (event description, guidelines etc.) (Table 1).
More than half (n=40, 57.1%) of the articles referred to “experts” as a source of evidence. Experts included academic thought leaders (n=12, 17%), federal leaders (n=16, 23%), and company CEO’s (n=16, 23%). Academic research was the source of evidence for 18% (n=11) of the articles. Approximately 26% (n=18) did not quote any source of evidence.
Table 1: Characteristics of the articles
Article Type
|
n
|
Percentage (%)
|
Research paper
|
7
|
10.0
|
News article
|
25
|
35.7
|
Opinion/editorial
|
29
|
41.4
|
Company website
|
3
|
4.3
|
Blog
|
2
|
2.9
|
Other (event description, guidelines, concept paper etc.)
|
4
|
5.7
|
Pre-identified themes
|
Travel
|
21
|
30
|
Ethics
|
22
|
31
|
Technology
|
41
|
58.5
|
Legal concerns
|
10
|
14
|
Public policy
|
9
|
13
|
Scientific concerns
|
1
|
1.5
|
Sub Themes
|
Reopening of economy
|
12
|
17
|
Data security
|
9
|
13
|
Transmission control
|
3
|
4.3
|
Inequities
|
3
|
4.3
|
Thematic Analysis
We evaluated the articles for six pre-identified themes. Technology emerged as the most dominant theme, appearing in 58.5% (n=41) articles. Ethics (n=22, 31%), travel (n=21, 30%), legal concerns (n=10, 14%), public policy (n=9, 13%), and scientific concerns (n=1, 1.5%) were also among the themes identified.
During our review we identified the following 4 sub themes: 1) reopening of economy, 2) data security, 3) COVID-19 infection prevention, and 4) inequities. Reopening of economy was the most common reason for introducing vaccine certificates (n=12, 17%). A lot of the discourse identified was around reopening of social events, gyms, and restaurants.
Issues around data security (n=9, 13%), COVID-19 infection prevention (n=3, 4.3%), and inequities (n=3, 4.3%) were also noted. More than half of the articles had no sub themes that were identified (n=43, 61%).
Digital Solutions for COVID-19 Vaccination Certificates
Table 2 identifies the countries which are considering or have implemented digital vaccine certificates and provides a brief summary of the details. To date, only Denmark and Estonia have implemented vaccine certificates9–11 while Chile has implemented immunity passports12,13. Estonia is piloting the VaccineGuard app in collaboration with the World Health Organization10. USA, UK, Pakistan, India, Russia, Finland, Indonesia, Australia, Italy, and Sweden, Switzerland, and Italy are all considering vaccine certificates9,14–23. Pakistan and India are considering the implementation of digital platforms under development, Vaccify and DigiLocker, respectively24–27 (See Table 3 for more details). Whereas Australia and Finland are considering the use of the existing health platforms, Express Plus Medicare app and My Kanta, respectively20,23. Indonesia has identified several processes which must be put in place in order for the certificate to be considered halal which will allow it to be acceptable by their larger population19. Canada has recently started to consider vaccine certificates for international travel28,29.
Table 2: Approach of countries towards a vaccine certificate for COVID-19
Country
|
Government issuing immunization passport?
|
Approach
|
Estonia9,10
|
Implemented. In pilot stage
|
VaccineGuard developed in collaboration with the World Health Organization and Guardtime (See Table 3)
|
Denmark8
|
Implemented
|
It has launched its own Corona passport. The passport grants the privilege to vaccinated citizens to travel beyond country borders.
Vaccinated citizens are able to download the certificate from a government website.
The government will soon be issuing digital certificates for business travellers.
|
USA13
|
Considering it
|
Details are not yet released
|
UK14
|
Considering it
|
The proposals are being discussed at the Cabinet's COVID operational committee. There is no final decision yet
|
Pakistan25,26
|
Considering it. Work in progress
|
Vaccify by Trust Net Pakistan (See Table 3)
|
India23,24
|
Considering it. Work in progress
|
DigiLocker - A government platform for issuing and verifying documents and vaccine certificate digitally (See Table 3)
|
Russia15,16
|
Considering it. Work in progress
|
Covid passports would possibly be in a digital form
|
Finland18
|
Considering it
|
The vaccine certificate would be available on “My Kanta” which is a nation-wide service platform for accessing health records
|
Indonesia17
|
Considering it
|
There are several processes that must be passed for Indonesia’s national agency BPJPH to issue a halal certificate: application, examination, determination, testing, checking, fatwa, and finally the issuance of the certificate
|
Australia21
|
Considering it
|
It will allow people to access digital proof of vaccination via the Express Plus Medicare app and MyGov accounts. Approval is expected by March
A paper form will also be available through Services Australia or through the vaccine provider
|
Italy20
|
Considering it
|
Details not yet released
|
Sweden8
|
Considering it
|
Details are not yet released
|
Canada27,28
|
Under consideration
|
Details are not yet released
|
Switzerland19
|
Considering it
|
Details not yet released
|
Italy22
|
Considering it
|
Details not yet released
|
Chile11,12
|
Implemented immunity passports
|
N/A
|
Technological architecture
The use of digital certifications was discussed in 78% of articles identified (n=53). Only one article mentioned the use of paper certificates for those who do not own a smartphone where in that situation, a printout of the Quick Response (QR) code would be given to them.
Our search identified 8 digital vaccine certificates in use or under development (Table 3). All solutions identified are using blockchain technology. The data privacy and security of the digital platforms identified were based on the fundamentals of blockchain, that is all personal identifiable information is kept encrypted and cannot be disclosed without the user’s consent30. All solutions allow the verifier of the vaccine certificate to scan the QR code indicating presence or absence of a vaccine certificate and date and details of the vaccination without disclosing other personal identifiable information.
There are many major standard setting efforts underway out of which the following two were mentioned in our articles. 1) Worldwide Web Consortium (W3C) is an open, globally interoperable standard for data security31. The body is also known for such standards as the early versions of HTML32. COVID-19 Credential Initiative with 60 participating organizations globally, of which TrustNet Pakistan is also a part, works on W3C standard and looks for instances where Verifiable Credentials (VCs) can be used to address the public health crisis32,33. CommonPass also uses W3C standards for their application34. 2) HyperLedger is another standard which is an open-source community focused on developing a suite of stable frameworks, tools and libraries for enterprise-grade blockchain deployments with interoperability and tokens as their expertise31. Quantum Materials Corp’s (QMC) blockchain-based QDX HealthID app, is based on the Hyperledger Sawtooth enterprise blockchain and for smart contracts, it’s using the Digital Asset Modeling Language (DAML)35. Apart from it, WISekey has implemented standards such as OpenID Connect and OAUTH2 to enhance the security of their cloud applications36.
Table 3: Digital solutions for COVID-19 vaccine certificates
Product name
|
Company name
|
Objective
|
Product operation
|
Product Stage
|
Technology
|
Data privacy
|
Data security
|
Vaccify (part of COVID-19 Credentials Initiative (CCI))25,26
|
TrustNet Pakistan
|
(1) To support safe domestic or international travel during COVID-19 pandemic. (2) To support return to work in-person. (3) To aid hospitals evaluate which staff/visitors are allowed into certain locations of the hospitals.
|
Users will be issued a vaccination certificate by the hospital/healthcare organization that administered the vaccine. The VC shows up as a QR code on the users Vaccify app that can be scanned by officials (e.g., employers, border agents).
|
Demo
|
Decentralized block chain - (1) Uses the "Hyperledger INDY", "Hyperledger ARIES", and "VON" (Verifiable Organizations Network) blockchain. (2) Verifiable Digital Credential Technology (VDCT) preserves privacy; many international organizations including the United Nations approve VDCT use
|
No personal information is exchanged with officials. QR code identifies whether the user has a vaccination certificate or a positive /negative PCR/antibody test.
|
(1) App is accessible through biometrics or a passcode.
Aligns with digital identity trust framework based on world wide web consortium (W3C) standards.
Certificate can be issued (or revoked) rapidly, thus, potential for fraud is mitigated.
|
CommonPass39-41
|
The Commons Project
|
To support safe domestic or international travel.
|
The Apple Health app (iOS) or CommonHealth app (Android), will assess whether the user’s lab test results or vaccination records (a) come from a trusted source, and (b) satisfy the health screening requirements of the country they want to enter.
|
In trials by United Airlines and Cathy Pacific Airways
|
Block chain - details are not mentioned
|
CommonPass provides a yes/no answer to whether the user meets the current entry criteria (e.g., vaccination certificate, immunity status, or COVID-19 test result). QR code is generated that can be scanned by officials (e.g., airline staff)
Underlying health information remains in the individual’s control.
|
Uses open, globally interoperable standards (e.g., HL7 FHIR, W3C verifiable credentials).
|
QDX HealthID Immunization Passports50
|
Quantum Materials Corp
|
Supporting return to work, social settings and society during COVID-19 pandemic.
|
App-based interface that provides a green, yellow or red indicator, as well as a scannable QR code. Green indicates the user is virus free and safe to return to work/socialize to some degree. Hosted on the Microsoft Azure cloud and can integrate with existing EMR system.
|
Beta testing
|
Block chain - Based on the Hyperledger Sawtooth enterprise blockchain
|
Verifiers of user’s vaccine certificate scan the QR code. Personal information stays with the user except evidence of VC.
|
Implements distributed ledger applications via Digital Asset Modeling Language (DAML) which decreases fraud risk.
|
Covi-Pass43
|
Tento Health
|
Supporting return to work, social settings, and society during COVID-19.
|
Considered in 15 countries including France, Canada and India. Currently, it only supports COVID-19 test results but there is a plan to expand the app to include vaccine certificates.
|
Available for download on the iOS and Android stores
|
Block chain - details are not mentioned
|
Verifiers of VC will scan the QR code which indicates presence/absence of VC. Personal information stays with the user. App is password-protected.
|
Not available
|
DigiLocker23,24
|
Government of India
|
Supporting return to work, social settings, and society during the COVID-19 pandemic.
|
A government platform for issuing and verifying documents and VC digitally. For dual-dosage vaccines, people are issued a provisional certificate. The full certificate will be issued after both doses, with dates of administration and vaccine information. Certificates are stored in DigiLocker.
|
Available for download on the iOS and Android stores
|
Block chain - details are not mentioned
|
Verifiers of the vaccine certificate scan the QR code indicating presence or absence of VC and date and details of the vaccination. Personal information remains with the user.
|
Not available
|
Digital Health Pass52,53
|
IBM
|
Supporting return to work, social settings, and society during COVID-19 pandemic.
|
Currently, supports COVID-19 test results but plans to add vaccination status and health records.
|
Demo
|
IBM Blockchain technology
|
Health Pass would be stored in digital wallet of the user.
User has control over what health data they wish to share.
|
Not available
|
WIShelter SafePass 29,35
|
WISeKey International Holding
|
Supporting return to work, social settings, and society during COVID-19 pandemic.
|
Vaccination certificate on WIShelter SafePass which ensures users’ privacy, security and safety while providing access to diagnostics, vaccine education and necessary medical services and data.
|
Not available
|
Block chain - details not provided
|
To ensure data privacy, each user’s Personal Identifiable Information is kept encrypted and only disclosed with users consent.
|
WISeID supports online KYC onboarding, OTP and digital certificate login, and an innovative “hands-free” secure login based on QR-Codes which users can read using WIShelter SafePass mobile app. WISeID implements standards such as OpenID Connect and OAUTH2, which enhances the security of their cloud applications.
|
VaccineGuard9,10
|
Guardtime, OpenHealth, SIPCA, WHO
|
To capture and protect proof of critical data accuracy, facilitate privacy-preserving global certificate verification and provide real-time insights on vaccination deployments for public health authorities.
|
It will provide proof of critical data accuracy, deliver automated aggregated reports from vaccination sites, automated monitoring of stock and vaccinations, and provide the ability to facilitate adverse effect reporting, supporting investigations around this more quickly.
|
In pilot stage with Estonia, Iceland, and Hungary
|
Blockchain - Keyless Signature Infrastructure (KSI)
|
Embedded decentralized privacy.
|
No data is registered into the KSI Blockchain itself - only hashes of data, any data movement is between known hosts in a point to point fashion using secure transport.
|
VC: Vaccination certificate
VDCT: Verifiable Digital Credential Technology
W3C: World wide web consortium
FHIR: Fast Healthcare Interoperability Resources
Purpose and Use Case
Some airlines are requiring a negative COVID-19 test prior to boarding a flight, and in future this may be adapted to a vaccine certificate for passengers and staff 37. The UK government has sought a proposal for digital health certificates for travel from the company Onfido38. Health policy experts39 envision vaccine mandates could be instituted and enforced by local governments or employers - similar to the current vaccine requirements for school-age children, military personnel, and hospital workers39. CommonPass, a product of the Commons Project is one example which have been trialed out by United Airlines and Cathay Pacific Airways for showing COVID-19 test results and has been presented to over 37 governments. In the near future, it will integrate vaccine certificates40. Germany, Indonesia, Italy, Israel, Colombia, Argentina, and the U.S. have considered implementing health passports like CommonPass41. The company has proposed its use for travel, schools, hotels, and concert venues42. Guardtime, a KSI blockchain technology company, in collaboration with the Estonian government and the WHO has piloted a digital vaccination certificate program43. The platform is based on KSI blockchain, an EU-EIDAS certified trust service and X-Road, Estonia's data sharing platform, and out of its many objectives, one of them is to test the proof of vaccination, similar to the International Certificate of Vaccination or "yellow card". Covi-pass is another app that is now being considered in 15 countries including France, Canada, and India and is also supporting return to work and society. It is currently available for COVID-19 test results but plans to expand to incorporate vaccine certificates44. A secure COVID-19 vaccination certificate will play a critical role as economies reopen and international travel resumes43.
Ethical, legal, and policy considerations
More than half of the articles combined (n=41, 58.5%) discussed legal, ethical, and policy concerns regarding COVID-19 vaccine certificate. The major concerns emerging from the ethical and legal perspective was that of inequities. Technology as much benefit as it brings, can also become a barrier for some, adding to existing inequities45. Development of vaccine certificates may exclude vulnerable and marginalized populations who do not have access to smart phones45. In terms of reopening the economy, including access to in-person social events, updating travel guidelines, or going to restaurants, gyms, and salons, one of the important questions will be to ask how society deals with the admission of non-vaccinated people. Alternatively, vaccine certificates may incentivize individuals to obtain vaccination against the virus, which is a social good46.