Using the NHS App as a covid-19 vaccine passportBMJ 2021; 373 doi: https://doi.org/10.1136/bmj.n1178 (Published 11 May 2021) Cite this as: BMJ 2021;373:n1178
The NHS App is a safe and obvious choice for a vaccine passport, but IT problems and the “digital divide” must be tackled
The UK transport minister, Grant Shapps, announced on 28 April 2021 that the UK government plans to use the existing NHS App to provide proof of covid-19 vaccination status for international travel. For many years, proof of polio, smallpox, and yellow fever vaccinations has been an entry requirement for many countries. The World Health Organization “yellow card” scheme has been in place since 1969, and proof of ACYW135 meningococcal vaccine is required for Hajj to Saudi Arabia.
So while discussions on “vaccine passports” are old, the scale of the covid-19 pandemic will require a large number of global travellers to use a vaccine passport, which is an unprecedented development; and the technological options are far more advanced than the paper based certificates used for other vaccines. There are arguments for and against vaccine passports. We are facing a global pandemic, with huge variation in disease prevalence and vaccine mobilisation between countries. And, while we watch the tragic scenes in India, many people in the UK are preparing for their first opportunity this year to visit relatives oversees or take an international holiday.
In a statement on 5 February 2021, WHO laid down its reasons (at that time) for not supporting vaccine certificates, based on ethical, legal, scientific, and technological reasons. WHO recommends that people who are vaccinated should continue to comply with other risk reduction measures when travelling. It also stated that its recommendations will evolve as vaccine supply expands and as evidence about the efficacy of existing and new vaccines increases. This, however, has not deterred some countries from introducing vaccine certification—notably Israel, which is pushing ahead with its digital “green pass” scheme, with the US also exploring options.
Should the UK government decide to proceed with a vaccine passport policy, what method would we use? GPs, who are already struggling to meet unprecedented demand while delivering around 75% of covid-19 vaccinations thus far, cannot be expected to provide proof of vaccination. There are digital solutions available such as the NHS App, or possibly the NHS Covid-19 App. Many UK patients already use their NHS App for services including seeking medical advice, viewing their GP records, making appointments, submitting secure electronic inquiries to their GP, and ordering repeat prescriptions. It’s also possible for people to use the app to view their covid-19 vaccination record. This area of the existing app, already used by millions of patients, is a safe and obvious place to use as a digital vaccine passport. Increased downloads of the app by those using it as their vaccine passport could have additional long term benefits by encouraging patients to use other digital NHS services.
Detailed medical record access—currently required to view vaccination records—is not enabled by default when you register with the NHS App, however. Proof of covid-19 vaccination status would therefore need to be separate from the rest of the medical record so that it can be enabled by default for everyone without the need for individual permissions from general practices. The covid-19 vaccination record can also sometimes appear in the acute medication section of the NHS App, but not usually with all details, such as vaccine batch number. This needs to be rectified so that the details are always in the same place in the app. We would expect NHS Digital to rectify these matters before enabling the NHS App as a covid-19 vaccine passport.
Covid-19 vaccination is recorded using the national PharmaOutcomes (also known as Pinnacle) IT system. NHS England decided to use this rather than recording directly into GP patient record systems because data can be entered using a web browser, and thus the system can be used across all vaccine sites, including those that have no access to GP medical record systems. Some people have reported, however, that the information on their vaccination is not always transferred to their GP medical record, and indeed GP teams have noted other discrepancies.
When inaccuracies are noted, covid-19 vaccination data must then be entered manually by the GP practice. This is not an ideal solution as errors and omissions in data recording can occur, in addition to creating extra work for primary care teams. If the NHS App is to be used to confirm vaccination status, it is essential that all IT problems are resolved promptly.
An editorial in The BMJ discusses some of the wider practical and ethical matters in the implementation and use of vaccine passports, such as the need to ensure they do not further exacerbate current health inequalities.1 For example, many people in the UK do not own a modern smartphone capable of running the NHS App, a feature of the “digital divide.” This may be because either they cannot afford a smartphone or they lack the technical proficiency to use one. This will affect older people and those from poorer sections of society; groups that already have lower levels of vaccine uptake and higher levels of illness and poor health. The UK government’s proposal to use the NHS App may work for the majority of the population, but we must consider other options for those without access to suitable technology so they are not prevented from overseas travel.
There is debate for and against vaccine passports, which are being implemented by several countries already but are not currently recommended by WHO. The UK government’s proposal to use the NHS App to provide proof of covid-19 vaccination status is a practical and pragmatic solution. We suggest, however, that IT problems need to be tackled before we can rely on the app as a covid-19 vaccination passport, to prevent extra bottlenecks and delays in airports. GP teams, who are already struggling for time, need to be protected from a deluge of requests for certification to travel; and solutions also need to be found in case of technology failure, and for those unable or unwilling to use the NHS App.
Competing interests: We have read and understood BMJ policy on declaration of interests. We have no competing interests.
Acknowledgments: AM is supported by the NIHR Applied Research Collaboration North west London. The views expressed are those of the authors and not necessarily those of the NHS, the NIHR, or the Department of Health and Social Care.
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