Intended for healthcare professionals

Rapid response to:

Head To Head

Are vaccine passports and covid passes a valid alternative to lockdown?

BMJ 2021; 375 doi: (Published 03 November 2021) Cite this as: BMJ 2021;375:n2571

Rapid Response:

Re: Are vaccine passports and covid passes a valid alternative to lockdown?

Dear Editor

No need for this polarised debate, there is a middle ground.

The Head-to-Head article by Kirsty Innes, Daniel Sleat and Imogen Parker [1[ (Are vaccine passports and covid passes a valid alternative to lockdown? BMJ 2021; 375 doi: (Published 03 November 2021) serves to polarise the debate around vaccination status and entry to mass, live events, rather than solve it. When vaccine status is viewed as a barrier (or facilitator) to entry, then arguments, for and against, inevitably centre on the irreconcilable tensions between individual freedoms and public health. However, there is a middle ground where restrictions on individual freedoms do not necessarily need to be imposed for the sake of wider public health benefits - vaccination can remain a question of personal choice without fear of being denied entry to cultural or other events that constitute an important part of normal societal interactions.

A more helpful and non-polarising perspective is to view vaccine status as a data point rather than as a passport to routine social interaction. If vaccine status and other factors such as mask-wearing are used as data, the COVID transmission risk in almost any setting (planes, schools, theatres, restaurants, festivals etc) can be modelled based on the overall preponderance of susceptible and protected individuals at the event and the characteristics of the venue. When the risk modelling is combined with robust screening protocols such as at-home videoed testing prior to the event, and linked to ticketing data for the venue, public health officials can use evidenced based decision making to inform go/no-go decisions on the overall safety of the event on a case-by-case basis. This type of hyper-local, data-driven, real-time decision making can ensure that events that are important to the economy and mental health and wellbeing of individuals can go ahead in a way such that individual freedoms are maintained without jeopardising public health. Protocols have already been developed and trialled in live events since July 2021 [2], and modelling assumptions are available for wider scrutiny [3]. It is time to stop viewing vaccination status in divisive, dichotomous terms, and pursue solutions that conciliate between the tensions of individual choice and public health. There are policy choices available that do exactly that.

Harris M [1], Kreindler J [1,2], Donnat C [3], El-Osta A [1], Filippidis FT [1], Esko T [4]

1 School of Public Health, Imperial College London, UK
2 Centre for Health and Human Performance, London, UK
3 Department of Statistics, University of Chicago
4 Institute of Genomics, University of Tartu, Estonia

MH is supported in part by the NW London NIHR Applied Research Collaboration. Imperial College London is grateful for support from the NW London NIHR Applied Research Collaboration and the Imperial NIHR Biomedical Research Centre. The views expressed in this publication are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care.

1. Are vaccine passports and covid passes a valid alternative to lockdown? BMJ 2021; 375 doi: (Published 03 November 2021)
2. Harris M et al. Safe management of full-capacity live/mass events in COVID-19 will require mathematical, epidemiological and economic modelling. Journal of the Royal Society of Medicine; 0(0) 1–5 DOI: 10.1177/01410768211007
3. Donnat et al. A Predictive Modelling Framework for COVID-19 Transmission to Inform the Management of Mass Events. JMIR Public Health and Surveillance, 18 Sep 2021, DOI: 10.2196/30648

Competing interests: No competing interests

05 November 2021
M Harris
Clinical Senior Lecturer in Public Health Medicine
Jack Kreindler, Claire Donnat, Austen El-Osta, Filippos Filippidis, Tonu Esku
Imperial College London
Department of Primary Care and Public Health, Reynolds Building, St Dunstans Road, Hammersmith, London W6 8RP