key: cord-0881863-v17dwbdy
authors: Doraiswamy, P. M.; Chilukuri, M.; Linares, A. R.; Bramstedt, K. A.
title: Are we ready for COVID-19's Golden Passport? Insights from a Global Physician Survey
date: 2020-11-27
journal: nan
DOI: 10.1101/2020.11.25.20234195
sha: ce69d873a0c032249162f4baf28173f88e5e63d3
doc_id: 881863
cord_uid: v17dwbdy

Background: COVID-19 immunity passports could protect the right to free movement but may also critics worry about insufficient evidence, privacy, fraud, and discrimination. Objective: To characterize the global physician community's opinions regarding immunity passports. Design: Cross sectional, random stratified sample of physicians registered with Sermo, a global networking platform open to verified and licensed physicians. Main outcome measures: The survey asked: "Digital immunity passports, based on antibody testing, are being considered to offer proof (e.g. via an app or QR code) that a person has developed lasting immunity to COVID-19 and hence can return to work or travel freely. In your opinion, do we know enough about COVID-19 immunity and it's duration to offer such immunity passports at the present time?" Possible answers were YES, NO, and UNCERTAIN. Results: The survey was completed by 1004 physicians (67 specialties, 40 countries, 49% frontline specialties) with a mean (SD) age of 49.14 (12) years. Overall, 52% answered NO, 17% were UNCERTAIN, and 31% answered YES (p<0.05). EU physicians were more likely to say YES but even among them it did not exceed 35% approval. US physicians (60%) were more likely to say NO (p<0.05) (Figure). Conclusions: Our findings suggest a current lack of support among physicians for immunity passports. It is hoped that ongoing research and vaccine trials will provide further clarity.

COVID-19 immunity passports are being considered by several countries to facilitate travel and commerce while mitigating spread. 1,2 Proponents argue immunity passports will protect the right to free movement and avoid penalizing those who are immune. 1 Critics worry about insufficient evidence, privacy, passport fraud, and discrimination. 1, 2 We report the results of a September 2020 survey conducted of verified physicians registered with Sermo, a digital platform for medical crowdsourcing. The survey asked: "Digital immunity passports, based on antibody testing, are being considered to offer proof (e.g. via an app or QR code) that a person has developed lasting immunity to COVID-19 and hence can return to work or travel freely. In your opinion, do we know enough about COVID-19 immunity and it's duration to offer such immunity passports at the present time?" Possible answers were YES, NO, and UNCERTAIN.

The survey was completed by 1004 physicians (67 specialties, 40 countries, 49% frontline specialties) with a mean (SD) age of 49·14 (12) years. Overall, 52% answered NO, 17% were UNCERTAIN, and 31% answered YES (p<0·05). EU physicians were more likely to say YES but even among them it did not exceed 35% approval. US physicians (60%) were more likely to say NO (p<0·05) (Figure) .

Our findings suggest a current lack of support among physicians for immunity passports. Even in the EU and Asia, where physicians and researchers have been working with COVID-19 for a longer duration than other parts of the world, physicians in these regions generally believe there is not enough evidence about COVID-19 antibodies to warrant immunity passports. It is possible that the current burden of COVID-19 cases, including the second wave hitting much of the world, has focused physicians on managing the severe, daily problems of morbidity and mortality. 3 From an ethics perspective, vaccine development and movement of people across borders are both community goods, but for a physician workforce faced with daily demands of patients with COVID-19, treatment is a real-time priority and the idea of patient travel is more focused on sending them home from the hospital healthy (rather than sending them off for travel).

. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

The copyright holder for this this version posted November 27, 2020. ;

Overall, a healthy global economy requires a healthy population (those cured of COVID-19 and those prevented from acquiring it). This population will need to move across regions for both leisure and commerce. It is hoped that the ongoing research and vaccine trials will provide answers to many of the unsolved COVID-19 immunology questions. 4, 5 

This anonymous survey was conducted in September 2020 following an online informed consent process. This was a broad survey across many topics of which one question pertained to immunology. De-identified data was analyzed for this report. This was reviewed and deemed exempt research by the Duke University Medical Center Institutional Review Board.

The authors received no external funding support for these analyses and have no financial ties to Sermo. Sermo provided the platform but was not involved in data interpretation, manuscript preparation, or decision to submit. Authors had full access to all the data and accept responsibility to submit for publication.

PMD has received research grants from and/or served as an advisor or board member to government agencies, technology and healthcare businesses, and advocacy groups for other projects, and owns shares in companies whose products are not discussed here. Professor Bramstedt owns a bioethics consulting company (AskTheEthicist, LLC) with industry clients involved in immunology and COVID-19; however, none of her clients were involved in this project.

The scientific and ethical feasibility of immunity passports

Antibodies as Currency: COVID-19's Golden Passport

Clinical Characteristics and Morbidity Associated With Coronavirus Disease 2019 in a Series of Patients in Metropolitan Detroit

COVID-19 and the Path to Immunity

Humoral Immune Response to SARS-CoV-2 in Iceland

The authors thank Sermo and the physicians who took part in the survey.

PMD drafted the paper, and ARL conducted analysis. PMD and ARL verified the underlying data. All authors aided in interpretation of results and manuscript edits.