Remember all the hype about the so-called “passport of immunity” to get the world back on track? The government is still exploring whether certificates, bracelets or mobile applications can make those who have recovered from Covid-19 work and travel again. But the idea that passport holders of immunity will be able to travel to the world, free of masks on planes and tour empty museums and amusement parks without fear of infection, is short-lived. Personal passports might seem basically a good plan, but experts are now sounding their alarms. Body testing is surprisingly inaccurate. Much ado was made when the Emirates airline began testing an antibody prick test on a small group of passengers in March. But when the accuracy rate was found to be around 30%, the Dubai Health Authority, which had carried out the test, banned the test altogether. Think 30% low? It is getting worse. A report by more than 50 scientists found that of the 14 antibody tests on the market, only three gave consistently reliable results (and even all three had problems). The Foundation for Innovative New Diagnostics (FIND), a global non-profit diagnostic organization, estimates that more than 250 antibody tests have been commercialized to date, with more than 30 under development. Nurses in Rome show a fast Covid-19 antibody test kit .TIZIANA FABI / AFPM Following criticism that allowed dubious antibody testing to flood the market, the US Food and Drug Administration announced in early May that antibody test makers had 10 days to provide accurate results or eliminate face of the market. On May 21, the FDA issued about 31 antibody tests from the agency’s official “notification list”, a decision praised by FDA Commissioner Stephen M. Hahn as “an important step taken by the agency to ensure that Americans have access to tests that can trusted. ” Even with a reputable test kit, one might not be enough. The FDA states that a single antibody test may not be accurate enough to know whether members of the general population have Covid-19 antibodies. This recommends a second test – ideally which evaluates antibodies to different viral proteins – to improve the accuracy of the results. If the test becomes more reliable, an immune passport might become a reality. But most likely we have to wait until we have the vaccine. Sharona Hoffman Lecturer in ethics at Case Western Reserve University Not surprisingly, erroneous results can have profound consequences. An article published by Johns Hopkins Bloomberg School of Public Health on April 22 states: “A false negative can prevent a person from returning to work; false positives can cause an epidemic chain.” Noting these inaccuracies, eight contributors to the article concluded that the certificate of immunity “is not a justifiable step at this time.” The presence of antibodies does not mean much. The assumption of testing accuracy increases, passport immunity has another big hurdle to overcome, and that is understanding what the actual results mean. While some antibodies provide immunity to the virus for decades (measles and chicken pox, for example), this is not the case for coronaviruses, in part because of its ability to mutate over time. The World Health Organization (WHO) issued a brief report at the end of April stating there was no evidence that those infected with Covid-19 were protected against a second infection. However, two days later, it was clarified in the tweet that they expected the antibodies to provide “some level of protection.” WHO also warns that antibody tests must be able to distinguish between past infections from SARS-CoV-2, the virus that causes Covid-19, and a set of six other human corona viruses, two of which are MERS and SARS (among which antibodies) convey average immunity average for one and two years, respectively). The other four cause the common cold; those who recover from a lighter coronavirus can expect less immunity against subsequent infections. In the end, Covid-19 antibodies may provide protection against re-infection, but to what extent and for how long is still unknown. This makes the prospect of widespread use of an immunity passport “very unlikely,” said Dr. Sharona Hoffman, a professor of bioethics at the Case Western Reserve University of Medicine. “If the test becomes more reliable, an immunity passport can become a reality,” Dr. Hoffman “But it looks like we have to wait until we have the vaccine.” Peter Gulick, an infectious disease expert at the University of Michigan State University’s Osteopathic Medicine, agrees. “At this point, we don’t know how long these antibodies last, whether a few months or a year,” he said. “Once we have the vaccine, requiring evidence of vaccination, as well as evidence of protective antibodies, it will be far more meaningful and safer for travel.” The travel industry is moving forward. While medical studies continue, the travel industry does not stand still on the sidelines. Eager to get planes in the air and hotels opened, the travel industry is formulating new ways to attract tourists back, walking the line between ensuring customer safety and not needing to disrupt their travels. Better than persuading those who have positive antibody test results, some opt for more accurate nasal swab molecular tests, also known as PCR tests, which detect active Covid-19 infection. The Telegraph reported last week that the Maldives plans to reopen tourists in July with plans to make the Covid-19 molecular test mandatory for all tourists. Sha Wellness Clinic, a medical and hotel clinic in southeastern Spain, requires all guests to give two negative tests – one taken several days before arriving and another at check-in. Travelers who are far socially awaiting the results of saliva samples at the corona virus testing facility at the AsiaWorld-Expo in Hong Kong on Thursday, May 14, 2020.Laurel Chor / Bloomberg Most countries and companies that reopen for summer travel choose the option that is lacking invasive, such as health checks, cleaning improvements, and social distance guidelines. In particular, the journey continues, and the absence of an immunity passport does not seem to hold airlines, shipping companies or hotels back. Official, legal and public policy concerns. Passport law appeals to anyone who longs for life as usual (ie all of us), but consider the consequences of certain sectors of society to be able to move, gather, travel and work freely – while others cannot. This is the subject of an article in the well-known medical journal “The Lancet.” Vulnerable populations, such as those who cannot afford long periods of time without work, may be motivated to look for infections, which can exacerbate existing racial and gender inequality, not to mention the level infection. Evidence of immunity can be a requirement for recruitment, and a black market for fake immunity documents can develop. In addition to the issue of discrimination, author Alexandra L. Phelan distinguishes between the WHO Carte Jaune, or the Yellow Card (which shows evidence of vaccination), and immunity passports by stating: “Vaccination certificates give individuals incentives to get vaccinated against viruses, which are social goods. Instead , a passport of immunity provides an incentive for infection. ” . Thomas Trutschel / Photothek A similar situation developed during the yellow fever outbreak in the US during the 19th century, which resulted in people who were not exposed to the disease being denied employment and housing. “City dwellers of that time tried to prove they had yellow fever to get a job,” Hoffman said. “People are looking for exposure and hope to live through it will be considered as acclimatization and have job opportunities. But many of them died after being exposed.” The United Kingdom is driving a passport program that uses testing and facial biometrics to identify those who use Covid-19. antibodies (despite the emphasis on work, not traveling), while Germany decided to seek advice from the national ethics council before using millions of antibody tests purchased from the Swiss pharmaceutical company Roche. If an immune passport is issued, there may be a population that does not have access to antibody tests or ways to pay for it, Hoffman said. “Hopefully, we will have a program that will make antibody tests very accessible, maybe even free for people who don’t have health insurance.” potential passport holders yet. For an immunity passport to work, there must be enough people who have them to make a significant effect on the travel industry. While countries with the highest Covid-1 infection rate – that is, the United States, Brazil, Russia, Peru, India and parts of Western Europe – may have the best reasons for making an immune passport, the number of those who have recovered in these countries maybe not enough to make the development of a valuable program. More than 6.3 million people have been infected with Covid-19 worldwide, a number far smaller than the estimated 1.4 billion international tourist arrivals in 2018.d3sign. Although this varies by region, it is estimated that no more than 5% of this amount. the population has antibodies (conversely, about 70% of the population needs to have antibodies, either through recovered infection or vaccination for herd immunity). Countries that have succeeded in “leveling the curve” – such as Australia, New Zealand, Vietnam, Hong Kong and Taiwan – have fewer cases, and thus fewer incentives to create an immunity passport program. What is a good antibody test for the moment? Although they might not be the golden ticket to travel the world, antibody tests are very important for other reasons. It can track the level of pandemics in a particular region, improve modeling data and (finally) determine which frontline workers can work with an infected person. Singapore has effectively used antibody tests to track the Covid-19 group. People with antibodies can donate plasma to help those currently fighting the disease and prioritize later vaccinations if it is determined they already have some level of immunity. If an immune passport won’t work, what will happen? Rather than an immune passport, a “digital” health passport – which can contain positive antibody test results, recent negative Covid-19 test results and finally, proof of vaccination – may be a more useful type of travel document to carry in the future. health can reduce some, but not all, of the problems inherent in passport immunity, although considerations of privacy and international cooperation must be addressed to make the health passport program work.