Implementing digital passports for SARS-CoV-2 immunization in Canada

By Kumanan Wilson MD MSc, Colleen M. Flood SJD

• Cite as: CMAJ 2021 April 6;193:E486-8. doi: 10.1503/cmaj.210244; early-released March 3, 2021

The emergence and deployment of vaccines for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that are safe and effective offers hope for the alleviation of the enormous social, economic and health tolls of the coronavirus disease 2019 (COVID-19) pandemic. Public authorities and private entities may soon require people to provide proof of immunization to SARS-CoV-2 in certain contexts as an adjunct to efforts to safely re-open society. “Immunization passports” or certificates would allow bearers to show proof of adequate vaccination. We discuss how SARS-CoV-2 immunization passports could work, the infrastructure required to operationalize them and potential barriers and limitations to their use.

Proof of immunization is far from a new idea; during campaigns for the smallpox vaccine, the vaccine scar often served as this proof and gated access to such things as train travel.1 In Canada, certain provinces require proof of immunization for school entry.2 Internationally, proof of vaccination against yellow fever is required for entry into countries where the disease is endemic, as outlined in Annex 7 of the International Health Regulations.3,4 In the current context, a move to digitize vaccination records and to use digital immunization passports to safely open activities and events to those able to prove their immunity is novel.

The World Health Organization (WHO), International Air Traffic Association and World Economic Forum have explored potential standards and mechanisms for the implementation of immunity passport solutions,5–7 reflecting the likelihood that their first implementation would be for international travel. However, their use may be extended to proving immunity for certain workplaces and mass gatherings. Several concerns have been raised in the past about immunity passports that focus on natural immunity.8 We believe the use of passports will be restricted to immunity conferred by vaccines, as there is more scientific evidence for immunity from vaccines than from natural immunity.

In Canada, a digital passport for SARS-CoV-2 immunization could take the form of a a scannable bar code or Quick Response (QR) code showing vaccination status, which would be stored on a smartphone device in the same way as an airline boarding pass. The passport could be downloaded from a provincial or territorial immunization repository through a government portal and be linked to an individual’s identity. On seeking entry to a restricted place or activity, the passport holder would present it to be scanned for verification of the holder’s immunity status. The bar code would include a cryptographic digital signature so that the verifier would know that the passport was issued by a trusted entity, such as a provincial or territorial government. The system used to scan the bar code would require the ability to check whether the immunization record satisfied current public health guidelines on which vaccine products, dose intervals and dose counts confer adequate levels of immunity based on currently available evidence. The passport holder may also need to provide proof of identity with government-issued photo identification.

To enable effective digital immunization passports, governments will need to establish several core requirements, such as those articulated by the Royal Society in the United Kingdom (Box 1).9 The foundation of any system must be an accurate and comprehensive digital vaccination record in a government repository, with a mechanism to give people access to their records and those of their children and dependents. In certain provinces, emerging digital identity solutions may help people securely access their 

health data through third-party applications, which may be used for return-to-work solutions. Governments will need the capability to generate and issue cryptographically signed immunization records. Software, implemented in a standardized fashion, will be required to verify vaccination status and to determine whether immunization passports meet current requirements for entry or access. Mechanisms must also exist to revoke passports if, for example, data emerge that new variants of SARS-CoV-2 are resistant to vaccines. The questions of what vaccination series constitute immunity, and for how long immunity is established after completion of the vaccination series, will be challenging to answer, as variations are already occurring with the recommended vaccine schedules.

The development and implementation of an immunization passport must occur with input from legal and ethical experts.10 Safeguards must be in place to protect the privacy of people’s information, for example when third parties are logging into the system to verify vaccine status. Although the information in an immunization passport should be verifiable without making a request to the government issuer, certain edge cases, such as passport revocation, may require the verifier to check the validity of the passport against the issuer’s server, which creates the potential for the issuer to track the location of passport holders.

Access to vaccines is another important ethical concern when considering the use of immunization passports. The deployment of such passports in Canada may need to be limited until population-wide access to vaccines is established. In the meantime, there may be situations where people are required to show either proof of vaccination or proof of recently testing negative for SARS-CoV-2 to obtain access to a restricted activity such as air travel. However, those who cannot be vaccinated should not be discriminated against or be denied access to services.

Access to technology may be a barrier to using immunization passports. Bar codes or QR codes could be printed on paper, although those without access to digital devices will likely be disadvantaged by not having easy access to records. The need for proof of identity could unfairly restrict access among marginalized populations who do not have this proof. Technological 

development should occur in concert with legal and ethical review to ensure that the solution is the least restrictive means of reopening society, without adversely affecting populations that are already marginalized.

In Canada, further complexities exist for the implementation of digital immunization passports, related to technological maturity, the absence of digital identities and our federated system of government. The federal government will need to consider international standards that are designed for international travel, and potentially facilitate their adoption by provincial governments for other purposes. At the federal level, the National Advisory Committee on Immunization should establish standards for what constitutes vaccination-derived immunity. As general responsibility for immunization resides with provinces and territories, they should develop digital immunization records that are accessible from their immunization repositories and that respect privacy and other human rights concerns as much as possible. However, these provincial efforts should be guided by a federal or international standard. If governments do not develop the necessary capacity to implement immunization passports, it is likely that private corporations (e.g., airlines and large event venues) will develop their own requirements and systems, potentially leading to problems related to equity, privacy and coercion.

We expect that immunization passports will be imminently introduced for international travel. Canada will need to ensure alignment with global standards for security, authentication, privacy and data exchange, developed by the WHO Smart Vaccination Certificate initiative.5 This initiative would further benefit from creating international standards for what constitutes immunity and standardizing approaches to gating access as evidence on immunity changes. A properly constructed approach to immunization passports, tested first for international travel, could help to limit the spread of SARS-CoV-2 while allowing the global economy to be revitalized.

References

1. Keelan J. Risk calculus and theories of viral attenuation in debates over compulsory smallpox vaccination in Montreal, 1870–1877. In: Kroker K, Keelan J, Mazumdar P, editors. Crafting immunity: working histories of immunological practice (History of medicine in context). Farnham (UK): Ashgate Publishing; 2008:29-54.
2. Immunization of School Pupils Act, R.S.O. 1990, c. I.1.
   • Available: www.ontario.ca/laws/statute/90i01 (accessed 2021 Jan. 27).
   • Mirror:  https://archive.li/1hOgr (archived 2021 Apr. 10)
3. Wilson K, Atkinson KM, Bell CP. Travel vaccines enter the digital age: creating a virtual immunization record. Am J Trop Med Hyg 2016;94:485-8.
4. International Health Regulations (2005) third edition. Geneva: World Health Organization; 2016.
   • Available: www.who.int/publications/i/item/9789241580496 (accessed 2021 Feb. 27).
   • Mirror: archive.li/C97cR (archived 2021 Apr. 10) 
5. Smart Vaccination Certificate Working Group: about us. Geneva: World Health Organization.
   • Available: www.who.int/groups/smart-vaccination-certificate-working-group (accessed 2021 Jan. 27).
   • Mirror: https://archive.li/O6SWu (archived 2021 Apr. 04)
6. IATA Travel Pass Initiative. Montréal: International Air Transport Association (IATA).
   • Available: www.iata.org/en/programs/passenger/travel-pass/ (accessed 2021 Jan. 27).
   • Mirror: https://archive.li/bzWzK (archived 2021 Apr. 10)
7. CommonPass. The Commons Project. Available:
   • https://thecommonsproject.org (accessed 2021 Jan. 27).
   • https://archive.li/y69cQ (archived 2021 Apr. 02)
8. Kofler N, Baylis F. Ten reasons why immunity passports are a bad idea. Nature 2020;581:379-81.
9. Twelve criteria for the development and use of COVID-19 vaccine passports. The Royal Society; 2021 Feb. 14.
   • Available: https://royalsociety.org/news/2021/02/12-challenges-for-vaccine-passports/ (accessed 2021 Feb. 20).
   • Mirror: https://archive.li/hYorx (archived 2021 Apr. 20)
10. Persad G, Emanuel EJ. The ethics of COVID-19 immunity-based licenses (“immunity passports”). JAMA 2020;323:2241-2.

Competing interests: Kumanan Wilson is the CEO of CANImmunize Inc. CANImmunize is currently not developing an immunization passport but has been asked to provide input on proof of immunization status for COVID-19. CANImmunize has received funding from public and private sources (https://www.canimmunize.ca/en/partners).
Dr. Wilson owns shares of CANImmunize and does not receive renumeration for his activities as company CEO. He is a member of the independent data safety board for the Medicago COVID-19 vaccine trial. No other competing interests were declared.

This article has been peer reviewed.

Affiliations:

• Department of Medicine (Wilson), School of Epidemiology and Public Health, University of Ottawa;
• Bruyère Research Institute and Ottawa Hospital Research Institute (Wilson);
• Faculty of Law (Flood), Common Law Section, University of Ottawa; University of Ottawa Centre for Health Law Policy & Ethics (Flood), Ottawa, Ont.

Contributors: Both authors contributed to the conception and design of the work, drafted the manuscript, revised it critically for important intellectual content, gave final approval of the version to be published and agreed to be accountable for all aspects of the work.

Content licence: This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is non-commercial (i.e., research or educational use), and no modifications or adaptations are made.
See: https://creativecommons.org/licenses/by-nc-nd/4.0/

Funding: This research is funded in part by the COVID-19 Immunity Task Force, launched by the Government of Canada in collaboration with Canadian Institutes of Health Research.

Acknowledgements: The authors thank Cameron Bell for guidance on the technological architecture related to digital immunization passports and Bryan Thomas for his contributions on this topic.

Disclaimer: Kumanan Wilson is married to an employee of CMAJ, who was not involved with the editorial decision-making process for this article.

Correspondence to: Kumanan Wilson, kwilson@ohri.ca

You can download the archived (PDF) directly from this Covfefe Bakery Cafe or just perv the historical embed mirror'd below.

• "Wilson is married to an employee of CMAJ, who was not involved with the editorial decision-making process for this article."
  Editor: We stand to gain from forcing this mark on the forehead or palm, and into the arm of every Canadian, but just "Trust us", right?

Original article from CMAJ (Canadian Medical Association Journal) Group at Implementing digital passports for SARS-CoV-2 immunization in Canada and be amazed at the ballsiness of Kumanan Wilson. He happens to be the CEO of CANImmunize Inc, and is married to an employee of the publishing organization CMAJ who is acting as his fluffer. But don't worry, they said that they're not sleeping in the same bed...

Dr Kumanan Wilson is a Registered Canadian Resident living at 490 Golden Avenue, Ottawa ON K2A 2E5, Canada. It is alleged that he is married to Kim Barnhardt, Senior Strategist, Communications and Partnerships, CMAJ (Canadian Medical Association Journal). He disclosed this connection when they published, at her behest, his paper on Implementing digital passports for SARS-CoV-2 immunization in Canada.

However, it is reported that he did not disclose the fact that he has received funding from He has received financial support from multiple organizations including the Canadian Institutes of Health Research (CIHR), the World Health Organization (WHO), The Bill & Melinda Gates Foundation and Canada’s Immunity Task Force.
Source: Ottawa Hospital, Researcher Profile
Archived at Archive.today

Additionally, it is also alleged that he has not yet made good on his annual filings for his newly minted shell corporation CANImmunize Inc. You know, the one which has a very cookie-cutter laundromat look and feel to its corporate structure. He's probably too busy taking calls from Mr Gates and Mr Ford, suggesting for them to follow the advice of his wife, Kim Bernhardt.. err, Canadian Medical Association Journal.

His wife, Kim Barnhardt, is the Senior Strategist, Communications and Partnerships, for the CMAJ (Canadian Medical Association Journal), so no, not that big of a deal. Nothing to see here.

CANImmunize Inc.

• Incorporator: Kumanan Wilson
• Board of Directors:
  1. Kumanan Wilson

ARTICLES OF INCORPORATION

On December 19, 2018 Dr Kumanan Wilson incorporated CANImmunize Inc. with a registered office of:

• 1 Calvert Street,
  Ottawa ON K2G 1M3

 pursuant his articles as follows:

• DIRECTORS:
  At least one (1) director, but no more than ten (10) with no restrictions on the business the corporation may carry on.
   
• SHARES:
  The Corporation is authorized to issue unlimited shares of each class, A, B, C. These will be explored further down the article.
   
• FILING:
  Dr K. Wilson filed his first and presumably only (because, COVID of course) annual return on or about December 19th, 2019, but as of April 10th, 2021 there is no record of his having done his requisite annual filing for 2020.
   
• SIGNALS:
  For the purposes of communicating with Dr Kumanan Wilson or his wife Kim Barnhardt, please direct any mail/inquiries to his registered cellular device at 613-878-7238, their shared phone at 613-728-4837, or even contact him via post at:
  490 Golden Avenue, Ottawa ON
  K2A 2E5, Canada

Peace be with you, patriots.

CANImmunize Inc.

• Incorporator: Kumanan Wilson (married to Kim Barnhardt)
• Board of Directors:
  1. Kumanan Wilson

EMPLOYEES OF THE CORPORATION

On December 19, 2018 Dr Kumanan Wilson incorporated CANImmunize Inc. with a employees listing including, pursuant his website as follows:

• Chief Executive Officer

  • Dr. Kumanan Wilson, MD, MSc, FRCP(C)
  • An internal medicine physician, scientist and expert in digital health, Dr. Wilson is an internationally, widely published expert in public health and immunization and the founder of the CANImmunize project.  Currently funded by the Bill & Melinda Gates Foundation and the World Health Organization Dr. Wilson’s vision is to use technology to solve public health problems.
     

• Chief Operating Officer

  • Katherine Atkinson, BSc, PhD (cand).
  • Katherine has worked with the CANmmunize project since its inception.  A passionate believer in the power of digital technology Katherine is a published expert in mobile technology and immunization. Katherine is currently a PhD candidate at Karolinska Institutet where she is learning how to improve immunization systems with digital technology.
     

• Chief Technology Officer

  • Cameron Bell, B.Eng.
  • Cameron is responsible for developing the original versions of CANImmunize (ImmunizeON/ImmunizeCA) and has been the architect of the project ever since. Cameron is a leading expert in immunization systems and built the Canadian Vaccine Catalogue.
     

• Software Engineer

  • Jordan Gignac
     

• Lead, CANImmunize Labs

  • Taylor Rubens, MPH
     

• Software Developer

  • Rayhan Moidu
     

• In-House Counsel & Privacy Officer

  • Pascal Thibeault
     

• Quality Assurance Analyst

  • Marlene Elliott
     

• Software Engineer

  • Margo Collins
     

• Software Developer

  • David Gao
     

• Full Stack Developer

  • Esteban Romo
     

• Communications Advisor

  • Kim Barnhardt