COVID-19 Vaccine Passports – Golden Keys to Freedom or Rubber-Stamps Curtailing Our Rights?
As the world attempts to resume post-COVID, the challenge now is to do all that is possible to curb the spread of the virus, including implementing travel regulations.
SUARA MANDIRI Issue #9
Couples and families wander along a white sandy beach, watching the sunset as the sea breeze caresses their faces. Children indulge in water fights and yell with delight as rolling waves crash against the rocks, splashing over them.
These scenes are no longer nostalgic flashbacks to the good old days before the COVID-19 pandemic upended the globe and put an end to large-scale gatherings, enforcing a “new normal” of trading in vacations to do our collective part staying at home and keeping our communities - and thus by extension the world - safe. Now, it has returned to reality as Thailand pioneers Southeast Asia's tourist reopening with the "Phuket Sandbox" programme, which began on July 1. As of October 15, Phuket has welcomed almost 48,000 international visitors to soak in the tranquil atmosphere after spending more than a year confined at home.[1]
However, some travelling procedures have changed due to the country's decision to hit the restart button and breathe life back into the tourism sector. A significant distinction is these travellers now arrive at their destinations with an additional form of documentation in their hands - a virtual certification known as a vaccination passport.
So, what are vaccination passports?
A vaccination passport is essentially a document certifying the immunisation of the bearer against specific infectious diseases and hence declaring the bearer to be safe for travel within or outside of a country. It has become a critical component in restoring the vibrancy of tourism operations by eliminating travel restrictions and assisting in the reopening of economies without jeopardising public health.
Vaccine passports are not something new. Some countries have long required proof of vaccination against diseases such as cholera, yellow fever and smallpox before entering their countries, in the form of an International Certificate of Vaccination or Prophylaxis (ICVP) known as the “Yellow Card” issued by the World Health Organization (WHO).[2]
In contemporary times, the European Union (EU) has become one of the first regions to issue a vaccine passport specifically for COVID-19, introduced as the EU Digital COVID Certificate Regulation in June this year and subsequently rolled out in July, allowing EU citizens and residents with the vaccine passport to forego free movement restrictions within the region.[3]
With COVID-19 affecting nearly every country on the planet, there have been requests for an updated, digitised version of the yellow card to verify vaccination status. Some countries have jumped on the vaccine passport bandwagon or are considering doing so. According to a poll conducted by market research firm Ipsos in March 2021, more than three-quarters of respondents surveyed (78%) across 28 nations think travellers entering their country should be required to have COVID-19 vaccination passports.[4]
However, the allure of a vaccine passport for globetrotting adventurers does not exist without controversy.
A Yay or A Nay for Vaccination Passports?
One of the frequently cited arguments against vaccine passports is, they violate the rights and civil liberties of unvaccinated individuals. Depending on the varying regulations adopted by different countries, unvaccinated individuals are restricted from various social activities, ranging from accessing public areas to attending large-scale events and travelling.
The group of individuals with doubts about vaccines and who refuse to take them are commonly referred to as vaccine-hesitant individuals. According to WHO, such hesitancy is caused by numerous factors, including complacency, inconvenience in accessing vaccines, and lack of confidence.[5]
Some anti-vaxxers, strongly opposed to vaccination, make and convey assumptions and accusations to the community and people around them. These include claims of vaccines being “experimental mRNA gene modifiers,” “bioweapons”, and “nanotechnology microchips” used to link people to the 5G network.[6] Indirectly, this encourages a broader group of people to reject vaccines, putting them on a dangerous trajectory.
The Vaccine and The Vulnerable Group
While efforts to make the vaccine accessible for all Malaysians is a valiant cause, non-Malaysians must not be ignored. However, this is not to say non-Malaysians within Malaysia are not getting vaccinated. There are vaccination centres set up specifically for undocumented migrants, but many are still hesitant to step forward to receive the vaccination [7]. This is no surprise considering the fact during Malaysia’s first lockdown last year, a number of undocumented migrants were threatened with deportation and blamed for spreading the disease.[8]
Continuous efforts are being made to ensure that Malaysia is on track to achieve herd immunity. These vaccination centres are not only open to undocumented migrants, but also to asylum-seekers registered with the UNHCR.[9] Despite hesitancy to approach vaccination centres, only 200,000 undocumented workers have been vaccinated as of October 16, 2021.[10]
Though walk-in vaccination centres have been successful to a certain extent in encouraging undocumented foreigners to get vaccinated, its service for undocumented foreigners ended on 23 August 2021.[11] Following this development, undocumented foreigners may become dubious about the commitment of the government to not arrest them, and may even construe this as wanting to keep their personal records for ill intentions and further actions against them in the near future.
Malaysians living in rural areas, often those within the B40 demographic, also face issues in attaining vaccinations, as their residences are not within close proximity to available vaccination centres. Accordingly, mobile vaccination clinics have been deployed by the health authorities to travel through rural areas to administer vaccines.[12] Hence, people who live more than 25km away from the nearest vaccination centre would still be able to receive their vaccinations akin to their urban counterparts.
Currently, the government has been working together with various non-profit organisations (NGOs) such as Mercy Malaysia and Red Crescent Malaysia to support the vaccination programmes in remote areas. Further, clinic practitioners are allowed to administer vaccinations in villages. In overcoming the lack of manpower, more collaborations are urged between the government, private sectors and NGOs as all hands are needed on deck to improve access to COVID-19 vaccines for everyone.[13]
Legal Issues
At present, all federal civil servants in Malaysia are required to be fully vaccinated against COVID-19 before Nov 1.[14] However, does the government have the power to enforce this? Surat Aku Janji, required to be signed by all the civil servants, contains a provision requiring civil servants to carry out their duties carefully, attentively, efficiently, honestly, trustworthily, and responsibly.[15]
Rejecting vaccines without good medical reasons will only expose the risk of COVID-19 to the public while the civil servants are discharging their duties and this is a grossly irresponsible act. Their reluctance might also discourage the public from getting vaccinated. Therefore, it is valid and even essential for the government to impose sanctions on the civil servants refusing to receive their vaccines without reasonable grounds.
Although the government would likely not issue a federal mandate to make vaccination compulsory, vaccine deniers will not have it easy according to the warning issued by Health Minister Khairy Jamaluddin on October 16. This raises some legal issues, particularly three main arguments against vaccine passports.
First, some claim the imposition of vaccine passports encroaches on individual freedom. They feel the government should not use the vaccine passports as a ‘threat’ to coerce people to get vaccinated against their will. In this context, individual freedom is not absolute and in fact, it is subject to constraints. Individual autonomy must be weighed against public interest and should only be allowed if that autonomy is not contrary to the public interest. This is precisely the reason why it can be deemed justifiable for the law to punish those claiming Ivermectin to be a COVID-19 treatment or anti-vaxxers spreading fake news regarding vaccines.
While some may say rejecting the vaccines will not cause much harm to the public since 90% of the population have been vaccinated and herd immunity has been achieved, SARS-CoV-2 has proven to be capable of mutating into different variants of the original agent. An unvaccinated pool of individuals becomes a hotbed for the virus to continue to grow and multiply, and therefore more opportunities for variants resistant to the vaccines to emerge, infecting even the vaccinated population.[16]
Herd immunity requires most, if not all, individuals to contribute by getting vaccinated. If all or most of the population think their choice is insignificant and choose not to get vaccinated, herd immunity will always be a distant dream. For this system to work, it is necessary to eliminate free riders. Hence, the onus is on the government to either mandate all individuals to get vaccinated or offer incentives such as vaccine passports, to encourage more vaccinations.
Preventing people without vaccine passports from entering premises or crossing borders has also been argued to be discriminatory. Although there are still people in Malaysia without access to the vaccines, an overwhelming majority of the population can simply get their vaccines in one of the walk-in vaccination centres. The application of vaccine passports are based on science and data, and unvaccinated people are refused entry into premises due to scientific reasoning instead of arbitrary ones like those of the anti-vaxxers, hence the argument of it being discriminatory falls short.
Turning To Alternative Medication Instead of Being Vaccinated
There has been no shortage of chainmail and WhatsApp messages warning people of the dangers of receiving the COVID-19 vaccine. Within these forwarded messages, discussions on available alternatives for those who do not wish to be vaccinated have burgeoned.
One of the more infamous ones would be the opted use of Ivermectin. Ivermectin is a drug used to treat those with parasitic infections.[17] While typically used to treat heartworm within animals, it is also prescribed to those experiencing diseases such as hookworm and scabies. It is only advised for people to ingest Ivermectin with a prescription from a medical doctor.
According to an ICU specialist who wishes to remain anonymous, a majority of those inquiring about Ivermectin are people from the older generations. Hospitals have seen their share of cases where patients decide to self-medicate with Ivermectin and end up with worsened conditions due to the adverse side effects of the medication. As a frontliner actively dealing with COVID-19 patients, he strongly condemns the usage of Ivermectin as a cure or prevention against COVID-19.
“As a clinician and medical doctor, I base my clinical treatment decisions on evidence-based medicine. As of now, worldwide, there is no evidence of ivermectin improving outcomes or reducing mortality in COVID-19.”
Although most cases of partaking in alternative medication may stem from anti-vax reasons, people with underlying illnesses, apprehensive of the potential reaction of the vaccines on their bodies and health, fall within the cracks. Mixed Connective Tissue Disease (MCTD), an incurable, rare autoimmune disease, potentially causing lupus, scleroderma and polymyositis, is such an exception.[18]
Judith Elise Gomez, suffering from MCTD, stated that while she was excited when vaccinations were announced to be beginning soon, she was worried for herself as she feared her immune system might not be strong enough to build immunity to fight against the vaccine. “If I'm being honest, I was also concerned about what other people might think of me for not getting the vaccine,” said Judith.
After consulting with her holistic doctor, she was advised to wait and only take the vaccine once it became absolutely necessary, for her body to build up the strength to withstand the effects of the vaccine. She was also advised to register for the Sinovac as it was the safest option for her, compared to the other vaccinations. After hearing Malaysia running out of Sinovac, Judith quickly registered for the vaccination. While waiting for her vaccination, she could only strengthen her immune system by taking algae supplements to calm and control the symptoms she feels due to her MCTD. Further, she had to regulate her diet and notice any triggers potentially deteriorating her health.
For Judith, she thinks it is unfair to strip somebody of their right to choose whether or not they should get vaccinated. “I think the line gets blurred really easily between the autonomy one has over their body versus what is in the public's best interest. This makes it difficult to identify a definitive line,” she says. While she does think it is unfair to strip people of their bodily autonomy, she feels people who make it their choice to not be vaccinated must be fully ready to accept the consequences of their actions such as not being able to travel and dine in. This is only fair to those vaccinated and who wish to preserve the health of the general public.
Alternatives to Vaccination Passport
Several countries, such as the United Kingdom (UK), have abandoned plans to introduce vaccine passports in favour of implementing frequent testing.[19] As the goal of vaccination passports is to reduce the spreading of the COVID-19, a negative COVID-19 test or an antibody test would similarly be reasonable for an individual to establish their health status.
Such alternatives, however, are only feasible if the affordability of COVID-19 self-test kits is increased. Some experts in Malaysia have warned the RM19.90 ceiling retail price for COVID-19 rapid antigen self-test kits is still too high, especially for low and middle-income groups, such as those in the B40 group with big families.[20] Thus, consumer and health advocacy groups have called on the government to subsidise or provide free COVID-19 self-test kits to low-income families.[21]
Further, the Malaysian government could emulate the UK's current COVID-19 testing guidelines and make COVID-19 test kits widely available. For instance, the UK government now allows its citizens to order a PCR test kit to be sent to their home or book an appointment at a walk-in or drive-through test site by calling 119 or through their official website and it is free of charge.[22]
If COVID-19 test kits become generally available and affordable, the ability to administer routine COVID testing would be beneficial in allowing more people to enter public spaces without requiring the introduction of COVID-19 vaccine passports.
Conclusion
With the issues raised, it begs the question, is the vaccine passport proof of us moving one step closer to returning to the normalcy we crave, or is it a bar placed on the community, cornering them to make a decision? Are people getting vaccinated to ensure the safety of the community, or do they simply not wish to be denied entry into malls and cinemas? Vaccination is not something as simple as a jab. It is no longer just an injection to protect you from an onslaught of diseases, it is a preventative measure to curb the spread of a highly contagious disease responsible for the loss of millions of lives.
While bodily autonomy should be prioritised, it becomes a problem when personal choices begin to affect the livelihoods of others. In the case of getting the vaccine, one’s personal choice of not getting the vaccine might snowball into creating a cluster of infections, and consequently send the country spiralling into another lockdown. Bodily autonomy can be prioritised when the choices one makes is something entirely under their control and only affects them as a person. Once it becomes a question of the general health of the community, public safety should take the top priority. A rotten apple spoils the whole barrel, after all.
If you have not received your vaccination, please make sure you are registered via your MySejahtera app or by contacting your nearest vaccination distribution centre that can be found here. If you are awaiting your vaccination dates, remember to adhere to the safety procedures in place to protect yourself and others.
References:
[1] ‘Though numbers have fallen short, the 'Phuket Sandbox' sets the stage for Thailand's tourism revival’ The Star (18 October 2021) <https://www.thestar.com.my/aseanplus/aseanplus-news/2021/10/18/though-numbers-have-fallen-short-the-039phuket-sandbox039-sets-the-stage-for-thailand039s-tourism-revival> accessed 29 October 2021.
[2] ‘Yellow card’ World Health Organisation <https://innov.afro.who.int/emerging-technological-innovations/yellow-card-3525> accessed 29 October 2021.
[3] ‘EU Digital COVID Certificate’ European Commission <https://ec.europa.eu/info/live-work-travel-eu/coronavirus-response/safe-covid-19-vaccines-europeans/eu-digital-covid-certificate_en> accessed 29 October 2021.
[4] Diyana Pfordten, ‘Vaccine passports – the what, how, why and why not’ The Star (6 May 2021) <https://www.thestar.com.my/news/nation/2021/05/06/interactive-vaccine-passports---the-what-how-why-and-why-not> accessed 29 October 2021.
[5] World Health Organisation ‘Ten Threats to Global Health in 2019’ <https://www.who.int/news-room/spotlight/ten-threats-to-global-health-in-2019> accessed 29 October 2021.
[6] ‘Anti-vax app squares off with Google, Apple over misinformation’ The Star (2 August 2021)
<https://www.thestar.com.my/tech/tech-news/2021/08/02/anti-vax-app-squares-off-with-google-apple-over-misinformation> accessed 29 October 2021.
[11] ‘LETTER | Make it easier for foreign workers to get vaccinated’ Malaysiakini (6 September 2021)
<https://www.malaysiakini.com/letters/590179> accessed 3 November 2021.
[13] ‘JKJAV ramps up vaccination programme in rural areas, sees encouraging response’ The Edge Markets (20 June 2021)
<https://www.theedgemarkets.com/article/jkjav-ramps-vaccination-programme-rural-areas-sees-encouraging-response > accessed 3 November 2021.
[14]’Unvaccinated civil servants in Malaysia may face disciplinary action or termination: Public Service Department’ CNA (19 October 2021)
<https://www.channelnewsasia.com/asia/malaysia-unvaccinated-civil-servants-disciplinary-action-service-termination-2254526> accessed 29 October 2021.
[15] ‘SURAT AKU JANJI’ <https://www.spp.gov.my/images/MuatTurun/PSST/guru/5_surat_aku_janji.pdf> accessed 3 November 2021.
[16] Emanuel Goldman, ‘How the unvaccinated threaten the vaccinated for COVID-19: A Darwinian perspective’ Proceedings of the National Academy of Sciences of the United States of America (28 September 2021)
<https://www.pnas.org/content/118/39/e2114279118> accessed 29 October 2021.
[17] ‘Ivermectin (Systemic)’ Drugs.com <https://www.drugs.com/monograph/ivermectin-systemic.html> accessed 29 October 2021.
[18] Mayo Clinic ‘Mixed connective tissue disease’ <https://www.mayoclinic.org/diseases-conditions/mixed-connective-tissue-disease/symptoms-causes/syc-20375147> accessed 29 October 2021.
[19] Marie Jackson, ‘England vaccine passport plans ditched, Sajid Javid says’ BBC News <https://www.bbc.com/news/uk-58535258> accessed 1 November 2021.
[20] Goh Pei Pei, ‘COVID-19 self-test kit should be priced below RM10, says Sarawak DAP’ The Star <https://www.nst.com.my/news/nation/2021/09/723674/covid-19-self-test-kit-should-priced-below-rm10-says-sarawak-dap> accessed 1 November 2021.
[21] Junaid Ibrahim, ‘Make testing kits more affordable’ The Star <https://www.thestar.com.my/news/nation/2021/08/25/make-testing-kits-more-affordable> accessed 1 November 2021.
[22] ‘Get a free PCR test to check if you have coronavirus (COVID-19)’ Gov.UK <https://www.gov.uk/get-coronavirus-test> accessed 1 November 2021.