Give Vaccine Passports a Chance | Opinion

The New York vaccine passport simply acknowledges what public health experts have understood since early in the pandemic, crowds of people, indoors, without masks create an epidemiological powder keg just waiting for a spark. The real questions to ask are whether this provides enough safety, and if so, should it be implemented nationally?

Will it Work?

We knew from the outset that the SARS CoV-2 vaccines dramatically reduce rates of infection, rates of symptoms and disease severity. But that was alpha. This is delta.

The Centers for Disease Control and Prevention (CDC), in justifying their renewed calls for mask mandates, warned that the delta variant is more contagious and probably causes more severe disease than the original, alpha variant. They also warned that the rate of transmission among vaccinated people may be higher.

A key motivating factor in this was the recent findings related to an outbreak in and around Provincetown, Massachusetts. In that outbreak of 469 cases of COVID-19, 74 percent occurred in people who had been vaccinated. Some will argue that this is evidence that the vaccine doesn't really work and any sort of mandatory vaccination puts people at unnecessary risk from the vaccine. A closer look at the data makes the opposite case.

The Pandemic and Provincetown

Of almost 35 million Americans who have had COVID-19, 7.2 percent have required hospital care. The effectiveness of the vaccines in reducing rates of hospitalization and death justified the emergency use authorization for the vaccine. Of the 346 vaccinated people who tested positive from Provincetown, only four were hospitalized, a rate 88 percent lower than the baseline rate from national data. Nobody died. In other words, the vaccine performed exactly as promised in this most important role.

But what about all those cases? First, it should be noted that this population probably had very high rates of vaccination, likely in excess of 90 percent, perhaps as high as 95 percent. If so, the rate of infection among unvaccinated visitors was six times compared to the vaccinated. So, it reduces transmission dramatically.

And we don't even know if those who brought the virus to Provincetown were vaccinated. This may well have been driven by unvaccinated cases. In fact, there is no direct evidence of spread from one vaccinated person to another.

New York State Excelsior Pass
This illustration photo taken in Los Angeles on April 6, 2021, shows a person looking at the app for the New York State Excelsior Pass, which provides secure, digital proof of a COVID-19 vaccination, in front of a screen showing the New York skyline. CHRIS DELMAS/AFP via Getty Images

Finally, it is important to understand the level and types of crowding and contact that occurred during Bear Week festivities in Provincetown. Google the images. Not your typical Manhattan restaurant scene.

The Bottom Line

Being in crowds indoors, especially if you take off a mask to eat or drink, may still pose a risk. In fact, it has always posed a risk of infection, we just weren't measuring it as carefully. What we do know is that, among those who are unvaccinated, the risk of infection, serious disease and death as well as the risk of transmission to others is dramatically higher.

Can we completely eliminate risk? No. But like masks, vaccines serve the function of not simply protecting us, but protecting our community.

Letting COVID-19 spread among a partially vaccinated population is like a person with a bacterial infection taking antibiotics at too low a dose. It won't kill all the bacteria and the ones that remain will be those with some capability to resist the antibiotic. Every time a person develops COVID-19, the virus mutates countless times and the virus strains most capable of replicating and transmitting infection to others will be selected. As time goes on, these new variants will look less and less like the virus used as the model for existing vaccines.

Anti-vaccine movements have always been with us, but it existed on the fringes. This is different. A cynical political calculus has whipped up an anti-vaccine frenzy and convinced a third of the country that the vaccine must be avoided. To his credit, New York City Mayor Bill de Blasio is hitting this head-on. Vaccine resistance is putting us all at risk. In many ways, it allowed the Provincetown outbreak to occur.

The real question is not whether this is appropriate, but why it is not being done on a national level. Localized policies are a bit like non-smoking sections in a restaurant. Half measures have failed us all the way through this pandemic. The only real alternative to the vaccine passport is going back to closing bars and restaurants entirely. This system provides a viable alternative that should be given a chance to work.

Robert D. Morris, MD, PhD, is a physician and an environmental epidemiologist.

The views expressed in this article are the writer's own.