Immunity passports and antibody testing: the pipe dreams of a new 'normal'?

Gemisha Cheemungtoo

Upon the wake of Britain lifting its lockdown, the idea of introducing an immunity certification scheme is under consideration by our government. Discussion with digital tech companies is underway about potentially issuing digital certificates based on antibody test results. These 'immunity passports' would help verify your movement across different social groups, from meeting co-workers to caring for vulnerable family members at home. 

 

The impact of COVID-19 is still fresh on our minds as the search for a vaccine continues, however the concept of health-based categorisation in society is not new. Examples in history have been highlighted by Virginia Berridge, Professor of History and Health Policy at London School of Hygiene and Tropical Medicine during a virtual talk about a public health identity emerging from COVID-19 antibody test results. These include the Yellow Fever outbreak in 19th-century New Orleans, premarital certification to confirm a syphilis-free status in 1930s America as well as HIV status potentially affecting insurance policies in the 1980s. Each example effectuated their own mixture of issues related to social exclusion, discrimination and the perpetuation of social inequities. 

 

It is difficult to explore the lessons taught by these case studies in a single blog post, let alone in a virtual talk: about how socioeconomic imbalances exacerbate poor health outcomes in minority groups, the role of public education in health promotion and the dangers of misinformation. However, the foundation upon which the immunity passport scheme would be based upon, the antibody testing programme, is not solid enough. 

 

According to current government guidance, the first phase for antibody testing gives priority to NHS and care home staff members, with an exception to certain patients if clinicians believe this blood test is indicated. It is important to note that this is not the same as the viral swab test, which detects if a person is currently infected with the SARS-Cov-2 virus. Hence results of the antibody test can only indicate past or recent infection, which informs us about how the disease has spread. As the longevity of these proteins and the implications regarding protection against future reinfection is unknown at present, a positive result does not exclude the person from social distancing or quarantining measures should they display viral symptoms again. 

 

These considerations were also expressed in a BMJ open letter written by a group of senior doctors and academics. Seeing as the test results would not impact a patient's clinical management, the reference standards of a 'true positive' and 'true negative' result is difficult to access between different testing platforms, and this 'non-evidence-based test' adds an extra burden to the limited resources of the NHS, the group questioned the government's strategy. Can the large scale of antibody testing be fully justified yet? 

 

That is not to say that monitoring the spread of Covid-19 is not important. If antibody testing extends to the community setting later down the line, they should perform as well with populations presenting milder forms or no symptoms of the disease as they have done in hospitalised patients, who had more exaggerated immune responses. According to a key Cochrane review conducted about the accuracy of antibody tests at different time points of the disease, this matter could not be evaluated as most studies reviewed only tested hospitalised patients. As this review is expected to be regularly updated as more research is published, this point could very well be addressed and a clearer strategy for public health surveillance outlined in the course of time. 

 

But what does it all mean for the individual returning to work and reconnecting with their social circles in the outside world again? For now, immunity certification remains a controversial concept saved for the future, and that the focus should be on making antibody testing the informative public health surveillance tool it should be. Oh, and to keep on following social distancing measures, of course.  


References:

https://www.bbc.co.uk/news/business-53082917

https://sifted.eu/articles/idnow-uk-immunity-passport/

https://www.politico.eu/article/digital-immunity-passport-is-the-lesser-of-two-evils-argues-uk-start-up-founder/

https://www.adalovelaceinstitute.org/testing-immunity-certificates-do-the-new-antibody-tests-open-the-door-to-the-creation-of-a-public-health-identity/

https://www.gov.uk/government/publications/coronavirus-covid-19-antibody-tests/coronavirus-covid-19-antibody-tests

https://www.who.int/news-room/commentaries/detail/immunity-passports-in-the-context-of-covid-19

https://www.bmj.com/content/369/bmj.m2420

https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013652/epdf/full 

https://www.evidentlycochrane.net/antibody-tests/


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