Posted: 27 Apr. 2021 10 min. read

Digital health credentials could accelerate a reopening of the world, but tough questions remain

By Dr. Stephanie Allen, partner, Global Public Health & Social Services leader, Deloitte Australia

Each day, millions of people around the world are getting vaccinated against COVID-19. As economies and societies begin to re-open, health care organizations, governmental agencies, and corporations are looking at ways digital health credentials can be standardized and managed by citizens to demonstrate proof of a vaccination or negative test result.

Requiring health credentials is nothing new. I grew up in Zambia in Central Africa. While I live in Australia now, I frequently go back to Zambia to visit friends and family. Whenever I go back, I have to show evidence that I’ve been vaccinated for Yellow Fever, Cholera, and Typhoid. Those vaccinations allow me to travel, keep me safe from infection, and ensure I don’t bring any of those diseases back home. As Deloitte’s global health care leader, I have been paying close attention to the development of digital health credentials in the era of COVID-19.

I recently took part in a global webinar hosted by Deloitte that explored how digital health credentials could help accelerate the reopening of the world economy. Appropriately, I participated in this virtual conference from the airport. I was waiting to board a plane from Sydney to Tasmania where I met with local officials to discuss their digital health strategy.

Digitized health credentials could have applications beyond COVID-19

During the HIV/AIDS epidemic in the 1980s, there was some talk about developing a travel credential that would help protect individuals and the broader society against infection. It was correctly determined not to pursue such a credential because it could have been seen as a way to further discriminate against an already vulnerable group. That could have eroded social equity and trust. But COVID-19 is different. What we are talking about is a digital and verifiable vaccination certificate that can help to protect the individual, other passengers, and the people who live in the destination country. It also could protect people in the passenger’s home country when the passenger returns. That is significant. In Australia, the infection rate is low, and we want to be able to send our citizens to other countries again…and have them return without worrying that they might spread the virus.

Seven questions about digital health credentials

My Deloitte colleagues addressed a number of important issues that should be considered as digital health credentials are developed. Here are a few of the questions we discussed:

  1. Will digital health credentials be standardized? Governments and organizations around the world are coming together to develop global standards. My colleague Jamie Sawchuk, a partner at Deloitte Canada who is co-leading Deloitte’s Global Citizen Digital ID, Verifiable Credentials, noted that European Union leaders recently announced a Digital Green Pass program. Some countries inside and outside of the EU are taking action to make digital health and travel credentials available to their citizens. Over the past month, Israel has allowed its citizens to download a Green Pass from the Health Ministry’s website that verifies the Pass holder was vaccinated against COVID-19 or has recovered from the disease.
  2. Will all countries require evidence of a vaccination or negative COVID-19 test? Some will, but others will probably leave it up to the private side. For example, the White House recently indicated that it would not issue vaccine passports, largely out of privacy concerns. However, there has been a push for people to show proof of vaccination before activities such as boarding a cruise ship, entering a sports stadium, or attending a university. PJ Rivera, principal in US Deloitte’s Government & Public Services Industry, noted that each state has a different perspective on this topic. New York state recently rolled out its optional and citizen-controlled Excelsior Pass, which it describes as a “free, fast, and secure way to present digital proof” of COVID-19 vaccination. Hawaii’s Safe Travels Program allows out-of-state visitors to skip quarantining if they can show a negative test results up to 72 hours before their flight.1 Other states are taking a slower and more deliberate approach, PJ noted.
  3. How often will credentials need to be updated? We don’t yet know how long the vaccines will be effective against COVID-19, or the new variants. Will the vaccine be effective for six months, 16 months or 26 months? As we learn more about the long-term effectiveness of inoculations, it’s likely that any health credential will require real-time information around the type of vaccine used and the date on which it was delivered. That will be extremely important. A year from now, we will need a mechanism to verify that each person’s vaccinations are updated as immunity fades and new vaccines are developed to counter variants.
  4. Who will issue and verify the credential? Citizens around the world have transitioned from paper currency to touchless payment systems. They will likely expect a similar seamless and secure experience when it comes to their digital health credentials. Jamie explained that there will likely be three parts to this type of digital credential. The issuer of a vaccination or negative-test credential would likely be a government health authority or agency. Each citizen would be the owner of their credential, which would likely be stored in a secure digital wallet on a smartphone, or as a paper document with a QR code. The third component will be the verifier. This could be a boarder agency, an airport, or an airline that verifies the legitimacy of the credential.
  5. Will digital health credentials be secure? Technology can do a lot to boost transparency and improve efficiencies, but it also can be intrusive, noted Amir Belkhelladi, partner at Deloitte Canada and national risk advisory leader. While a digital health credential might be easier to manage than a paper one, it also could be a prized asset for fraud given the amount of personal health information that might be included. Ensuring data is safe and secure will be critical.
  6. Can a digital health credential help to improve health equity? The purpose of a digital identity is to create or improve access to health, not to remove or limit it, explained Christine Robson, senior manager of Financial Services, Deloitte Canada. It is important to consider that not everyone has access to a smartphone. Certain populations will still require a paper option to ensure they aren’t excluded.
  7. Can a digital identity move us closer to the Future of HealthTM? Some countries already have a well-established digital identity. In Australia, we have an electronic health record called My Health Record, which is used by every citizen. All of our immunizations already exist in that digital format. The next step is to determine how to use some of that data to proactively and preventively intervene with individuals based on their health status. That can move us closer to the Future of Health if this data can be used for early intervention and prevention of disease. But it should be done safely and securely. For countries that don’t yet have a national EHR, a digital health credential for COVID-19 could be the first step in creating an appropriate platform. 

Unlike other infectious diseases, COVID-19 has had an enormous impact on the world economy. The International Monetary Fund estimates that the global economy shrunk by 44% in 2020. The pandemic has affected international trade routes, international supply chains, and travel. Governments, health care organizations, and corporations are under tremendous pressure to move quickly to reopen their borders, travel, and economies. As Jamie noted, they are all at different points, and have different strategies for developing and launching digital health credentials. They should collectively build on open interoperable global standards to enable those different technologies to connect.

Join us on May 12, 2021 for a webinar that explores how digital health credentials can accelerate reopening the economy.

Endnotes:

1. Kauai Rejoins Hawaii's Safe Travels Program for Visitors, US News and World Report, April 6, 2021

Return to the Health Forward home page to discover more insights from our leaders.

Subscribe to the Health Forward blog via email