Vaccine Blues -

So, you received the vaccine. But are you really vaccinated?

COVID has proven to be a pain in the butt for many and deadly for others. An entire planet is looking for relief. Tensions in richer countries are easing as a series of vaccines become available to the public, and many people are looking forward to receiving the vaccine and having their lives return to normal. But the post-COVID world may throw challenges at us that we don’t expect. Some could find themselves staring down the barrel of a question, “But are you really vaccinated?”

Let’s imagine that you have weathered the storm, visited your local pharmacy or drive-through site, and received the necessary vaccines. As social interactions become more common-place, you decide to celebrate with a vacation to the Mediterranian Sea for a bit of well-deserved R&R — your destination, Kefalonia.

After a long flight to Amsterdam and the second leg of travel to the Greek Isles, you are elated as the plane descends for landing and your eyes drink in the beauty of azure waters lapping onto whites beaches. The trip was tiring, but the delight of a real vacation re-energizes you while the plane touches down on the runway. Life is good as you traipse off the plane with your fellow passengers and sort into lines at immigration.

You finally step up to the booth staffed by officer Theos Angleopolis and proudly hand him your passport and the CDC card recording your COVID vaccination data. After all, it is the only vaccination verification data you received, and clear instructions were issued to you by the pharmacist to hold on to that card. You have done your research and know that Greece requires proof of vaccination for entry, particularly in those desirable tourist destinations where a COVID outbreak would seriously dent their local businesses.

Officer Angleopolis examines your passport, comparing the picture to your face, and then picks up the CDC card. He looks over his glasses at you, smiles, and says, “Thank you, but do you have your vaccination passport?”

At this point, confusion starts to creep in. “Yes, officer, in the United States, the CDC card is our proof of vaccination. You can see in the last column where Ron Pumpkin at my local pharmacy in Willsonville, Oregon, signed for both doses of my vaccine.”

“Thank you,” the officer replies, “but the Greek Government requires verifiable proof of vaccination when you enter the country.”

“I’m sure a call to Ron could clear this up,” you blurt out, immediately realizing how ridiculous this sounds even as the words leave your mouth. “I’m sure the CDC provides your government access to vaccination records for international travelers,” you follow up with, in an attempt to sound more reasonable.

Officer Angleopolis gives you that kind but sorrowful look you might use for a misguided child as he says, “Thank you again for the CDC card, but are you really vaccinated?” Your heart sinks as you realize your vacation is over before it starts. Unfortunately, the CDC does not keep track of who is vaccinated, and no one in Greece will be calling Ron Pumpkin or any other pharmacists to secure verification.

Life after the COVID vaccine rollout may be more complicated than we believe. Large portions of the population are leery of taking the vaccine. Then there are the anti-vaxxers banding together in their health jihad to secure their right for unfettered access to all sorts of nasty diseases. Add this to the real possibility that new variants of COVID will continue to mutate in their effort to do an end-run around the vaccine you received, and you can begin to see how some countries will want verifiable documentation of your vaccinations. In fact, there may be local, domestic venues requiring some proof of your status.

Many schools currently won’t let your child attend without proof of certain immunizations. Perhaps we will find restaurants and hotels wanting similar assurance that you won’t infect the rest of their customers. All of this ‘wanting to know’ will undoubtedly create headaches and probably spawn lawsuits. I am fairly sure anti-vaxxers don’t want regulations interfering with their right to spread infections.

However, my intent is not to focus on the social or legal fallout of vaccinated versus unvaccinated. Rather, I am more interested in the question of how do I obtain acceptable immunization verification, so I am not left standing in front of the immigration booth or at the hotel check-in desk, cursing under my breath at my bad luck of being caught short? What verification will be accepted?

The words best describing our current situation with verifying COVID immunizations are: confusion and chaos. Let’s face the facts, a photocopied form with a CDC symbol and a bunch of handwritten information is a beacon for forgery and fraud if we depend on it as official verification. Immunization records are not like driver’s licenses. With no national healthcare system, USA citizens are at the mercy of thousands of individual medical organizations who, like small children, don’t share well.

Using myself as a case study, I assessed my situation. My COVID shots were provided by a local pharmacy, which is also part of a national chain. They have a great app for ordering and checking on prescriptions, but the app provides no functionality giving me a history of my immunizations, much less a mechanism providing authorized sharing of that information. Then we have my primary physician with a more complete service, Healow, providing me with records of past immunizations, but only full records the ones they provide.

I momentarily had a brilliant idea involving the consolidation of my health records into the Apple Health App on my phone. Following Apple’s online instructions, I managed to find my way to the records section of Apple Health and went to the function for adding an account. Unsurprisingly I found that neither my pharmacy nor my primary physician were on the list of linkable accounts. I even checked to see if I could add the information by hand, and sadly, but wisely, this was not possible.

This first failure spurred me on to investigate the size of the problem. Evidently, the USA has over 200,000 primary care practices alone. We can add this to the 6,000 hospital networks operating in the country. Each of these groups is, in principle, faithfully recording your health records with each visit. Paper and handwritten records are still used in some places, but more and more medical practices are moving to Electronic Health Records (EHRs). However, in order to exacerbate the chaos within this wriggling mass of data, we have sixteen distinct EHR platforms in use.

A valid question is, “Why would I care to consolidate my records in the Apple Health app?” It seems my first foray into the world of immunization verification highlighted the CommonPass initiative. The organization developing this program self-describes as follows:

“The Commons Project, The World Economic Forum and a broad coalition of public and private partners are collaborating to launch CommonPass, a trusted, globally-interoperable platform for people to document their COVID-19 status (health declarations / PCR tests / vaccinations) to satisfy country entry requirements, while protecting their health data privacy.
“CommonPass lets individuals access their lab results and vaccination records, and consent to have that information used to validate their COVID status without revealing any other underlying personal health information. Lab results and vaccination records can be accessed through existing health data systems, national or local registries or personal digital health records (Apple Health for iOS, CommonHealth for Android). Apple Health and CommonHealth let individuals store their health records securely and privately on their phones, entirely under their control.”

So, the first global effort I could find for COVID immunization verification specifically identified Apple Health as an input source, and I have an iPhone. These two facts lead me down the path of getting my records into Apple Health. But Common Pass is not alone in the emerging vaccination verification game. Other players include:

IBM with their Digital Health Pass

The International Air Transport Association (IATA) is working on a Travel Passthat connects in with existing standards for tracking passenger information

Smart Health Cards

But all verification applications face a functional problem. Will the application’s records be accepted? Imagine if twenty different platforms emerge on the digital horizon, all equally viable. If immigration control, hotels, restaurants … etc., each decide to use different platforms, then the end-user needs all twenty applications on their phone to stay covered.

Users face another problem, how do we get our information into these applications. Naturally, we will not be allowed to hand-enter since the only verification is our word — the honor system. So, each platform will need to receive an individual’s vaccine records from a trusted source. Written CDC cards date back to the 1880s and don’t exactly represent an emerging technology suitable to the modern digital world. However, Los Angeles County has been experimenting with directly loading digital verifications into e-wallets, like Apple Wallet.

But back to my saga. In pursuit of immunization verification, I took a trip to my local pharmacy, where I inquired about direct downloads of my vaccine records into the Apple Health app, or a digital CDC card for my iPhone wallet. I could immediately tell by the pause and look of confusion in the clerk’s eyes that my question posed bold new ideas in the world of pharmaceutical care. The head pharmacist came over and politely suggested that perhaps my primary care physician could register the information into their health portal. Fifteen minutes later, I was walking through the door of the medical clinic.

A delightful young woman moved me another step down the road when she copied my CDC card and confirmed that the information would be entered into the Healow portal. All journeys start with the first step, and I moved on to step two by asking, “Will Healow be able to talk to Apple Health, my digital Wallet, or an app like Common Pass.” A fog of confusion descended over the conversation at this point, and I had to explain that after my full vaccine, I may need to engage in international travel and would like to be able to prove I was vaccinated. Beyond the initial confusion of why someone would want to travel outside of the USA, the attendant was unable to provide me with any real direction.

The next day I verified that the immunization records were in Healow, but they did not include all of the information from my CDC card. So it turned out that step one was not as complete as I thought. I am sorry to report that I have not yet had a breakthrough in my quest for valid vaccine verification. While I am sure the U.S. government will eventually support some sort of valid verification system, that day does not appear to have arrived. I would imagine a valid Q-code with CDC approval and shipped to my digital wallet would go a long way towards solving this problem. I would also imagine that this feat will not be achieved with warp speed.

Wish me luck with the Vaccine Blues, and I will be sure to post any future breakthroughs to help the next weary traveler with their journey.

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