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So you’re vaccinated for COVID-19. When does life go back to normal?

So you’re vaccinated for COVID-19. When does life go back to normal?
Canada
This week, Canada received its biggest delivery of vaccines to date, part of a process that will hopefully pave a path out of the ravages of COVID-19 and back to normal.

But what will that journey look like?

Those wondering may have received a sneak peek this week from Israel, as Prime Minister Benjamin Netanyahu enjoyed a cappuccino and a pastry at a Jerusalem cafe. Netanyahu holds one of his country’s new “green passes,” given to people over the age of 16 who are fully vaccinated against COVID-19. Pass holders can now eat inside, work out at the gym and even attend concerts with a real, live audience.

The pace of Israel’s vaccination effort has led the world, and about half of the country’s population has at least one shot of vaccine, though it’s faced criticism for largely excluding Palestinians. Now, Israel is at the forefront of a global debate — how to chart a path back to normalcy, when only part of the population is vaccinated?

It will be our next balancing act.

Epidemiologists have stressed time and time again that getting a shot doesn’t make you bulletproof. Most vaccines require two doses for full protection and even once you’re vaccinated, you might still be able to transmit the virus to the unprotected.

But as more people are vaccinated in Canada and abroad hospitalizations and deaths will hopefully begin to drop, and our risk assessment — the balance of lockdown versus liberty — may start to shift.

Experts stress it’s something that must be weighed carefully to ensure that efforts to contain the virus aren’t undone, and that divisions don’t fester between the vaccinated and the non.

The United States took its first steps toward loosening rules for the vaccinated this week, with hotly anticipated guidelines that say the inoculated can now safely visit other vaccinated people, and even small groups of unvaccinated people.

The new American guidelines still advise people to wear a mask, maintain a distance from people you don’t live with and avoid medium and large gatherings. But vaccinated people there now have the greenlight to socialize indoors with the fellow vaccinated, and not to quarantine if they have contact with someone who has COVID-19 and don’t develop symptoms.

Canada may eventually consider something similar, says Dr. Anna Banerji, an infectious disease specialist with the Temerty Faculty of Medicine and the Dalla Lana School of Public Health.

“I don’t know when that’s going to happen, but I think people are, after a certain period of time, going to demand that if they’ve been vaccinated that they would like to see other vaccinated people,” she said.

“You can’t hold them back forever.”

In the coming months, it will make sense to allow people who are vaccinated to let their guard down — at least a little — says Dr. Prabhat Jha, a professor of global health and epidemiology at the University of Toronto.

Maybe they’ll be able to gather together indoors in larger numbers, or forgo masks when around each other.

“At the end of the day ... it does come down to a value judgment, to some degree,” said Maxwell Smith, a bioethicist and assistant professor at Western University. (Smith sits on Ontario’s vaccine task force, which is not involved in questions around reopening.)

“What degree of risk are we willing to tolerate?”

Vaccination ‘passes’

The idea of a vaccination pass similar to Israel’s has been floated here in Canada, as a way to reopen the economy and allow vaccinated people to resume some semblance of normal life.

However, the concept has raised concerns about equity.

Israel’s green pass is an app or printed certificate provided by the government to people a week after they’ve received their second shot, when immunity is presumed to have kicked in. Right now, it allows access to places such as gyms, hotels, pools and concerts.

According to local newspaper Haaretz , the app has faced “serious problems” in its first few weeks, including functioning slowly and taking up a lot of memory. Experts have also reportedly discovered security issues that cast doubts on its reliability.

The Health Ministry is also concerned about fake documentation, according to the Guardian , and has said that anyone with a fake green pass would be fined 5,000 shekels, or about $1,900.

Jha questions whether a pass system would be open to abuse.

“If I get on the Toronto subway, and I say, ‘I’m not wearing a mask, I’ve been vaccinated,’ and there’s no way that anyone can verify that,” he speculated.

The European Union became the latest jurisdiction Thursday to confirm it is considering some sort of certificate to confirm vaccination status. But European Justice Commissioner Didier Reynders said these won’t function as passports — as vaccines aren’t mandatory or yet available to all, so discrimination is a very real concern.

The idea of dividing people into “have been vaccinated” and “not” is not universally applauded.

The German Ethics Council, an independent body that advises the government, recently issued a statement saying that the vaccinated should not get special privileges.

The committee pointed out, according to broadcaster Deutsche Welle , that it wasn’t fair, when not everyone had had the opportunity to be vaccinated yet and warned that lifting restrictions for the vaccinated risked upsetting those still in line.

Travel

Perhaps more likely is the prospect of vaccination passports, says Banerji, which would require you to show proof of vaccination status when entering another country.

China has introduced a digital health certificate for its citizens that shows each person’s vaccine status and test results in the hopes of eventually easing cross-border travel. The European Union has announced plans for a digital passport to ease travel between member countries. There is some precedent for this, as many countries around the world have long required proof of vaccination against yellow fever.

“It’s being discussed around the world. I’m a member of the G7 health ministers, we meet every couple weeks. This has been on our agenda,” Patty Hajdu said.

Smith points out there are still a lot of questions about how COVID-19 documentation would work in practice, from privacy concerns about sharing health data to the fact that there are now at least a dozen different vaccines in use worldwide, all of which may have different levels of effectiveness and longevity.

Some countries are nonetheless welcoming vaccinated travellers with open arms. In January, the Seychelles became the first country in the world to allow vaccinated tourists to visit without quarantining. The cluster of islands in the Indian Ocean is dependant on tourism, and the measure was planned to inject some money back into the economy. Vaccinated travellers will still need to present a negative COVID-19 test taken within 72 hours of travel and must stay at hotels certified by the local health authority, but once there will be allowed “free movement through their stay,” according to the government website .

Similarly tourism-dependant Iceland became, starting in January, the first country in Europe to issue and recognize vaccination certificates for incoming travellers, who are no longer required to abide by other entry requirements, including COVID-19 testing and quarantine. A handful of other countries, from Greece to Belize, have announced plans to follow suit.

Whether countries will recognize each other’s passports remains to be seen, as well as what the standardized documentation should look like. Iceland , for example, currently lists both the vaccines they’ll accept (Pfizer-BioNTech, Moderna and AstraZeneca) and the languages (Icelandic, Danish, Norwegian, Swedish, English or French) but border control will still have final say over whether your certificate counts or not.

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There are also private entities looking to move into this space. CommonPass is a digital vaccine pass created by a Swiss non-profit that is designed so that countries can set standards for their own borders, and travellers can verify that they meet them, without having to share any personal data. Its app has been tested by multiple airlines.

The way vaccination is unfolding suggests that the wealthy parts of the world will be vaccinated long before the poorer regions. Some experts warn that a world where residents of rich, vaccinated countries are able to travel for tourism while the rest of the world is stuck dealing with the still-raging pandemic disadvantages everyone, but vulnerable countries most of all.

Then there’s the question of where, if you’re vaccinated, you’ll be able to go. If most Canadians are vaccinated by summer or fall, the country will reopen to a shrunken world. It bodes well for Canada that U.S. immunization is going well, Jha said, but the same can’t be said for most of the planet.

“That means our main trading partner will not be the one that gives us a lot of infections or variant infections, but for any other aspirations that we have for trading with the world or travelling, it’s a ‘lose’ for Canadians.”

Workplaces and businesses

Part of the onus or sorting out the path to normal may fall to workplaces and businesses. Expect some to create their own policies — for employees as well as for customers.

“If you’ve got a situation where some people are vaccinated, and some are not, places will have to have protocols in place,” Jha says.

“For example, lunch rooms. I know it sounds terrible, but you may need segregated lunch rooms for a while. So you’ve got a vaccinated lunchroom and an unvaccinated lunch room. The reason is, we know that some of the transmission, even in hospitals, occurred during lunch breaks when people are eating together.”

He adds that workplaces also have an obligation to help their employees get vaccinated, whether that means giving them time off or helping them book appointments.

Politicians across the country have said repeatedly that they don’t want to make vaccines mandatory, but that doesn’t mean businesses or organizations won’t try — though it’s a practice that be legally tricky, experts say.

Israel, for example, is requiring proof of vaccination status to enter some businesses, such as theatres or pools, though the country has also seen a few protests by those who worry that the unvaccinated are being left behind, according to the Guardian.

Cara Zwibel, a lawyer with the Canadian Civil Liberties Association, told the Star back in December that the prospect of mandatory vaccines pits companies’ obligation to keep their employees safe against human rights legislation.
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