No shirt, no shoes, no vaccine – no service.
That's the future critics of "vaccine passports" fear as Americans vaccinated against COVID-19 can safely live more normal lives, including spending time in most indoor settings without a mask.
The notion that a "passport" could separate the vaccinated from the unvaccinated has sparked fears of a dystopian future where people's health decisions would limit where they could travel, where they could shop, what events they could attend and whether they would be asked to wear a mask.
Many states have taken a stand against that possibility.
Alaska, Arizona, Florida, Idaho, Montana, South Dakota, Texas and Wyoming have all moved to restrict the use of "vaccine passports." Even more states have signaled they're not interested in launching any such program.
“The residents of our state should not be required by the government to share their private medical information. … Vaccination is up to each individual, not the government,” Doug Ducey, Arizona's Republican governor, said in a statement in April.
Idaho Gov. Brad Little, a Republican, went even further in his criticism: “Vaccine passports create different classes of citizens.”
Many public health experts are exasperated by the controversy, given that Americans have long been expected to provide proof of vaccination in some circumstances.
“It’s not a new idea that you would document whether or not you’ve been vaccinated and share that information at certain points,” said Rebecca Fielding-Miller, a professor at the Herbert Wertheim School of Public Health at the University of California, San Diego.
“This is something we already do,” she said.
Schools typically require students to be vaccinated, and proof of vaccination has long been a staple of international travel.
Though critics fear the technology could be used to restrict the daily freedoms of Americans, few health experts expect or want that.
What is a 'vaccine passport'?
A "vaccine passport" has become an ill-defined buzzword for vaccine verification. Though there are many programs in the works, none has launched as a national or international standard.
“There is no vaccine passport right now,” Dr. Jay Wolfson, a public health expert at the University of South Florida, told USA TODAY on Thursday.
Paper cards from the Centers for Disease Control and Prevention that are easy to fake and hard to put in a wallet or purse have served as the default verification method. Wolfson expects something else to take their place soon, especially for international travel.
Since there is no federal vaccination database, the logistics of verifying a person's vaccination status are a challenge. Obtaining vaccine documentation beyond the CDC card would require navigating a patchwork of systems and regulations that vary between states.
Further complicating matters: States' vaccine passport bans may extend to issuing documentation for the purpose of providing proof of vaccinations, as is the case in Florida.
Wolfson said state governments' bans show that vaccine verification programs will probably not be widely run by states.
But businesses – most notably cruise lines – are increasingly motivated to find ways to keep their customers safe. Some will seek out technologies to verify customers' vaccination status, Wolfson said.
In a high-profile example, the parent company of Norwegian Cruise Line announced in April it would require all passengers and crew on its ships to be "100% vaccinated" two weeks before boarding.
After cruise ships became ground zero for deadly COVID-19 outbreaks early in the pandemic, it makes sense the business would want to "be as squeaky clean as possible,” Wolfson said. “They don’t want to have this happen again.”
In the USA, businesses have good legal standing to require customers to be vaccinated, said Wolfson, who holds a law degree from Stetson University College of Law.
What's wrong with the term 'vaccine passport'?
The term "vaccine passport" has led to negative connotations, possibly stoking fears they would be used to keep unvaccinated people out of common public spaces such as dining and retail – but that's not the future Rachael Piltch-Loeb sees.
Piltch-Loeb, an associate research scientist at NYU School of Global Public Health, said Thursday most public health experts envision "vaccine passports" used in situations where vaccine verification is already fairly common.
International travel, schools, colleges, some workplaces and some large events probably have an interest in keeping vaccine rates high and are prime areas for vaccine verification, Piltch-Loeb says.
Retail, restaurants and daily activities are less likely to require vaccine verification, she said.
Such businesses generally don't want to act as a “vaccine bouncer," Piltch-Loeb said.
In general, there's little appetite in the public health community for a future where an app-based passport, possibly controlled by a tech company, would regulate Americans' ability to do everyday activities such as go to a grocery store.
Many of the experts who have advocated for public health measures such as masks and social distancing throughout the pandemic share privacy concerns about a digital passport of medical information. It could become a "slippery slope," Wolfson said.
What's at risk with 'vaccine passports'?
Health experts said a solution for verifying a person's COVID-19 vaccination status is needed, but there's plenty of room for debate about the details.
It's easy to compare a vaccine passport to a "no shirt, no shoes, no service" sign, but in reality, “this is something kind of new,” Wolfson said.
The disease is new, the politicization around it is new, he said.
Wolfson said tech companies are among the most likely players in the vaccine passport space, and there are questions about how much health data people should be willing to give to big tech.
But being able to verify who has been vaccinated and who has not is a problem, given how effective the vaccines are at preventing the spread of a virus that has killed nearly 600,000 people in the USA.
“There is a definitive public health need for … proof of vaccination,” said Brian Castrucci, president of the de Beaumont Foundation, a health advocacy organization.
Castrucci said the politically charged discussion on the topic was “premature and distracting." He emphasized the focus should be vaccinating Americans and worried that the debate is a sign that vaccines are becoming a political battleground.
“We continue to politicize a public health crisis,” Castrucci said. “Even the suggestion of a vaccine passport … pushes nearly every partisan button on the right.”
It's a continuation of a trend seen in mask mandates and state shutdowns, he said. Liberals were more accepting of “collective action” – changing their behavior for the common good. Conservatives tended to push back to threats to individual liberty.
“This is what happens when you politicize a public health crisis,” Castrucci said.
Contributing: Maria Polletta and Stephanie Innes, Arizona Republic; The Associated Press
This article originally appeared on USA TODAY: 'Vaccine passports': COVID-19 vaccine verification is coming