Centre of Biomedical Ethics, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore.
Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.
J Infect Dis. 2020 Aug 4;222(5):715-718. doi: 10.1093/infdis/jiaa352.
A number of countries are planning the use of "immunity passports" as a way to ease restrictive measures and allow infected and recovered people to return to work during the COVID-19 pandemic. This paper brings together key scientific uncertainties regarding the use of serological tests to assure immune status and a public health ethics perspective to inform key considerations in the ethical implementation of immunity passport policies. Ill-conceived policies have the potential to cause severe unintended harms that could result in greater inequity, the stigmatization of certain sectors of society, and heightened risks and unequal treatment of individuals due to erroneous test results. Immunity passports could, however, be used to achieve collective benefits and benefits for specific populations besides facilitating economic recovery. We conclude that sector-based policies that prioritize access to testing based on societal need are likely to be fairer and logistically more feasible, while minimizing stigma and reducing incentives for fraud. Clear guidelines need to be set out for which sectors of society should be prioritized for testing, and rigorous mechanisms should be in place to validate test results and identify cases of reinfection.
许多国家正计划使用“免疫护照”，以此作为在 COVID-19 大流行期间放松限制措施并允许感染者和康复者重返工作岗位的一种方式。本文汇集了使用血清学检测来确保免疫状态方面的关键科学不确定性，并从公共卫生伦理角度提供了信息，以告知免疫护照政策实施中的关键伦理考虑因素。考虑不周的政策有可能造成严重的意外伤害，从而导致更大的不平等、社会特定部门的污名化，以及由于错误的检测结果导致个人面临更高的风险和不平等待遇。然而，免疫护照可以用于实现集体利益和特定人群的利益，除了促进经济复苏。我们的结论是，基于社会需求优先考虑检测机会的部门政策可能更公平，在逻辑上更可行，同时最大限度地减少污名化和减少欺诈的动机。需要为应该优先进行检测的社会部门制定明确的指导方针，并建立严格的机制来验证检测结果和识别再感染病例。
