Plans to roll out so-called vaccine passports are gaining momentum globally as people around the world get inoculated against COVID. The requirements of putting in place a vaccine verification process is touted as one way of opening up borders for trade and travel, and technology including blockchain and mobile apps are poised to take centre stage.
In Africa, there are already plans by different governments to launch technology-led solutions for vaccine passports. Ultimately, these initiatives could give birth to a revolution in how health data is acquired, managed and used, say officials involved with the programmes. In this scenario, vaccine passports used for travel purposes may evolve into more general-purpose “smart” health cards or digital health passports that are important components of national healthcare systems.
Rishon Chimboza, head of technology partnerships at the nonprofit Tony Blair Institute (TBI), says the rollout of vaccine passports has to go beyond global travel purposes. TBI is working with the governments of Ghana, Senegal and Rwanda to expedite digital health management systems, in collaboration with Oracle. These initiatives not only look at the current pandemic but seek to establish health management systems that include digital health passports.
What are health passports?
A health passport collects information that is essential for emergencies and routine medical treatment. The information can include patient identity, medical history, allergies, contact person, and blood type, according to Fatou Caro Ndiaye, CMO and data analyst at SenVitale, a health technology company in Senegal.
“Holding a health passport saves you time, speed of handling and data portability in any place with complete safety,” she adds.
Plans for health passports include technologies such as blockchain-based smart contracts to ensure verification of health passports, mobile technology or QR Codes that let users travel with the digital passports, and cloud services that enable the availability of the data.
Blockchain is a distributed electronic ledger shared and built around a peer-to-peer system used to create a record of transactions, each cryptographically linked – or “chained” — to the previous one. Smart contracts are automatically executing transaction applications are hosted on blockchains to simplify and secure multiparty operations.
Health passport users may have QR codes generated on their mobile phones or printed on a physical card which can be scanned whenever there is a need to access their information.
Recently, the discussions about health passports have been conflated with the need for proof of vaccination, TBI’s Chimboza told CIO Africa. However, his sentiments are that the technology component that shows proof of vaccination as a means to travel is a big piece of the overall health passport puzzle.
“Vaccination has to take place and then technology has to be in place to show you that you have been vaccinated,” he notes, adding that the underlying technology can also be used for more general-purpose health passports.
The WHO (World Health Orginsation) is considering “smart health cards,” says Anstes Agnew, the head of health systems for TBI. But trust in the systems used by such passports or cards can affect their rollout, she says. She concurs that the use of blockchain systems is one way to build trust in medical verification.
Michael Caplovitz, the CEO of GetChkd, a US-based health passport platform, has also promoted the use of blockchain to support health passports. GtChkd is currently partnering with various third parties to provide a fraud-proof COVID test or vaccine credential that will work with any system globally.
“GetChkd is a backend solution that utilizes Hyperledger Fabric to enable all existing platforms to share data. Any platform can be used as an onboarding platform, connect to the GetChkd REST API and user’s COVID vaccine/test results can be shared across all, provided that the user gives permission,” he explains.
He added that COVID test and vaccine data can dynamically be updated, whenever there is a new test or result. Smart contracts will be utilized to ensure all protocols are followed at points of origin and destination.
Another key consideration, according to the TBI’s Agnew, is how you provide the data to people who do not have smartphones or live in areas where connectivity is a challenge. “How do you ensure that data is secured on the back end while users can access it in several settings around the world?” she asks.
Concern for interoperability
The creation of digital health passports is still in the beginning stages as international bodies and start-ups mull over how to ensure a smooth rollout for the different solutions.
But the issue of interoperability of the various systems is an immediate issue.
“There is a broad movement that realizes that there is a need for interoperability of the various platforms that the different countries use for their health registries with these travel passes,” the TBI’s Chimboza said.
The Africa CDC (Centres for Disease Control and Prevention ) is already working on a framework for interoperability of health management systems. Other organisations working on the issue include The Good Health Pass Collaborative, formed to work on standards, and the Vaccination Credentialing Initiative, which is also looking to offer solutions towards interoperability. In addition, the WHO has formed a Smart Vaccination Certificate Working Group.
Chimboza said that eventually there will be a need for agreement and collaboration among these initiatives, governments and software developers to ensure that the health systems can talk to each other.
Data protection, privacy standards for health data
Privacy and data protection are big issues for these systems. Questions abound on who owns the data and who can access it.
A pilot medical health registry initiative in Kenya, spearheaded by telecom company Safaricom, ensures that the patient authorizes sharing of data to medical experts. The Afya Moja mobile health system allows a patient to send a code to a specific health worker. The code is then used to access the patient’s data. Experts agree that this policy should be universal.
“Only the user has the private key necessary to view and share any information. They will know the requirements for entry to a venue or travel before leaving their home and they can make their own decision whether they wish to share the required data,” GetChkd’s Caplovitz said.
For SenVitale in Senegal, encryption and user authentication ensure that health data is safeguarded against misuse. The company had to obtain approval from the Data Protection Commission in Senegal, a move that Ndiaye encourages for all health data platforms.
TBI’s Agnew says that governments are also considering the use of HL7 FHIR (Fast Healthcare Interoperability Resources), which is a standard for exchanging healthcare information electronically, for smart health cards.
Health passports serve many purposes
Health passports have benefits beyond allowing their holders to travel. Leveraging privacy-protected data can have great benefits for any country. Insights generated by digital health systems can help evaluate standards for how vaccines and medicines are being distributed and aid governments plan healthcare initiatives.
Smart contracts could be applied to data from infinite sources for highly personalized care and aggregated anonymized data can be shared with any required parties in real-time to deploy resources as need at a global level, Caplovitz says.
Beyond the COVID pandemic, blockchain-backed systems can increase trust in health data records and, in turn, ensure that access to healthcare is broadened and citizens lives are improved.