Roughly one year after global lockdowns began, we finally see the light at the end of the tunnel with Covid-19 vaccinations underway. However, reopening global travel and public spaces may require not only vaccinations, but digital proof of them.

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There is now a growing spotlight on Covid-19 digital health passports (DHPs), which serve as electronic confirmation of a user's vaccination status. DHP technology, if implemented successfully, allows the vaccine provider to upload an individual's confirmed status after their vaccination, which would be displayed in an app using, for example, a QR code or barcode in a smartphone.

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The interest in DHPs is expanding rapidly as more governments and private businesses start to roll out their own versions of DHPs. Recently, Walmart announced a new DHP initiative in a partnership with Clear and The Commons Project Foundation. Customers who receive vaccines at Walmart and Sam's Club locations will have free secure access to their digital records via an app, based on the SMART Health Cards guidelines developed by the Vaccination Credential Initiative. They can continue to use this record to confirm their vaccination status for all purposes (school, offices, travel, etc.). 

While DHPs are primarily viewed as a safety component for cross-state or international travel, such technology can apply to any situation that requires screening post-Covid (e.g., welcoming employees back into an office, hosting in-person conferences or events).

But this technology is already starting to raise a few red flags and will likely be a contentious issue if universal rollouts occur or DHPs become mandatory for common access and navigation.

Five barriers to DHP adoption

DHPs will need to overcome various regulatory, technical, and social challenges to reach widespread adoption. Here are five big hurdles DHPs must overcome:

1. The pace of vaccinations, and the lingering unknowns about the virus

• A DHP can confirm that an individual was vaccinated, but we still don't know the long-term effects of Covid-19 vaccines or if the novel coronavirus will continue to evolve into new strains. Early research shows that the vaccine can prevent severe cases of the Covid-19, but it's still not clear whether vaccinated people can still transmit the virus to other (non-vaccinated) people, making a DHP far less useful.

• Furthermore, there is some risk that getting the vaccine and having a DHP will encourage risky behaviors. Will a DHP give people an excuse to ignore social distancing and other safety protocols, especially while most people still are not vaccinated?

• Timelines for vaccination can vary across the globe. Even in Denmark, a leader in worldwide vaccination, only around 11% of the population (as of March 23) have begun vaccination. In addition, an estimated one in four countries will not have access to the vaccine until after 2021.

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2. DHP security and validation

• QR codes are particularly prone to hacking, which can put users' sensitive information (passwords, credit cards, etc.) at risk. Some vendors, such as VST Enterprises (VSTE), are bypassing this by not using QR codes in their technology.

• There are also concerns around the risk of centralized information gathering, although some systems (such as the International Air Travel Association's Travel Pass) use blockchain to ensure data remains decentralized and traceable.

• In 2020, when airlines started mandating negative Covid-19 test results for international travelers, there were some reports of groups selling fake negative Covid-19 test results to passengers. It's possible that a similar "black market" for DHPs may come up if such passports become mandatory.

3. Data privacy

• Privacy is another big concern, particularly with private sector DHP development ventures. Possible solutions include using protective frameworks for development, such as anonymized credentials.

• Public sector initiatives for DHP frameworks, like that led by the European Union, do not raise as much concern around privacy since they have to abide by regional data protection frameworks, which already feature established personal privacy requirements.

4. Access and equity

• It is important to make sure DHPs do not exacerbate socioeconomic, racial, and other inequities that already exist in health care and broader society. Mandating the use of DHPs can create a tiered system that keeps underserved populations "locked in place."

• Addressing the digital divide will be crucial, such as ensuring that individuals have access to printable or alternative options for a DHP.

• While DHPs assume populations will be vaccinated, there is also the reality that many individuals do not plan to get a vaccine or distrust the process, requiring health care providers and public health experts to evaluate how they create or rebuild that trust.

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5. Lack of DHP interoperability

• Another glaring challenge is how to ensure the various DHPs work from one setting to another or across different technology platforms.

• Countries and organizations currently using DHPs have differing recommendations, guidelines, and methods of authentication. There is still no global set of standards or technology framework for DHPs. This lack of coordination on an international scale can make accurate vaccine confirmation and global travel requirements complicated.

DHPs are quickly evolving, and their success depends on various developments over the next few months as new information on DHPs is coming out every week. One area of interest for us will be the release of global guidelines and authentication standards on DHP technology use. Various public and private sector initiatives (such as those from the World Health Organization (WHO), European Union, World Economic Forum, as well as partnerships in the travel, health care, and tech industries) are all working now to produce universal DHP guidelines and standards. The WHO is planning to release its guidelines by the end of Q1 2021.

While we have outlined five barriers to DHP adoption, there is perhaps one other barrier to mention: the failed efforts to get the public to adopt contact tracing technology. We covered contact tracing efforts at the start of the pandemic, as it was pitched as a viable solution for using mobile technology to track the spread of the virus. Even Google and Apple teamed up to create a contact tracing framework that public health organizations could leverage. But by the end of 2020, contact tracing efforts had largely dissolved in many parts of the world due to inconsistent government mandates and consumer resistance. It is still unclear whether DHPs will go the same route.