The most common reason to need an immunization record is to enroll in school. In Georgia, where I live, new students must file a document, Form 3231, before they can register. A physician is supposed to fill out this form, which amounts to little more than a series of blank fields for various immunization dates. An FAQ from the Georgia Department of Public Health indicates that “only health departments and physicians licensed in Georgia can obtain blank immunization certificates,” presumably to control access to this official record in order to prevent misuse. But when I performed a simple Google search for Form 3231, the third result linked to exactly that, a blank immunization form. If someone wanted to, they could easily falsify the dates and claim inoculations they hadn’t really gotten. (The Georgia Department of Public Health didn’t respond to my request for comment.)
One big difference between an immunization record and a COVID-19 vaccination card is that the official record is signed by a health-care provider. Forging this signature could amount to committing a felony in all 50 states. This appears easy enough to get around: Some vaccine-record fraud has been perpetrated by complicit doctors. But also, the data on these forms might hardly be verified in the first place. Schwartz, whose research at Yale focuses on the history and public policy of vaccination, suspects that these documents are checked to see if they look like medical records, but not for much else. “If it passes that very low bar of looking plausibly accurate, I suspect that is considered good enough,” he said.
Even international verification faces similar limitations. In the case of vaccines recommended or required for travel abroad (such as those for yellow fever, typhoid, and rabies), most countries rely on the International Certificate of Vaccination or Prophylaxis, provided by the World Health Organization. That instrument is—wait for it—a yellow card with written inoculation records accompanied by medical stamps or signatures.
America’s resolutely patchwork approach to vaccine verification is not a failure of imagination. Schwartz noted that the technical hurdle is relatively surmountable; given verifiable vaccine billings to Medicare, Medicaid, and private insurers, along with the state databases, you could get a pretty comprehensive accounting. Eventually, in theory, some aggregation of state immunization registries could make the fantasy of a countrywide vaccine passport a reality.
But the U.S. has already chosen a different path. Introducing a universal vaccine passport would not change the cultural, psychological, and civil-libertarian resistance to a national medical-certification system. When vaccination becomes an amorphous, cosmic battle of national political division, getting people to accept inoculations—which is the goal—becomes even harder. The existing recordkeeping system has worked well enough over the years, and so it will likely persist: Scribbles on sheets of paper, some signed and some not, will corroborate protection. COVID-19 vaccination cards will give way to … more cards or papers, probably. Perhaps signed by a doctor this time. Perhaps with a barcode that systems such as Excelsior Pass might read. The honor system will persist too, like it does with most documents and identification.
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