A hypothetical: Should Boston have vaccine passports?

TO: Interim Mayor Kim Janey

FROM: Carolyn Freeman, health policy adviser

DATE: October 20, 2021

RE: Vaccine passports

I. Combatting COVID-19 spread

As the pandemic continues, we need to implement more formal measures to stop the spread of COVID-19 that allow individuals to know the vaccine and COVID status of those around them. We must consider equity and security challenges to implement this policy in the remaining days of our administration.

II. The stakeholders

III. Criteria to keep in mind

We need to control the COVID-19 crisis without compromising city equity or security goals.

1. Equity concerns: We cannot impede any populations from accessing businesses, hospitals, or public areas. We need to balance public health priorities with access.
2. Security concerns: Any measure that increases transparency will result in a decrease in security. If our policy includes a digital component, we need to make sure that it won’t be vulnerable to hackers. An adversary may have a political motive to hack into our vaccination or COVID record system. For instance, an anti-vaccine group may want to prove that vaccine records are bad for privacy, so they have an incentive to hack into the records system to disrupt our political and public health strategy. These political adversaries may be motivated by long-term goals of disrupting the democratic governance of Boston, so we need to ensure that any system we use is secure from hackers.
3. Political feasibility: How possible will it be to implement our policy? We are close to the mayoral election, so we will likely need to implement a program that the next mayor will enforce.

IV. Policy options

Option 1: Extend universal mask mandate

Following the September 2021 indoor mask mandate, all businesses in Boston will continue limited indoor seating and will require all patrons to wear masks indoors. This policy has the benefit of ensuring that all Bostonians, regardless of vaccination status, are protected. It also comes with risks: after eighteen months of mask mandates, Bostonians may 1) refuse to comply or 2) stop going to businesses that enforce the mandate, which could have economic consequences. There are no major equity or security concerns here, as everyone would have to wear a mask and there would be no stored record of vaccination.

Option 2: Require all individuals to show proof of vaccination when entering a business

With this option, individuals would show a paper vaccine card or proof of vaccination in an app, like NYC’s Excelsior app, when entering a business or indoor public place. Users who don’t have proof of vaccination will not be allowed to enter but will be given resources on where to get vaccinated. This is a strict measure, and will have the impact of strictly curtailing spread in indoor places, as vaccinated people are less likely to spread the coronavirus. However, it also has several privacy and security implications: 1) some people may not want their medical information in an app that may or may not be secure, 2) some may not want to share their vaccine status, 3) some Bostonians may resent being forced to get vaccinated to go out to dinner, and 4) adversarial actors could take advantage of the digital storage of health data and hack into the system and destroy data. There are also equity concerns to take into mind, like thinking about the populations that will be most affected, and considering why they have not yet been vaccinated.

Option 3: Increase outreach to unvaccinated communities

We will increase outreach to unvaccinated communities and educate them to get a sense of their concerns and why they aren’t vaccinated. From an equity standpoint, this is the best option to reach those who are physically vulnerable due to lack of vaccination. It may introduce some security concerns: a list of unvaccinated people could be hacked and an adversary could use it to target those people with misinformation. But, with proper measures in place, data on unvaccinated people could be kept secure.

V. Recommendation

To comprehensively approach this problem, we should combine options 2 and 3 and implement a Boston-wide vaccine requirement and passport as well as increase outreach to unvaccinated communities. This two-pronged approach will allow us to lead with empathy and understanding without sacrificing the public health and safety of all Bostonians.

Vaccine passports are a tried-and-true approach to COVID spread management. In New York City, residents have been required to show proof of vaccination through their physical card or the Excelsior app since September 13, 2021. Since then, overall vaccination rates of New Yorkers has increased from 56% to over 65%. There has been some limited backlash over the requirement, but for the most part it seems to have helped get more New Yorkers vaccinated.

Massachusetts residents are still unvaccinated for a variety of reasons. Some believe the vaccine is unsafe, while it seems that others have not received enough outreach or know that the vaccine is free and available to all. Almost half of all Black and Latino Massachusetts residents are unvaccinated, which indicates that in Boston, a vaccine passport may systematically exclude non-white residents. In order to combat this, our policy must include an active investment in vaccine outreach in Boston, especially to communities that have historically been neglected.

Both of these policies introduce security concerns: an app could be vulnerable to hacking and a list of unvaccinated people presents an opportunity for targeted misinformation. An adversary with political motives to undermine our public health strategy could use both of these strategies to decrease trust in the vaccine and in our administration. We need to think proactively about security experts who can ensure our data and lists are safe from adversarial attacks.

VI. Implementation

We will use currently available resources in order to launch our two-pronged plan ASAP. A note on timing — since the new mayor will be sworn in on November 16, we will introduce and begin our plan, but it will be up to her to execute and enforce it.

Vaccine passport: In collaboration with New York State, we will use the blueprint of their Excelsior pass to build our own Boston pass. This will be launched three weeks before enforcement of the vaccine passport so that users and businesses can get used to navigating the app. Residents will still be able to use their original vaccine card if they do not want private medical information stored in the app.

Vaccine outreach: We will revive and expand the grassroots outreach that the Massachusetts government has been doing since early spring until September. With an additional budget of up to $2 million, we will re-fund the ASG, HCFA and 33 community organizations that participated in grassroots outreach. When these organizations left off, they had contacted 40% of unvaccinated individuals in Massachusetts. We will aim for these groups to contact 100% of unvaccinated individuals in Boston. Vaccination information will also be available at all vaccine passport checkpoints, so that unvaccinated individuals have all the information they need to make a choice.

Timeline:

October 20–25: Meet with stakeholders, finalize budget for app development and vaccine outreach, meet with New York State policy manager for advice and last-minute support.

October 26: Announce new passport mandate at press conference. Announce timeline for implementation.

November 2: Mayoral election. Convene with winner to discuss transition.

November 16: New mayor takes over, begins to enforce the passports.

References

The Cards | The Security Cards: A Security Threat Brainstorming Kit. http://securitycards.cs.washington.edu/cards.html. Accessed 20 Oct. 2021.

What to Know about the City’s Vaccine Passport Rules That Start Tuesday. https://www.ny1.com/nyc/all-boroughs/news/2021/08/13/what-to-know-about-the-city-s-vaccine-passport-rules-that-start-monday. Accessed 20 Oct. 2021

Lonas, Lexi. “Almost Two-Thirds of New York State Is Fully Vaccinated.” TheHill, 16 Oct. 2021, https://thehill.com/homenews/state-watch/577073-almost-two-thirds-of-new-york-state-is-fully-vaccinated.

“Over 2 Million Mass. Residents Aren’t Vaccinated. What Will It Take to Persuade the Holdouts? — The Boston Globe.” BostonGlobe.Com, https://www.bostonglobe.com/2021/08/05/nation/over-2-million-mass-residents-arent-vaccinated-can-we-change-that/. Accessed 20 Oct. 2021.

COVID-19 Vaccine Equity Initiative: Focused Grassroots Outreach | Mass.Gov. https://www.mass.gov/info-details/covid-19-vaccine-equity-initiative-focused-grassroots-outreach. Accessed 20 Oct. 2021.