The Covid-19 passport and the risk of voluntary infection
Covid-19 has made it
risky to have a job that cannot be done remotely and requires contact with the
public. Given the danger of infection facing frontline workers, employers confront
the risk of legal consequences in the event of insufficient protection. This
new risk could lead to changes in the characteristics of the workers being hired,
as the threat of lawsuits creates an incentive to discriminate by choosing
workers who are least at risk for these positions. As long as the Covid-19
virus is in circulation, we could therefore witness the rise of a powerful new
source of discrimination in the labour market based on the risk of serious
infection. But according to some epidemiologists, the virus could be circulating
and creating episodic outbreaks for 18 to 24 months [1], with the result that Covid-19 could leave a lasting
imprint on the job market.
Which workers are
least at risk? First, there are those with no apparent co-morbidities, which means
that individuals who are obese may face even more pronounced discrimination on
the labour market [2]. However, the main easily identifiable group at lower
risk are the young, since the under-30s face a very low risk of developing a
serious form of Covid-19 [3]. This situation is unprecedented – for the first
time, we’re experiencing a recession where young people are less affected than
more senior employees!
But while the young are
less at risk, there is one group of individuals for whom the risk could be even
lower. Experience with other viruses suggests that individuals who have
previously contracted Covid-19 gain at least temporary immunity from future
infection [4]. Although such immunity remains uncertain and
controversial [5], some employers may want to test their employees,
especially those in at-risk positions, to rule out the danger of infection
attributable to their professional activity.
Information on the
state of an employee’s immunity could therefore be very valuable for an
employer – so much so, in fact, that it could lead to the development of
low-quality private tests and a risk that false immunity certificates could
proliferate. To avoid these risks, many countries are considering creating
immunity passports certifying that a worker has already contracted Covid-19 and
is, at least in the short term, safe from the risk of infection [6]. Chile has announced that it is implementing such
a policy, and it is under discussion in various European countries.
An immunity passport
is expected to provide high wages in labour markets wracked by Covid-19,
particularly in high-risk jobs, including those requiring close contact with
infected people, such as in hospitals. In turn, in an economy in crisis, an
immunity passport guaranteeing well-paid employment could generate high demand for
voluntary infection among those in direst need.
This
possibility of self-infection when immunity is socially valued or economically
profitable is not merely a theoretical question. In an article published in
2019, historian Kathryn Olivarius of Stanford University showed that there are
numerous historical precedents [7]. Being recognized as having
immunity was in particular an essential condition for economic integration
during the colonization of tropical zones, where infectious diseases were decimating
the colonists. In the early 19th century, immigrants recently arriving in New
Orleans were said to be “non-acclimated”, and sought to quickly suffer and
survive yellow fever, which at that time had an estimated mortality rate of
about 50%, which is well above that of Covid-19, currently estimated at between
0.3% and 1%. To integrate, you had to prove that you survived the infection and
thus became “acclimated”. Only after becoming “acclimated”,
with the risk of early death being ruled out, did it become possible to have access
to the best jobs in the local labor market, to get married and to access credit
from local banks.
If a Covid-19
immunity passport is developed, it will in a similar manner foster a dangerous
temptation to become infected in order to gain access to jobs where the risk of
infection is high but wages are also high. The temptation to self-infect would
be even stronger in the case of Covid-19, the consequences of infection are usually
benign. But voluntary infection could lead to risky behaviour: one can imagine
individuals trying to get infected, and in doing so spreading the disease
around them, especially if they remain asymptomatic.
Alex Tabarok, a professor
of economics at George Mason University, argues that the issue of immunity
passports by the public authorities would also imply the need to regulate the demand
for voluntary infection that this would give rise to. So the public authorities
should offer the possibility of infection in moderate doses, in a medical
setting and by ensuring medical follow-up during a period of quarantine
following voluntary infection.[8]
The supervision of a
voluntary infection motivated by the desire to obtain an immunity passport clearly
poses ethical problems. First, it would be individuals in the most precarious
situations, especially those most affected by the recession, who would volunteer.
Furthermore, it is not certain that medical supervision reduces the risk of
death or serious sequelae. Above all, voluntary infection contradicts the apparent
policy goal today, which is to curb the epidemic as much as possible, as the
possibility of achieving collective immunity seems distant. So such an approach
is for the moment dangerous.
To be consistent with
the goal of suppressing the epidemic, it therefore appears necessary to discard
the policy of immunity passports, which give value to having been infected. As is
set out in the French protocol for lifting the lockdown [9], it is also necessary to ensure that the private
market does not fuel this demand and that companies don’t create their own
immunity passports or try to acquire information about immunity through other
means. While a rule like this might seem paradoxical, the risk of
self-infection can be eliminated only if a non-discrimination rule is imposed that
prohibits employers from using or requesting the results of serological tests
to employ workers in high-risk positions and that also bars employees from
revealing their immunity status.
[1] Moore Kristine, Marc Lipsitch, John M. Barry and Michael
T. Osterholm, 2020, “The Future of the COVID-19 Pandemic: Lessons Learned from
Pandemic Influenza”, COVID-19: The CIDRAP Viewpoint,
April. https://www.cidrap.umn.edu/sites/default/files/public/downloads/cidrap-covid19-viewpoint-part1.pdf
[2] Greve J., 2008, “Obesity and labor market outcomes
in Denmark”, Economics & Human Biology, 6(3), 350-362. https://doi.org/10.1016/j.ehb.2008.09.001
[3] Verity Robert et al., 2020, “Estimates
of the severity of coronavirus disease 2019: a model-based analysis”, The Lancet infectious diseases. https://doi.org/10.1016/S1473-3099(20)30243-7
[4] Altman Daniel M., Daniel C. Douek and Rosemary J.
Boyton, 2020, “What policy makers need to know about COVID-19 protective
immunity”, The Lancet. https://doi.org/10.1016/S0140-6736(20)30985-5
[5] See the opinion of 24 April 2020 by the World
Health Organisation, “Immunity passports in the
context of COVID-19”, https://apps.who.int/iris/bitstream/handle/10665/331866/WHO-2019-nCoV-Sci_Brief-Immunity_passport-2020.1-eng.pdf
[6] The Guardian, 2020, “‘Immunity
passports’ could speed up return to work after Covid-19”, 30 March. https://www.theguardian.com/world/2020/mar/30/immunity-passports-could-speed-up-return-to-work-after-covid-19
[7] Olivarius K., 2019, “Immunity, Capital, and Power
in Antebellum New Orleans”, The American Historical Review,
124(2), 425-455. https://doi.org/10.1093/ahr/rhz176
[8] Tabarrok A., 2020, “Immunity Passes Must Be Combined With Variolation”, Marginal Revolution, blog post, 5 April, https://marginalrevolution.com/marginalrevolution/2020/04/immunity-certificates-must-be-combined-with-variolation.html
[9]https://travail-emploi.gouv.fr/IMG/pdf/protocole-national-de-deconfinement.pdf