Digital Health Passports and a Global ID Database?

Gavi, the Vaccine Alliance, is at the forefront of the COVID-19 vaccination campaign, leading the operation of COVID-19 Vaccines Global Access (COVAX) alongside the World Health Organization (WHO).

Automated Tracking and Monitoring on a Global Scale

Gavi cites data management as one of the most important ways to strengthen health systems, and the organization has an extensive database that enables automatic tracking and monitoring at the global level. Gavi’s now-defunct INFUSE program was launched in 2016 and called on governments and companies to develop innovative solutions to reach and vaccinate more people. INFUSE 2018 specifically called for digital technologies to identify and register unvaccinated children and monitor and follow up with them after vaccination.

TrialSite has previously reported on the links between WHO, Gavi, and the Bill & Melinda Gates Foundation (BMGF), including concerns that Gavi’s approach to public health may be too “business and technology oriented.” Questions arise about the impact a global health registry could have on current and future pandemics and whether it could be a tool for influential funders.

Gavi, The Vaccine Alliance (Gavi) was established through global public and private partnerships to improve global immunization coverage, particularly among children in low-income countries.

Gavi was founded in 2000 as the Global Alliance for Vaccines and Immunization and says it has helped vaccinate more than 888 million children and save more than 15 million lives. It works with WHO, the United Nations Children’s Fund (UNICEF), the World Bank, BMGF, as well as government agencies, research institutions, vaccine manufacturers and private sector partners.

What is INFUSE?

Innovation for Uptake, Scale, and Equity in Immunization (INFUSE) was a program launched by Gavi in 2016 to develop innovative solutions to modernize global health and immunization. Each year, INFUSE works with funders, stakeholders, and governments to fund innovations that best meet this goal. INFUSE reviewers evaluated innovations submitted by individuals or organizations against criteria that would support their sustainable application, including evidence of impact, cost-effectiveness, and adaptability.

Each year, INFUSE had a different focus. In 2019, the last year INFUSE took place, the focus was on accelerating immunization coverage and finding innovations to address immunization challenges in urban areas. The previous year focused on technologies for infant biometrics, mobile apps for accessing digital health cards, and analytics tools for mapping and surveillance.

The 2018 INFUSE Call for Innovation included a statement explaining the versatility of digital health cards and biometrics: “As children grow, their digital health card can be used to access secondary services like elementary school, or it can facilitate obtaining alternative IDs.” The statement said these digital technologies are designed to integrate with other identity management systems so that international partners have access to “verifiable evidence and accurate, aggregated data.”

Their vision is a digital health card that would organize immunization registration, monitoring, and tracking. It could also include a record in a global database run by Gavi in collaboration with governments. These digital health cards are intended to improve immunization coverage rates by tracking when children are vaccinated and ensuring accurate recording of immunizations. However, as indicated in the call for innovations, the digital health card will no longer be limited to promoting immunizations, but will evolve into a global identification system to be used in education and other areas.

The 2018 call for innovations also referenced Gavi’s collaboration with the ID2020 Alliance, which supports its vision of a global digital identification and biometrics system. ID2020’s founding partners include technology companies Microsoft and Accenture, and the alliance is also working with other institutions, including the Rockefeller Foundation, PriceWaterHouse Coopers, and Cisco Systems Inc. In addition, crypto technology experts have joined the ID2020 alliance to contribute their technology expertise to help achieve this agenda.

The ID2020 Alliance is supported by the United Nations, and its goal is part of the UN’s 2030 Sustainable Development Goals, which call for “digitized legal identity for all people worldwide, including birth registration, by 2030.”

In 2018, Gavi also partnered with The Audacious Project to improve immunization in Africa, particularly in remote areas of Liberia, Uganda and Kenya, through “digitally-enabled community health programs.” The goal of this new collaboration was to provide $18 million to Last Mile Health and Living Good’s Audacious Project to bring access to vaccines to more than 8 million people and deploy 50,000 health workers by 2021. The goal of the funding was to equip health workers with smartphones to track children’s immunization status in real time, send automated immunization reminders via text message, and identify immunization gaps.

While it seems promising to digitally track one’s health, there are concerns about creating a centralized database of digital ID cards that could be used by Gavi and governments for other purposes. It is likely that private partners and large technology companies that fund Gavi and the ID2020 Alliance could have access to the global digital database and use it to their own advantage.

The Future of a Global Health Registry

As TrialSite has reported, the interplay between pharmaceutical companies, healthcare organizations, and national or global health authorities provides room for conflicts of interest and regulatory capture, especially when the same individuals wear several different hats.

It is worth noting that Gavi received $1.16 billion from the U.S. government under former President Trump’s administration. The government’s statement says these funds are for childhood vaccines, but there is speculation that one of the reasons for this funding was to support digital identification and tracking of children’s vaccination status.

Of interest in the context of such a database is the role of Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Disease (NIAID), senior medical advisor to the U.S. President, and member of the COVID-19 lead response team. In addition to these roles, Dr. Fauci is also listed as a member of the Leadership Council for the Decade of Vaccines Collaboration (DoV), which laid out the vision for the 2011-2020 Global Vaccine Action Plan. The goal of this framework was to increase vaccination coverage. It was driven by BMGF in collaboration with Gavi, UNICEF, NIAID, WHO, and other stakeholders.

Dr. Fauci is currently advocating for COVID vaccines to be given to children 5 years of age and older, and proposed that infants and toddlers be vaccinated with COVID 19 vaccines by spring 2022. With the detailed database that Gavi’s digital health cards would provide, it would be much easier to increase vaccination coverage through immunization prescriptions.

The Risk of Master Databases

There are real concerns about centralized, globalized personal digital information used for health monitoring or legalized identification, as the system poses potential risks if used by an ambitious company or government.

China’s social credit system (CSC) has been criticized for similar concerns. The system rates individuals and companies based on a “holistic assessment of their trustworthiness.” Through the National Credit Information Sharing Platform (NCISP), the CSC tracks and monitors activities based on reports from the public. The system has been implemented in various regions of China and is designed to either reward individuals or companies with privileges in society or punish them via a central blacklist.

The consequences of doing poorly in the CSC system impact a person’s ability to travel, work, study, and access funding. Critics say the system gives the Chinese government the ability to gain total control over its citizens – even over basic human rights such as the free movement of people. The system is also reportedly designed to spread fear with a policy of “name and shame” and restricts freedom of association by threatening penalties to companies that employ a blacklisted individual.

This is a prime example of how a large database can be used by those in power or influential people to make people in society comply with plans. This also promotes the loss of certain human rights, control over information, and privacy.

TrialSite will continue to monitor the future use and development of Gavi’s proposed digital health database.