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Last Updated : Apr 17, 2020 05:52 PM IST | Source: Moneycontrol.com

In-Depth | With practical, ethical conundrums, could 'immunity certificate' help India ease the coronavirus lockdown?

If a person can contract COVID-19 and survive it, he or she might be entitled to what is referred to as an immunity certificate

Over 2 million cases of coronavirus have been registered in 185 countries and territories since the epidemic first emerged in China in December 2019. The worldwide death toll from COVID-19 has risen to over 1,46,500 on April 17, according to Johns Hopkins Coronavirus Resource Centre.

The coronavirus pandemic has pushed the world into lockdowns, social distancing, or some or the other form of restrictions to help curb the spread of COVID-19.

As the lockdown continues to inconvenience people and cripple economies of several countries, experts are thinking about strategies to end the limitations on everyday activities and help normalcy spring back.

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Amid the pall of gloom, a silver lining is that around 550,000 have recovered from the infection.

COVID-19 Vaccine

Frequently Asked Questions

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How does a vaccine work?

A vaccine works by mimicking a natural infection. A vaccine not only induces immune response to protect people from any future COVID-19 infection, but also helps quickly build herd immunity to put an end to the pandemic. Herd immunity occurs when a sufficient percentage of a population becomes immune to a disease, making the spread of disease from person to person unlikely. The good news is that SARS-CoV-2 virus has been fairly stable, which increases the viability of a vaccine.

How many types of vaccines are there?

There are broadly four types of vaccine — one, a vaccine based on the whole virus (this could be either inactivated, or an attenuated [weakened] virus vaccine); two, a non-replicating viral vector vaccine that uses a benign virus as vector that carries the antigen of SARS-CoV; three, nucleic-acid vaccines that have genetic material like DNA and RNA of antigens like spike protein given to a person, helping human cells decode genetic material and produce the vaccine; and four, protein subunit vaccine wherein the recombinant proteins of SARS-COV-2 along with an adjuvant (booster) is given as a vaccine.

What does it take to develop a vaccine of this kind?

Vaccine development is a long, complex process. Unlike drugs that are given to people with a diseased, vaccines are given to healthy people and also vulnerable sections such as children, pregnant women and the elderly. So rigorous tests are compulsory. History says that the fastest time it took to develop a vaccine is five years, but it usually takes double or sometimes triple that time.

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Some experts see this figure as a resource for restarting the economy. Policymakers of countries like Germany, Italy, and the UK, as well as some US health experts have reportedly started considering issuing 'immunity certificates', which will indicate that a person has immunity to COVID-19. This means, this person is no longer infectious or vulnerable to the disease and thus, can return to normal life.

What is an immunity certificate?

If a person can contract COVID-19 and survive it, he or she might be entitled to what is referred to as an immunity certificate, also known as the 'immunity passport'. It is a certificate that proves the person is at less risk of contracting COVID-19 as they have immunity that will protect them from getting the infection again for some time.

The certificate will most likely exempt the person from the restrictions put in place to curb the spread of the virus. This means the person will be able to leave isolation and move outside freely.

How to get an immunity certificate issued?

The certificate of immunity can be given on the basis of the antibody test, which detects signs of an immune response, Dr Ashok Mahashur, consultant chest physician at PD Hinduja hospital, Mumbai told Moneycontrol.

When the body of a person encounters a virus, it takes some time for it to recognise the invader and begin to scale up an immune response. Immune molecules, called antibodies, are a crucial part of this response.

The first type of antibody to appear is called immunoglobulin M, or IgM, and its levels increase within a few days of the person getting infected. But, IgM is a generic fighter.

To target and destroy a specific virus, the body refines it into a second type of antibody, called immunoglobulin G, or IgG, that can recognise that virus.

There is a third type of antibody, called IgA, which is present in mucosal tissues — like the inner lining of the lungs, a report in The New York Times pointed out. IgA is known to be important for fighting respiratory infections, such as influenza, and is likely to be central in coronavirus infections too.

Many of the tests look for levels of all three antibodies; whereas some look for just IgM and IgG, and still others test for only one type.

Also read | WHO recommends limiting access to alcohol, dispels rumours that it protects people from COVID-19

Which countries are planning to detect immunity and issue certificates?

In the UK, Health Secretary Matt Hancock, who has himself just emerged from self-isolation after testing positive for COVID-19, suggested that Britons who've had the virus might be issued with a certificate, which has already been dubbed as an 'immunity certificate'.

“It (an immunity certificate) is an important thing that we will be doing and are looking at but, it’s too early in the science of the immunity that comes from having had the disease,” Hancock said at a press conference earlier in April.

German researchers have proposed testing 100,000 people for antibodies to SARS-CoV-2, the virus that causes COVID-19, and giving 'immunity certificates' to those who have these antibodies, which presumably make them resistant to re-infection, according to a report in Business Insider. They can be even allowed to leave the country's coronavirus lockdown earlier than the rest of the population, the report added.

A US-based medical devices and health care company, Abbott Laboratories, has announced that it has developed an antibody test that will determine if someone has been previously infected with the coronavirus and has potentially developed immunity.

"It is a great test. The company says these tests could be available to screen up to 20 million people in a matter of weeks," US President Donald Trump had said.

Also read | Are Lockdown Bonds a balm for the virus-hit businesses?

Theoretically, the antibody test-based certificate is a strategy that could work to identify people who have immunity against the disease, but it still relies on several factors to work properly and safely.

Potential benefits of immunity certificates

The certificate of immunity is a proposal with an obvious appeal to move the life of the people as well as economy back toward normalcy. Giving immunity certificates to COVID-19 survivors would purportedly:

# Help ease the lockdown as people with ‘immunity’ can move freely;

# Get the economy rolling, as persons having the immunity status could safely return to work considering they would not get sick again and start passing the virus around; and

# Bring doctors and other healthcare workers as well as security personnel back to their jobs after isolation, so that they can restart working to cure infected persons and prevent the spread of COVID-19, respectively.

Challenges that come with issuing immunity certificates

Issuing of immunity certificates includes many risks like inaccurate testing, forging or buying black market forgeries of the certificates, deliberate contracting the COVID-19 infection with perhaps a misplaced confidence that one would quickly recover and be duly certified to go back to work, social divide, among others.

Let’s understand these possible scenarios thoroughly:

# Test accuracy: Potential challenges include finding a reliable test to determine whether a recovered COVID-19 patient is actually immune to a new infection or a relapse; or if they are immune, how strong is that immunity and for how long will it last. Although some labs are claiming to have COVID-19 antibody test, like Abbott labs, no test is said to be perfect.

Furthermore, scientists are not yet sure whether some recovered individuals have a high enough level of antibodies to fight this coronavirus a second time, making antibody tests and immunity certificates implausible as exit strategies, according to a European journal DW. For instance, there are reports of people being infected twice in China. Also, in South Korea, a small, but growing number, of recovered coronavirus patients are relapsing, testing positive for the virus again.

# Discrimination in society

It isn’t just the science that makes immunity certificates problematic, difficult social questions could also be thrown up. These certificates might create a kind of two-tier society, where those who have them can return to normalcy while others are compelled to follow the restrictions.

The tagging of immunity status is even more problematic in smaller towns, where residents know each other. The risk of creating resentment by dividing the society into two groups, where one is allowed to break free of the lockdowns and the other is not, would be extremely "detrimental to the community solidarity," that is holding society together at the moment, a DW report said, quoting Dr Martin Schnell, a professor of social philosophy and ethics in healthcare at Germany's University of Witten/Herdecke.

# Possibility of deliberate exposure to COVID-19

The idea to issue the certificate of immunity brings the possibility for people, especially millennials (who might feel their chances of surviving the disease are high), deliberately trying to contract the virus.

The economic value of an immunity certificate would be enormous, and plenty of people would be desperate enough to lie or pay to get one. That sounds crazy, but if having the antibodies becomes the cost of entering the job market and thus feeding one’s family, there may be workers who feel pressured into it, I. Glenn Cohen, a bioethics expert at Harvard Law School told Bloomberg.

# Providing fake certificates

There is another possibility of people lying about their own past symptoms. According to Statnews, some people would use another’s immunity certificate – unless it is a photo identity card or requires biometrics like thumbprints, retinal scans, or other identity verification. This could lead to new privacy issues. Also, it can encourage a black market in forged immunity certificates.

Also read | New normal: How coronavirus pandemic will change lives

How will immunity certificates help in response to the coronavirus pandemic?

If experts of some countries are considering adopting the practise of tagging people with their immunity status, it might be of some help in the fight against the deadly COVID-19.

According to Dr Martin Schnell, the plan can only be considered ethical if the authorities keep all the other social distancing measures in place, such as standing 1.5 meters apart or wearing masks, to protect both the healthy and the vulnerable. However, this could be extremely difficult to do in certain scenarios, such as in public transport where many people travel together, he added.

Also read | COVID-19: India can turn this crisis into an environmental and economic opportunity

Is it possible to issue immunity certificates in India?

The number of confirmed coronavirus cases across India has soared past 13,000, with Maharashtra alone recording over 3000 cases, the highest in any state so far.

Of these, as many as 1,748 have been cured / discharged after recovery. So, this population can be tagged with their immunity status.

Now the important question is about the feasibility of issuing such a certificate in India on the basis of the antibody test.

Let’s look at the science first. According to Dr Mahashur, in a country like India, there are so many viruses around, including a variety of coronaviruses, of which COVID-19 is just one type.

So, it would be difficult to detect what antibodies a person has. In such a situation, it won’t be reliable to label a person as immune to COVID-19 with the presence of antibodies, Dr Mahashur told Moneycontrol.

Population is another hurdle in adopting this practice. In a population as huge as India's, measuring antibodies itself is going to be a difficult task, said Dr Mahashur.

Its utility is another limitation.

“So, keeping these factors in mind, I do not feel it is practical to use this test in India”, the doctor added.

Also, in India, the history of "papers, please" is not exactly a shining beacon of freedom. A recent example of this is the Citizenship Amendment Act and the proposed National Register of Citizens, against which people hit the roads and protested massively. In such a country, issuing a paper of immunity could bring another wave of resentment among people who are denied the tag.

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First Published on Apr 17, 2020 05:52 pm
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