A growing number of states are rolling out digital credentials commonly known as vaccine passports and taking on an initiative the Biden administration signaled this spring that it would own by issuing nationwide standards.
The rise of the Delta variant and a surge of counterfeit vaccination cards have added urgency to an effort that could speed the reopening of the country but has been a flashpoint for critics on the right, who view use of the credentials for certain activities as government overreach with possible privacy concerns.
California, New York and Louisiana are deploying SMART Health Cards developed by the Vaccination Credential Initiative, a consortium of health and technology companies that includes Apple, Microsoft and the Mayo Clinic. At least a half dozen other states are considering adopting the credentials, according to people familiar with the effort.
“It's an elegant solution. It works well, it's open-source,” said Rick Klau, California’s chief technology innovation officer, who said some 3.7 million of the credentials have been downloaded in his state.
If enough states embrace the technology, it could become a de facto nationwide standard and relieve the Biden administration of having to lay out federal requirements for domestic purposes. But experts worry that a lack of federal guard rails will result in a confusing patchwork of unregulated and unreliable tools for verifying vaccination status — further complicated by regions where they’re off limits. Conservative governors in states like Florida, Texas, Arizona and Georgia have already issued orders banning the passports.
“Different states, businesses, venues and universities and colleges may use different platforms that are difficult to transfer information between as people travel between states or even cities,” said Lucia Mullen, senior analyst at the Johns Hopkins Center for Health Security.
The Biden administration in the spring said it would work with private industry on nationwide passport standards while making clear the government wouldn’t issue the credentials or store the data. Since then, federal officials have been publicly quiet on the matter, other than exploring how the digital certificates could enable international travel.
The White House and the federal Health Department’s health IT office declined to comment for this story.
The transportation industry is pressing the administration to move, citing a proliferation of fake vaccination cards that are available online that could make it difficult to verify if travelers have actually been vaccinated.
“What could drive the conversation — because I would say it's not driving this conversation right now—- is a concern about fraud and whether or not a piece of paper can be verified, or whether or not a digital QR code that's not tied back to a verified database,” said Sharon Pinkerton, senior vice president for legislative and regulatory policy for Airlines for America.
The standard CDC vaccination cards lack a scannable QR code that could help verify their authenticity. There’s also no national vaccination database, leaving businesses and others requiring proof of vaccination relying on an honor system, said Mullen, adding the cards may have been hastily designed amid the push to get vaccines in as many arms as possible amid a winter Covid surge.
Experts fear the market for fake cards will grow as more workplaces and public venues require proof of vaccination. Both the Federal Trade Commission and Department of Health and Human Services' inspector general have seen an increase in fraudulent activity, and U.S. Customs and Border Protection officials have reported mass seizures of counterfeit paper cards.
Public health officials say fake cards could undermine public confidence in vaccines, if there are outbreaks in places where documentation is required. “If someone has false documentation then uses that, you can be sure that the first rumor will be that that's a breakthrough infection,” said Georges Benjamin, executive director of the American Public Health Association.
Such arguments are putting more pressure on states and localities to respond with digital credentials like New York's Excelsior Pass Plus, which is built on the SMART Health Cards framework. The pass displays vaccination status and test results and is used to gain access for indoor activities like dining and entertainment. The LA Wallet app similarly offers verification through the Louisiana Department of Health.
The Delta variant's rapid spread and rising hospitalizations and deaths is putting more pressure on undecided states to act, even without a national standard. Some pharmacies have their own digital copies of vaccination records, and companies like CLEAR and CommonPass are offering their own digital verification tools.
“The Biden administration is unwilling to get out front on this because it's highly politically charged,” said Joel White, executive director of the Health Innovation Alliance, a leading health-tech lobbying group.
Rebecca Coyle, the executive director of the American Immunization Registry Association, said broad adoption of SMART Health Cards could fill the void left by the federal government. There can’t be “endless” standards, and the private sector is in a position to act faster than the federal government, she said.
“[It’s] a double-edged sword,” Coyle said. “It’s a trade off. I don’t think necessarily one is better than the other. It’s just that’s what’s happening today.”
Oriana Pawlyk contributed to this report.
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