Share on Pinterest
Vaccinations have stalled in the U.S. despite rising number of COVID-19 cases. Joe Raedle/Getty Images
  • Proof of COVID-19 vaccination is now required to enter cafés, restaurants, and other public spaces in France. Could this help the United States contain its ongoing pandemic?
  • Vaccine passports have been in use in the United States as early as the late 19th century.
  • However, today, vaccine passports or similar credentials are likely to remain voluntary.

Starting in August, anyone in France entering a café, restaurant, shopping center, or hospital, or taking a long-distance train, will have to show a special COVID-19 health pass, President Emmanuel Macron announced on July 12, 2021.

The increased restrictions in public spaces are aimed at containing the rapid spread of the highly transmissible Delta variant in the country.

The health pass — known officially as the EU Digital COVID Certificate — shows whether a person has been vaccinated against COVID-19, received a recent negative test result, or recovered from COVID-19.

Anyone over the age of 12 will also be required to show the pass to visit a movie theater, museum, live theater, theme park, or cultural center starting July 21.

Within 48 hours of Macron’s announcement, more than 2.2 million vaccination appointments were booked online, according to a tweet from Our World in Data’s Edouard Mathieu.

But many French citizens took to the streets to protest the new rules, saying they encroached on their freedoms and discriminated against the unvaccinated, according to Reuters.

To date, France has fully vaccinated almost 40 percent of its population.

The United States is facing a similar surge of the Delta variant, with a similar vaccination rate. Is the country ready for Macron-style vaccine requirements?

Dr. Bruce Y. Lee, professor of health policy and management at CUNY Graduate School of Public Health and Health Policy, said vaccine passports in the United States aren’t a new concept.

“There is precedent for vaccine passports, in the sense that if you want to attend school, you need to get immunized; if you want to travel to certain countries, you need to get immunized,” he said. “It’s not like these discussions are completely out of the blue.”

In fact, vaccine passports were in use in the country as early as the late 19th century, reports Time.

Travelers entering the country had to show proof that they were vaccinated against smallpox. This could be a vaccination certificate or a vaccination scar on their arm. They might also be allowed in if they had distinctive scarring on their skin showing they had survived smallpox.

Later, proof of smallpox vaccination was a requirement for many types of employment, especially ones in confined work environments such as factories, mines, and other industrial workplaces.

Some social gatherings and clubs asked people to show proof of vaccination before they could attend.

Public schools also required students to be vaccinated against smallpox, as they do today with measles, mumps, and other infectious diseases.

Thanks to the smallpox vaccination program, the last natural outbreak of this disease in the United States occurred in 1949. The World Health Organization declared smallpox eradicated from the world in 1980.

Even with America’s long history of requiring people to be vaccinated in order to enter certain public spaces, today there’s still — often politicized — resistance to the idea.

“There has already been some political leaders [in the U.S.] railing against the possibility of vaccine passports,” said Lee.

Richard M Carpiano, PhD, a professor of public policy at University of California, Riverside, said part of the opposition to vaccine passports stems from many Americans not being used to thinking about what’s best for the community versus the individual.

“A lot of times [the discussion about mandates] gets spun as ‘I should be able to do whatever I want,’ but that’s really not the basis of our social contract in this country, which is: ‘You’re free to do things that you want, provided that they don’t harm other people,’” he said.

The Biden administration said in April that there won’t be a national vaccine passport, leaving it up to states, companies, and schools to decide how to handle vaccination requirements.

Secretary of Transportation Pete Buttigieg later clarified that the federal government would support local efforts.

“If a company, a business, wants to take steps to keep their workers and their passengers safe, I would think that, from a government perspective, we want to do everything we can to encourage that,” he told KDFW FOX 4 in Dallas in June. “And that’s certainly our view at the federal level.”

As with many things related to the pandemic, this has led to a mix of state responses.

“Over the past year, we’ve been seeing 50 different types of policies getting rolled out,” said Carpiano, “particularly when it comes to vaccinations and public health.”

This includes vaccine passport policies.

California, Hawaii, Louisiana, and New York have all developed vaccine certification apps. Colorado, Illinois, and Oregon are considering similar systems.

Nineteen states have banned vaccine passports, with proposed bans in seven additional states. Many of these states are Republican-led.

The remaining states currently have no position on vaccine passports.

State bans on vaccine passports also vary among states, with some, like Arizona, providing exceptions for healthcare professionals. Certain bans are already embroiled in lawsuits.

In May, Florida Governor Ron DeSantis signed a bill that prohibits businesses from requiring proof of vaccination.

In response, Norwegian Cruise Lines sued the state, saying it can’t safely resume sailing without knowing whether its passengers and crews are vaccinated against COVID-19.

“We could see [Norwegian’s position] as a staff and passenger safety issue,” said Carpiano, “but it’s also protecting their bottom line.”

“They only need one bad cruise [with a COVID outbreak] to hurt their business and leave a mark on the industry itself,” he added.

A majority of Floridians agree with the cruise industry. Over 76 percent said proof of vaccination should be mandatory for all cruises, or the decision should be made by individual cruise lines, according to a survey from the University of South Florida.

Many U.S. colleges and universities have already decided that mandatory immunization is the best way to protect their campuses — more than 500 require students or staff to be vaccinated against COVID-19.

Some businesses — such as Morgan Stanley in New York City — have also made vaccination mandatory for workers returning to the office.

In addition, many health systems will likely implement their own vaccine requirements, especially after Houston Methodist in Texas survived a legal challenge of its employee COVID-19 vaccine mandate.

However, even in states that have developed vaccine passport apps, the programs are largely voluntary. That means businesses decide whether to require proof of vaccination.

Carpiano said that’s not necessarily a bad thing.

“The private sector really does have a role in vaccine passports,” he said. “We might not think about it as analogous to what Macron is doing, but already we’re seeing small-scale signs of this.”

For example, Bruce Springsteen and the Foo Fighters both recently required concertgoers to be vaccinated.

Still, without a state or national vaccine passport requirement, restaurants, bars, cafés, and other small venues that choose to require proof of vaccination or a negative COVID-19 test are left to face the social media backlash of the unvaccinated.

If the pandemic in the United States was fading away, discussions about vaccine passports might disappear with it.

But the pandemic shows no sign of letting up any time soon — especially with the rising cases of the Delta variant.

“There are a lot of people acting as if the pandemic is over,” said Lee. “But the pandemic is far from over. The question is: How long will it keep going? Because we’re not really doing enough to stop it.”

Cases are rising in every state and Washington, D.C., with 38 states seeing an increase since last week of at least 50 percent, according to a CNN analysis. Hospitalizations are also on the rise, with younger people now getting hospitalized with COVID-19.

The rollout of the COVID-19 vaccines have also dropped off sharply since the spring. Less than half of Americans are fully vaccinated, according to the Centers for Disease Control and Prevention (CDC).

At the current pace of vaccination, the country won’t hit 70 percent vaccinated until January 2022, according to a New York Times analysis, although no vaccine has been granted emergency use authorization yet for children under 12.

In spite of the stalled vaccine rollout, those who are vaccinated are highly protected against severe COVID-19.

This has led to what CDC Director Dr. Rochelle Walensky calls a “pandemic of the unvaccinated.” Recent data shows that almost all COVID-19 hospitalizations and deaths are among the unvaccinated.

Unless vaccination in the United States picks up speed again, other measures will be needed to contain the pandemic.

France’s vaccine passport rules are intended to help control cases of COVID-19 by limiting indoor public venues to people at low risk of severe COVID-19 or of transmitting the virus.

The CDC’s guidelines for what fully vaccinated people can safely do in public spaces had the same intention, but they were voluntary — which only worsk if people follow them.

One of the CDC’s recommendations was that unvaccinated people should continue to wear face masks while in indoor public spaces.

But Lee said if you visit some indoor public spaces, the percentage of people wearing masks doesn’t fit with the vaccination rates in the community.

“That suggests that there are people out there that are not wearing face masks and not practicing social distancing, even though they are not vaccinated,” he said.

Without public venues limiting access to people who are vaccinated, have recovered from COVID-19, or have recently tested negative, local governments are forced to resort to broad public health measures to contain the virus.

“What we’re seeing [in the U.S.] right now is situations like Los Angeles County, where they’re going back and saying, ‘Okay, everyone needs to wear face masks indoors,’” said Lee.