២៨ ឧសភា ២០២០ / 28 May 2020
គំនិតលោក សម រង្ស៊ី ស្តីពីការបង្កើតឲ្យមាន "លិខិតឆ្លងដែន បញ្ជាក់ភាពសុាំ ពីជំងឺកូវីដ-១៩" (Immunity passport) ត្រូវបានពិភពលោក យកទៅអនុវត្ត កាន់តែច្រើនឡើងៗ។
The Geopolitics, 28 May 2020
LACK OF COVID-19 VACCINATION MEANS IMMUNITY PASSPORTS ESSENTIAL
By Sam Rainsy
Immunity passports or certificates are simple common sense and a precious tool to safely restart the world during the COVID-19 pandemic. This health document allows the identification of people who will be neither infected by the coronavirus, nor a source of transmission. For at least a certain period, these people are protected against the virus.
These people, who are growing in number all the time, must be given this document and allowed to work, travel and carry out their normal activities. They present no health risk to society.
There are obstacles and objections to the generalized adoption of immunity passports. Some of these are technical and concern medical knowledge. Others are social and psychological.
These obstacles and objections will diminish and eventually disappear over time.
Serological tests, antibodies and immunity
The current inadequacy of medical techniques and knowledge concerns two key areas: the precision and reliability of the serological tests to detect the presence of antibodies, and uncertainty over the existence, nature and length of the immunity acquired after contact with the coronavirus and the appearance of antibodies.
Serological tests are becoming more and more precise and reliable. Their “false negatives” (a problem of sensitivity) and their “false positives” (a problem of specificity) are falling towards zero, or the level of maximum security. BioWorld reported on May 5 that the Swiss company Roche has produced a test with sensitivity of 100% and specificity of 99.8% which it is preparing to distribute on a large scale. The American company Abbott has developed a serological test which has sensitivity and specificity above 99%, so providing reliable practicality. The two companies say that the antibodies against the coronavirus can be detected starting 14 days after the infection or the onset of symptoms. (1)
As for immunity to COVID-19, normally associated with the appearance of antibodies (notably the IgG immunoglobins), the most recent research on a significant scale reported by The New York Times on May 7 confirms the appearance of antibodies among practically all people having had contact with the coronavirus and that these antibodies lead to immunity against COVID-19.
The short historical time frame available (around three months) means that the length of this immunity can’t yet be determined. With a longer time frame and better samples due to the growing number of officially cured COVID-19 patients (already more than a million in Western Europe and North America), further research has every chance of confirming and expanding on the results of these early studies. It will be possible to measure whether the immunity which is generated lasts longer than a year. (2)
Social and psychological problems
Some people have raised concerns over the inequalities, social distorsions and abuses that such a document could provoke. This is like rejecting the use of the car because it can lead to dangerous behaviour, cause accidents, create pollution and highlight social inequality. As with the car, the problems associated with the immunity passport can be resolved through regulation, education and responsibility.
The risk of inequality or social segregation between holders and non-holders of the immunity passport has nothing in common with the classic distinction between the “haves” and the “have nots”. There is no economic, social, institutional or even psychological barrier between these two “health groups”. Everyone can move from one group to the other, according to whether or not immunity has been acquired, sometimes without even knowing it.
Up to 80% of the people who catch COVID-19 feel no symptoms, and about 99.5% are cured within a few weeks at most. The boundaries between the groups are therefore invisible and in flux.
Humanity, whether it likes it or not, is divided into two groups which are hard to distinguish: group A which has not yet been touched by the coronavirus, and group B, which has encountered the virus and overcome it, often without even realising it. This group therefore has immunity, the duration of which scientific studies will confirm.
In each country and globally, it is fundamental to identify and track the invisible frontiers between the two groups. Only serological tests, the results of which must be noted in immunity passports, can do this. Fine-tuned regulation can allow issues of privacy and confidentiality to be overcome, as for tracking operations during the pandemic. The immunity passport is a better way to respect the individual than the use of sniffer dogs to publicly detect coronavirus carriers. (3)
Opinions on immunity passports are evolving quickly due to these rapid developments in medical knowledge concerning the precision and reliability of serological tests and the existence of immunity to COVID-19.
A few days after the March 27 publication in The Geopolitics of my article “How to prevent Covid-19 from paralysing the world’s economy” in which I defined the bases of the immunity passport, several countries – including Germany, the UK and Luxembourg – announced plans to issue such passports on the basis of large-scale serological tests. (4)
Cold water was thrown onto these plans by a warning from the World Health Organization (WHO) on April 24. The WHO advised against issuing such passports due to the uncertainties noted above and the risks they generate. (5)
Some of the uncertainty has since been lifted after a breakthrough in South Korea. The country had signalled that hundreds of people who were thought to have recovered from COVID-19 had caught the virus again. It was finally found that the virological tests on which this conclusion was based were erroneous and that those who had been ill were indeed immunised. This is the problem of “false positives” as the tests suggested the presence of the virus when, in fact, only fragments of the dead virus were present.
The latest news underlines the reliability of the tests and confirms immunity. This can only strengthen the case for immunity passports. After Chile, Estonia is the second country to adopt such a document to end confinement. The WHO warning seems to have been forgotten. In the UK, The Telegraph reflects this change in an article on May 14 which says that the immunity passport is an obvious choice that it is becoming “inevitable” to allow governments to safely open their borders. (6)
But the strongest pressure for the establishment of an immunity passport or other form of documentation of immunological status is coming from the public. This is underlined by an article in France’s Le Monde on May 21 which reports a “run on serological tests by people wanting to find out if they have been contaminated by COVID-19″. (7)
There is nothing more understandable and legitimate than an individual wanting to know if they are immune to COVID-19. In the face of widespread fear and worry, the immunity passport would provide a certain psychological comfort as well as a precious margin of freedom in a world that will remain in at least partial confinement, with all its professional and social constraints, for some time to come.
The advantages of the immunity passport can only increase with time, which will allow the duration of immunity to be measured. We are now virtually sure that this immunity lasts for at least three months: this is the length of time that the short history of the pandemic has so far allowed us to measure. New studies on larger populations are likely to allow confirmation of a longer-lasting immunity.
Even now, a certificate of non-infection and non-contagion valid for just three months would be more reassuring than a negative virological test, which shows only that a person is free of coronavirus today, but tells us nothing about tomorrow. The only way to find out is to test for immunity via antibodies in the blood, which is the point of the immunity passport.
In a worse-case scenario, even a guarantee of immunity for three months certified by an immunity passport which has to be renewed after that time, or by a document in digital form that can be continuously updated, would be very useful. It would help work to be rationally organised and projects to be safely executed. International travel would return, without the need for quarantine imposed on “COVID-19 suspects” by many countries.
(1) BioWorld, 5 May 2020
“Roche discusses launch of newly approved serology test to detect COVID-19”
(2) The New York Times, 7 May 2020
“After Recovery From the Coronavirus, Most People Carry Antibodies. A new study adds to evidence of immunity among those who have already been exposed to the pathogen”
(3) Bloomberg, 16 May 2020
"Covid-19 Sniffer Dogs: The U.K.’s Latest Attempt to Tackle Virus"
(4) The Telegraph, 29 March 2020
"Germany will issue coronavirus antibody certificates to allow quarantined to re-enter society"
(5) World Health Organization, 24 April 2020
“'Immunity passports' in the context of COVID-19”
(6) The Telegraph, 14 May 2020
“Health passports ‘inevitable’ as governments seek to reopen borders”
(7) Le Monde, 21 mai 2020.
“Coronavirus : ruée sur les tests sérologiques pour savoir si l’on a été contaminé par le Covid-19″
Sam Rainsy, Cambodia’s finance minister from 1993 to 1994, is the co-founder and acting leader of the opposition Cambodia National Rescue Party (CNRP).