Concerts, performances and other public gatherings are back on come April 15 — that is if attendees can prove they've been vaccinated or recently tested negative for COVID-19.
This announcement came on Friday, with no clear plan of how Southern Californians will prove their credentials.
Experts are worried about initiating this new strategy without a set of single standards or regulations. It raises a host of questions about forgery, health privacy records and accessibility.
"Each jurisdiction is kind of left to their own devices," said Rita Burke, an assistant professor of clinical preventive medicine at USC's Keck School of Medicine of USC. "There's no one set of guidelines which — in a situation like this — would be really, really helpful."
On eBay, she said, scammers are already selling replica vaccine cards for around $200.
The landscape of vaccine passports has evolved into an unregulated, crowded market. At least four Los Angeles entities have created their own, some working with others, including UCLA and health care startups Carbon Health and Healthvana.
President Biden's chief medical adviser Dr. Anthony Fauci said Monday on Politico's podcast that the federal government will not require the credentials for businesses or travelers.
And last week, the Biden administration said it's letting private companies take the reins over vaccine passports, opting out of creating a centralized system for verifications.
How California — and any other state — will use the digital tools is still unknown. And the state has remained quiet on its strategy.
New York officials have launched their own version called Excelsior Pass for concert and event-goers. Meanwhile, a Florida governor on Friday banned digital certifications for vaccines, citing concerns over privacy and "individual freedom."
"It's going to be hard for businesses to require a passport because nobody wants to be perceived as forcing people to take a vaccine," said Ken Mayer, co-founder and CEO of the health tech company SAFE Health.
The L.A. startup is working with IBM and a coalition called the Vaccination Credential Initiative to develop passports for people to show proof of vaccination or recent COVID-19 test via QR code. It's one of several tech companies working behind the scenes for what will essentially be a ticket to freedom for many.
But the system, some worry, could create a have-and-have-not world where those with the vaccination gain access to concerts, offices and international travel.
"I think COVID passports should not be a thing that further divides people and makes it even more difficult for people who are on the margins," said Jakub Hlavka, a fellow at the USC Schaeffer Institute.
Hlavka said that inequitable vaccine distribution — especially in rural areas unable to preserve vaccines at specific temperatures for long — will impact how freely people are able to travel internationally, or how families across borders will reconnect after the pandemic.
It's also raising concern about personal health record keeping.
"This is a new concept so it sounds simple until you get into the security and privacy details," said Eren Bali, the co-founder and CEO of Carbon Health, which runs L.A.'s vaccine appointment website.
Bali said that any digital application should be for a single use and not allow providers to store "random health data" such as diabetes or other personal medical information that is protected and has no bearing on public health.
The company recently developed its own digital certification card called Health Pass, which is automatically provided to individuals who completed vaccination through the city of Los Angeles.
"I think this is only relevant for highly infectious diseases," he said, pointing to yellow fever as another use case for a vaccine passport.
L.A.'s Department of Public Health did not immediately reply for comment, but in March, a spokesperson confirmed that the county was working with Healthvana to send out their own electronic passport.
Even if vaccine passports catch on, people will still receive a white vaccination record card after getting the shot. But it's unclear whether venues or businesses will accept them as proof, or how they'll be verified for authenticity.
Almost a third of California residents have been partially vaccinated. Health officials in Los Angeles County report 1.3 million people have been fully vaccinated, but that data doesn't include Pasadena and Long Beach.
One upside to a digital passport is that it could serve as an incentive for those yet to be vaccinated, said Assemblymember Jesse Gabriel, who represents much of the west San Fernando Valley and sits on the Assembly's Privacy and Consumer Protection Committee.
The committee oversees California's Department of Technology, responsible for partnering with state and local government to deliver digital services like MyTurn, the vaccination appointment portal run by the state.
"Hopefully it's something that'll motivate people who may be on the fence, knowing that they're able to do these things," he said.
But Burke says those who are skeptical about the vaccine are also the people wary of a vaccine passport.
Plus, proving a negative COVID-19 test "does not guarantee that you don't have COVID," she added. Venues and businesses should reconsider accepting days-old negative test results before letting customers inside.
"Showing a negative test is not really a good way of approaching this," Burke said. "Now, as we're opening up, we really need to focus on getting as many folks vaccinated as possible."
This story has been updated.
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Scheduling Apps Have Been Around a Long Time, So Why’s It So Hard To Book a COVID Vaccine Appointment?
Los Angeles residents scrambling to book vaccination appointments by refreshing their web browsers and flooding hotline numbers are out of luck. By Monday, most appointments on city and county-run websites were taken for the week.
It took just 10 minutes for thousands of reservations to get snapped up on L.A. city's appointment site run by Carbon Health last week.
"The experience has been a little bit like trying to get Rolling Stones tickets," said Sujal Mandavia, the chief medical officer of the San Francisco-based company.
As the city and county update their respective sites with new appointment slots, many eligible for the vaccine are hitting roadblocks — some users seeing appointment times that, in reality, have already been booked. The county is receiving about 160,000 doses each week. According to the state's epidemiologist, vaccinating the region's estimated 1.3 million people over 65 will take until June.
The rush to schedule vaccinations for health care workers, residents of nursing homes and, now, people 65 and older will serve as a logistical trial for a larger roll out expected over the coming months. It's become a test of tech providers' ability to build platforms that match the steady wave of traffic.
"It's just been very difficult because of the overwhelming demand," Mandavia said.
On Monday, Carbon Health's website announced that it was not taking new appointments at all. And L.A. County Public Health Director Barbara Ferrer said there were no available appointments at county-supported sites through the end of this week. She hopes new slots will be added for Saturday and Sunday.
Without a national strategy for testing or vaccination rollout, cities and municipalities are relying on healthcare and tech companies to digitize tasks from booking appointments to storing medical information.
On Monday, Gov. Gavin Newsom announced a new statewide appointment management site called My Turn.
The platform — built by Salesforce, Accenture and Skedulo — is piloting in Los Angeles and San Diego. It's designed to inform California residents whether they are eligible and, if so, to send them notifications about available slots.
A venture-backed startup founded in 2013, Skedulo has been scheduling appointments for the American Red Cross and supporting coronavirus testing efforts with New Jersey-based BioReference Labs. The majority of its revenue comes from healthcare clients, marketing executive vice president Miles Kelly said, making the company "relatively prepared for the critical mass rollout on the vaccination side."
Navigating the Tech
Kelly said the company has strived to "make something that is super-sophisticated come across as relatively straightforward or simple."
"One of the biggest issues we're experiencing now is that the people that we are striving to get vaccinated are not necessarily those who would be digitally native," said Shira Shafir, a UCLA associate professor of epidemiology.
But even younger people familiar with the internet are struggling to make appointments online.
On Sunday, Shafir saw an email for open appointments and rushed to My Turn to book a slot for her 80-year-old doctoral advisor "knowing with certainty he would not be able to do so."
The website crashed, then listed times that she wasn't able to reserve.
"You look to platforms booking tickets for very in-demand concerts and there are certainly wait lists and people pushing refresh, refresh, refresh," Shafir said. "This is not a new phenomenon, though it might be new to public health."
The city's appointment site will stay up even as My Turn is rolled out across the county. Carbon Health entered the deal to help L.A. schedule its vaccine appointments after working on the city's testing efforts. In a little over a week, the $175 million venture-backed company built the platform to list every open appointment offered at five city-run vaccination sites.
"We have really bulked up our network server resources so that we're able to handle any variation in volume," Mandavia said.
But things could get even more complicated. Johnson & Johnson's vaccine is reportedly inching closer to approval, a development that could pose other challenges, said CORE CEO and co-founder Ann Lee. The nonprofit group operates vaccination pop-ups in L.A. including the Dodger Stadium location.
"It's just a one-dose vaccination which makes life easier, but how do you deal with two different types of vaccines on the same site?" she said.
Lee is reminding residents that most appointment-booking issues have to do with supply and demand. There just aren't enough vaccines available for everyone eligible to get one.
"The thing I have been telling the people I care about is the minute they get the notification that appointments are available, they do need to drop everything," Shafir said. "There are very few things on anybody's calendar that would be more important than getting to a vaccination site."
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