Hi folks. Hope you’re enjoying the summer in which Schmigadoon beat the Olympics in must-see TV.
The Plain View
Repeat after me: The SMART health card is not a vaccine passport. The federal government doesn’t issue it. No one is required to download it.
But if it does its job, this digital proof that someone has received a Covid shot will be a vaccine passport, kind of. One we desperately need.
Let’s back up. Last fall, as it became clear that a Covid vaccine was on the way, several organizations, including Microsoft, MITRE, and the Mayo Clinic, began thinking of a way for vaxxed people to verify they’d been inoculated. They sought to improve the CDC’s verification—an easily forged piece of paper that doesn’t fit in a wallet and loses its value if you leave it in your jeans pocket when you do the laundry. They looked to a preexisting open-source project called the SMART health card framework, designed for people to digitally store their health information. This became the basis of a new coalition of tech, health, and government entities called the Vaccine Credential Initiative, or VCI. It doesn’t issue cards by itself, but it presents an open-source blueprint for institutions to make apps that draw information from a vaccine database, like the ones kept in all 50 states and by health care providers such as Athena or Walmart. When vaccinated individuals voluntarily use one of those apps, they can download proof of their jabs, which they can then present via a QR code to anyone who asks. The framework is built for interoperability; though the apps are developed by different entities, the system is designed so any SMART health card reader—downloadable from Google or Apple—can verify the information.
Right now, the coalition has more than 500 partners, including big health providers like Athena and the medical records giant Epic. States are just beginning to implement the cards. So far, only four have adopted the SMART health card framework as their approved verification system, but two of those states have a good chunk of the US population.
“It served our needs perfectly,” says Rick Klau, a former Googler who is now chief technology innovation officer for the state of California. California launched its Vaccine Record Portal, based on the SMART system, in June. “It was open, so there was no incremental cost for us to adapt. If any other state wanted to do this, they didn’t need to talk to us, they could just deploy it in the same manner that we would.” So far, about 10 percent of the 20 million vaccinated people in the state have downloaded the card, but Klau expects it to pick up as more places ask for proof of vaccination. “In the last couple of weeks, we’ve seen an organic groundswell of entities that want to use it,” he says.
And this week, New York state announced a SMART health card upgrade to its existing Excelsior app. State CTO Rajiv Rao says that it was a no-brainer to augment the closed-loop system of Excelsior with the more extensible SMART system. “My job is to provide technology to make people’s lives easier,” he says. Rao says it took only five weeks for his 20-person team to implement what they are calling Excelsior Plus (they also worked on other stuff during that period).
But remember: It’s not a vaccine passport. New York and California aren’t forcing people to download the app. No Big Brother. They, and other VCI participants, are simply offering it to provide a means for anyone to verify their vaccination status on their own initiative. It’s not even an identity document; the QR code doesn’t say who you are, just whether you got the jab, what vaccine you received, and when. If bar owners, restaurateurs, and employers want vaccinated customers and workers for the good of their own operations, now they have a foolproof way to verify people’s status. Foreign travel is also increasingly dependent on confirming vaccination status. But it’s not Joe Biden who will demand that you prove yourself before crossing a border—it’s your destination country. Up to you! In July, the entire country of Aruba announced that the only proof of vaccination it would accept from visitors is the SMART health card. You like Aruba? Download, baby, download. If, of course, you got your Fauci-ouchie.
The biggest obstacle, it seems, is those politicians who reject the idea that anyone has the right to filter out non-vaccinated (and possibly infected) people from businesses, workplaces, and events, even if it means more infections, more hospitalizations, and more deaths. “Given the political sensitivities that we’re all aware of, there are a number of states that have clearly told us they’re not interested in moving forward with this,” says Brian Anderson, MITRE’s chief digital health physician, who is a co-lead of VCI. Some states have even passed laws that seem to criminalize the use of VCI and other verification processes. In June, Texas governor Greg Abbott proudly tweeted that a law he signed “prohibits any business operating in Texas from requiring vaccine passports or any vaccine information.” In May, Florida governor Ron DeSantis also signed an executive order banning businesses from asking for documentation on vaccination status. (Last week, a third of all Covid cases in America were in Texas and Florida.)
Oh, and before some of you cancel your subscriptions because I’m pounding on GOP governors, let me take a shot at the mayor of New York City. In the same week that his state was introducing a cryptographically secure proof of vaccination that could be read anywhere in the world, Bill de DiBlasio announced that NYC was rolling out its own app, which actually doesn’t verify anything, since it’s basically a way to take a picture of your current, not-very-secure CDC card. Within hours of its release, people were getting the app’s green check mark of approval by uploading pictures of their cats, Mickey Mouse, and restaurant menus. “It’s sad,” says Rao. “I cannot comment on what the logic is there in the city, but he did not serve the intent we are trying to address.” The effort would be funny, except for one thing: In a pandemic, counterproductivity is death.
The SMART system is far from a panacea. For one thing, not everybody has the same access to smartphones or the technical savvy to use the app, and so there are legitimate concerns that underrepresented people might be at a disadvantage. Anderson tells me that VCI can offer people a way to get a paper card with a printed QR code, but that requires an extra step that not everyone will take.
Still, if the system works, someone who lives in Hawaii can get into a bar in Los Angeles that only admits vaccinated patrons. And New Yorkers visiting New Orleans can prove to the New Orleans Jazz and Heritage Festival that they’re vaxxed. (OK, the jazz fest hasn’t said whether it’s making that demand yet. But it should.)
And here’s where Smart Card advocates think they have a shot at overcoming the red-state gubernatorial death squad. Right now, non-vaccinated people can pretty much live their lives however they like, even going maskless. But patience is running thin, and more employers and businesses are itching to turn away the unvaxxed. Also, more countries may follow Aruba’s lead and demand those cards for international travelers. Eventually, you may need one simply to get on a plane. New York’s Rao says while that may not happen soon, it could be inevitable. “I’m sure there will be some announcements,” he says.
So imagine a virtuous cycle: With an interoperable and verifiable way to prove vaccination, concert facilities, bars, and workplaces will have a quick and easy way to adopt vaccine mandates. Non-vaccinated people won’t have any easy way to lie about their status, and their lives will get uncomfortable. This just might lead those skeptics or conspiracy believers to roll up their sleeves and get a jab! Meanwhile, citizens in Texas, Florida, and other states resisting participation in the SMART system could demand that their vaccination information be available to them. They have a good case. “Health systems are required to share records and copies of health data with individuals that make requests of them,” says Anderson. “That’s a federal law.” As bigger majorities are vaccinated, there will be less patience with politicians who stand up for increasingly isolated holdouts. Result: more vaccinations, fewer infections.
No, the SMART card is not a passport. But if we treat it like one, we might get out of this mess sooner.