On April 2, health secretary Matt Hancock offered a glimmer of hope for members of the public already beleaguered after weeks of lockdown. If people could take tests that prove they were immune to the virus, they might be able to return to normal life sooner, he said.
The inspiration for this plan likely comes from Germany, where researchers at the Helmholtz Centre for Infection Researchers plan to send out hundreds of thousands of antibody tests over the coming weeks. In a scheme identical to Hancock’s proposal, those who test positive could receive an “immunity certificate” allowing them to return to work and some elements of normal life.
But the government’s plan is far from straightforward. First off, it would have to procure a working test, which is still not on the immediate horizon. Even if we did have a functional test – and that’s a big if – making immunity passports work is fraught with difficulties.
Ostensibly, it’s clear why the idea is being explored. It’s obvious that with each day we stay in lockdown the economic repercussions grow worse. (Though this says nothing about the repercussions of lifting the lockdown too early.) “There clearly is an urgent need to get people back to functioning, and if it’s the case that a number of people who would be safe then we need to take that really seriously,” says Robert West, a professor of health psychology at University College London.
Yet there are serious reasons why splitting society along the lines of immune and not-immune people might not be a good idea. It’s not hard to imagine how the split might generate resentment – imagine being locked indoors while your immune neighbours galavant around the park. Social cohesion will suffer. “There’s so much evidence on ‘in group’ and ‘out group’ work that, even when you set up arbitrary ‘in groups’ and ‘out groups’, people become quite tribal,” says West
“The whole approach might also undermine the message that we are all in this together, which is crucial if we are going to get through this relatively quickly,” says Adam Oliver, a behavioural economist at the London School of Economics.
It’s also hard to imagine how this divide would be enforced. Police have struggled to contain a blanket ban on picnics and sunbathers. “If somebody feels that they can go to the pub and meet with their friends, and then they claim they’ve got a positive test, which they did at home, how do we know whether that’s true or not?” says Martin Hibberd, a professor at the London School of Hygiene and Tropical Medicine.
As with many public health issues, the coronavirus pandemic has disproportionately affected poorer people, and the same is true for the consequences of the lockdown. One frightening scenario is that those in more economically precarious positions – or those who cannot bear isolation – might go out and try to catch the virus, in order to return to work. A market might emerge for validated passports or blood that passes the lockdown-lifting test. “There is absolutely no doubt that if people start to become desperate because they can’t feed their families [...] then I think you can expect people to start behaving in ways that we wouldn’t have seen otherwise,” says West.
From a legal standpoint, letting certain employees return to work is a minefield too. Beyond just employee relation issues, where those who can’t return to work fear losing out to those who can, the main legal issues concern health and safety, explains Rob Collier-Wright, a senior associate at the law firm Bird & Bird,. Namely, whether employers might breach their health and safety duties by permitting employees with immunity passports to return to the fold. “This would depend to a great extent on the government advice to employers from time to time,” he says. “Currently, all employees are required to work from home unless they absolutely cannot do so. It seems likely that the government would only relax the workplace restrictions if the testing had been found to be effective, in which case employers may feel comfortable reopening workplaces to employees who have undergone compliant immunity testing.”
Employers might also run into legal issues if they require employees to carry out immunity testing or return to work prior to the general workplace restrictions being lifted, particularly if they provide non-essential services or can carry out their work from home. The private health data in an immunity passport is also likely to be a sticking point, explains Collier-Wright. This data is subject to enhanced processing obligations and restrictions, which will likely complicate its collection.
Employers would possibly be better off avoiding any immunity passport scheme entirely. “From a practical standpoint, employers who are able to keep their business open using remote working or who are receiving grants from HMRC under the furlough leave scheme may prefer to stick to the status quo until such time as all restrictions are lifted, rather than re-integrating employees on a case-by-case basis once they have obtained immunity passports,” he says.
Underpinning all this are the problems with the tests themselves, which are numerous. For a start, no test is a guarantee of immunity. “In a situation where the prevalence of people with antibodies in the population is quite low – probably no more than around ten per cent people – even if you’ve got a highly highly specific test, it is still going to give you quite a lot of false positives,” says West. “That means the government cannot say to people – because you’ve got this test result, you’ve got the antibodies.”
Dispelling this assumption is going to be key to any government strategy, particularly if people view it as a gateway to returning to normal social interactions. “The government needs to work with people like [the statistician] David Spiegelhalter, whose whole job is to work out how you communicate uncertainty to people in a way that they understand,” says West. “All it will take is for one headline case of someone given the all clear to work – let’s say in a hospital – and infecting people, and trust will go through the floor.”
“Imagine the psychological state of a person who thought they were in the all clear and has gone back to work in a care home and ended up killing several people,” says Susan Michie, a professor of health psychology at University College London who is also a member of the scientific group advising the government’s response to Covid-19. Headlines like this are likely to precipitate even more fake news and conspiracy theories. “We would want people to understand the benefits of having these tests, along with the uncertainty, and we don’t want these people to turn into a group like the anti vaccination groups. That could be very damaging,” says Michie.
Will Bedingfield is a staff writer for WIRED. He tweets from @WillBedingfield
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This article was originally published by WIRED UK
