Sunday , June 13 2021

Hungary and Iceland embrace ‘immune passports.’ Why not the rest of the world?



(CNN) – With miles of barbed wire and electric fences along its border and hostility of open government to migrants, the Hungarian border is not always the most friendly place for foreigners.

That is during normal times. In the midst of the pandemic, Hungary has closed its doors to almost everyone, even its European neighbors.

Unless, they’ve got Covid-19.

This is not the place where you would expect to find such a new exception to otherwise difficult access rules.

The policy, which came into effect in early September, opens the door for visitors who can provide evidence of improvement from Covid-19 – a test of positive and negative testing in the past six months.

Iceland has plans for a similar policy starting next week – and is already allowing previously infected citizens to ignore the nationwide mask mandate.

Experts call these types of policies a kind of “immune passport.” But does beating the virus actually give you immunity? The evidence so far suggests that it does so for most people.

“It is certainly theoretically possible that even some people with antibodies will not be protected,” said Dr. Ania Wajnberg told CNN outside her lab at Mount Sinai Hospital’s Icahn School of Medicine in New York.

“But I think the majority of people who test positive for antibodies will be protected for some time.”

Reopen society

Hungary has not disclosed any results from its Covid border strategy.

Hungary has not disclosed any results from its Covid border strategy.

Ajpek / Getty Orsi Images

Wajnberg is leading a massive study of more than 30,000 people who had mild to moderate cases of Covid-19. Her latest research published in October found that more than 90% of people had enough antibodies to kill the virus for many months after infection, perhaps longer.

So the risk of someone entering Hungary under this policy being re-infected, or infecting others, is low, he said. Although the science is not completely settled on how long immunity lasts, only a handful of redefinitions have been documented.

“This may be a reasonable way to start reopening society and allow for travel and business,” he said.

Iceland’s chief epidemiologist, Thorolfur Gudnason, has reached the same conclusion based on his own country’s data, and studies from abroad.

“I think it’s pretty safe. I mean, everything we do has uncertainty with it. Nothing is 100%,” he told CNN.

Border quarantine testing and exemption begins December 10. The North Atlantic tourism magnet will receive a documented test of a positive polymerase chain reaction (PCR) test that is at least 14 days old, or an immunosorbent assay test (ELISA) enzyme-linked probe measures antibody levels – subject to publication by an approved European laboratory.

Thorolfur says Icelanders who have beaten the virus are also exempt from the nationwide mask mandate with a letter from their doctor – though he says most people wear them anyway because of social stigma . He has never heard of anyone intentionally getting infected, especially with a vaccine coming soon.

“That’s possible. But on the other hand, I think it’s also unfair to people who have had the infection. Why shouldn’t they be allowed to travel freely?” he said. “I think it’s a question of justice, basically. If you have the medical condition that you don’t spread or get the virus, you are not a risk to the environment, then you should be kind of recognized for that. “

Covid spike risk

Iceland allows non-quarantine access for people who can prove they have Covid.

Iceland allows non-quarantine access for people who can prove they have Covid.

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Iceland is also in talks with the other Nordic countries – Sweden, Denmark, Finland and Norway – so that people with that exemption can travel freely without restrictions. While Thorolfur says the negotiations have not gone far – and he does not expect any other countries to follow Iceland’s lead.

Thorolfur was unaware of Hungarian policy.

Central European country has almost nothing to say about the success or failure of its unique exemption, what science it is based on, and how it weighed the pros and cons.

The Hungarian government declined interview requests and sent a statement describing only the policy itself. Many of the experts contacted by CNN were unaware that it was in operation. It has not been widely discussed even inside Hungary.

The World Health Organization (WHO) advised against immune passports in April. “There is currently no evidence that people who have recovered from Covid-19 and who have antibodies are protected from a second infection,” his scientific brief read.

On Thursday, WHO confirmed that it has not changed its position, but, Regional Advisor Dr. Siddhartha Sankar Datta said he was looking to help countries implement electronic vaccination certificates. Other experts have also raised concerns about immune passports.

“I think the worst case scenario is that you see a spike in cases that happen because people are motivated to try to get Covid to show immunity,” said Carmel Shachar, a bioethics and health expert Harvard University, told CNN.

“So all of a sudden you would see people not wearing masks, not respecting social distance, because they want Covid. Especially if more and more countries were adopting a similar scheme.”

Experts in several leading medical journals have also warned that immune passports may intentionally motivate otherwise healthy people to seek infection.

It is unclear whether anyone has been purposefully infected in order to enter Hungary, but Oxford University ethicist Rebecca Brown finds it hard to believe.

“It would be a pretty extreme thing to do. And I think probably not the vast majority of people would be,” he said, explaining that Covid-19 can even have long-term effects in young, healthy people.

‘Bad idea’

Hungary has closed its borders to most of Europe.

Hungary has closed its borders to most of Europe.

Ajpek / Getty Orsi Images

Shachar also argues that “immune passports” could reward reckless people who become infected after ignoring Covid’s rules or eroding medical privacy.

“The more information you need to give out then the more normal it is to invade people’s privacy,” she argues.

Harvard biologist Natalie Kofler is outspoken in her opposition to immune passports. “It’s a bad idea,” he said.

Kofler says they could exacerbate existing inequalities.

“If you’ve had [the virus] before, it’s not like a vaccine from an ethical standpoint. That’s because you had to be healthy enough, privileged enough to get the health care you might need, and rich enough to have the tests you might need to survive the virus, ” he said.

Brown from Oxford wrote a paper examining the pros and cons of immune passports, which ultimately argues that the potential benefits outweigh the disadvantages.

“Many people who are worried about immune passports have not made many suggestions about how we might solve the difficulties and are not looking insurmountable. types of problems that could arise, ”she says.

‘Positive benefit’

The IATA aviation body wants to introduce vaccination passports to open borders.

The IATA aviation body wants to introduce vaccination passports to open borders.

STR / AFP via Getty Images

Immune passports can come back into fashion once vaccinated. The International Air Transport Association, which represents hundreds of airlines, is pressing for a safe, digital “travel ticket” for passengers to show proof that they have been vaccinated, once a shot is available.

The CEO of Australian airline, Qantas, Alan Joyce, has already suggested that passengers will have to prove they have been vaccinated in order to board the future.

Brown argues that those who have recovered from the virus should be treated the same as those who have had the vaccine. Even skeptical Shachar is open to the idea.

“There is actually a positive benefit to treating them all the same. We do not want to waste vaccine doses, it will be a time before we have enough vaccines for every human on the planet,” he said.

When asked if those who have recovered from the virus should be placed at the back of the vaccine line Wajnberg says it’s a good idea in theory. In practice, he says, the same high-quality, accurate ELISA tests he uses in his laboratory would need to be introduced on a massive scale.

“It might make sense … not to vaccinate people who already have very high levels of antibodies, but I think that’s going to be very challenging operationally.”

Neil Bennett, Christian Streib, Oscar Featherstone Bálint Bárdi, David Allbritton and Adrian Divirgilio contributed to this report


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