Vaccination Documentation

On Tuesday, April 6th, New York state will eliminate the last government restriction on COVID vaccine eligibility.  On that date, the shot will be available to anyone over 16 (the lower age limit of the Pfizer vaccine’s emergency use authorization). Hooray, and a big THANK YOU to the scientists who got us here!

Now the #1 reason to get the shot is to keep you from dying of COVID, and the #2 reason is to reduce spread, limit cases, and stop the evolution of new variants. Also, the CDC says that getting vaccinated is a big part of our safe return towards normalcy - being with other people outside of your household, indoors, and without masks (even if they aren't vaccinated, as long as they are healthy).  And you don’t need a piece of paper to get those benefits.  Nevertheless, it seems like more and more companies, schools, venues and other organizations are going to be asking for evidence of vaccination. This might be in the form of your completed vaccine card or something more high-tech.

When I’m vaccinating people, I got a lot of questions about this, so I figured I would write a something about it. Here are a few of those questions.

1) What should I do with my card?

Well, you should really try to hang on to it. As I discuss below, there are some digital projects in development, but having that paper card right now is the one universal way of proving your vaccination status. And that means taking a picture of it with your phone each time you get a shot, in case you lose the card itself. You should be able to get a duplicate wherever you went for vaccination, but having a picture will make that process easier.

2) Should I laminate my card?

Not a bad idea, since a spilled drink could make your card illegible. Remember, heat lamination has been reported to degrade some types of ink, so better just use those sticky sheets. Some people worry about the last two lines on the card marked “Other” below the first and second dose lines, since we don’t know just yet if boosters will be necessary in the future. I think that’s overthinking it. If we need COVID boosters, no one is going to be denied because their card is laminated, and you could always just get another card.

3) Isn’t there a fancier, high tech way of showing my vaccine status? Like an app or something?

Why yes, and thanks for asking! Last week, New York State launched a project called the Excelsior Pass, which is a system that lets people upload their vaccination information, along with COVID test results, into one common, secure database. This makes it easy to provide this proof, and for gatekeepers to rapidly verify it - something that will be extremely helpful when you need to move large numbers of people safely into a venue like a concert or a game. Also, if anything changes with regard to state regulations, that can easily be updated centrally and accommodated, rather than trying to communicate directly with thousands of security guards. You can show your pass on a smartphone, or by printing out the QR code. So far, it seems to work quite well, and hopefully this will be inspire other states to do something similar, possibly developing a nationwide "vaccine passport" in conjunction with the travel industry.

4) My vaccine card has an expiration date on it! Does that mean I’m not safe after that?

OK, first of all, there are two types of “expiration dates” that you might see. The one on the little stickers, right below the lot number does NOT refer to the last day that you are immune to COVID-19. It is the expiration date of that particular batch of vaccine, which means that it can’t be thawed out, drawn up into a syringe and injected into someone after that date. As long as the date you got the vaccine is earlier than the lot expiration date (trust me, it is), you are fine. If you drink a glass of milk, you don’t get sick a few weeks later when the expiration date of that carton arrives...

The other expiration date is what you might see on a digital pass (like on the Excelsior system, if you are in New York State). This actually IS an expiration date for the pass itself, and you can’t use it as evidence of vaccination after that day. But the thing is, no one knows how long vaccine generated immunity lasts. There are a few people who got this vaccine early, during testing, and those people are being monitored for long term efficacy. But the vast majority of recipients were vaccinated after December.

So initially, the passes were set to expire in 3 months, because we were pretty sure that protection lasted at least that long from the trials. When I first downloaded the Excelsior app this week, my pass said that it expired on 4/14/21 (3 months after my second dose). But I just checked it again (a few days later), and I got a new pass that expires on 7/13/21. This is because more recent research has shown that the immunity is good for at least six months! And as time goes on, we will probably see these expiration dates revised again. No one knows how long the various COVID-19 vaccines will protect us. Some vaccines (like those for smallpox or measles) seem to protect for life, while others (like the flu shot) provide immunity that fades fairly rapidly.

5) Should I post a pic of my card on Instagram or Facebook or whatever social media site is hot now and that Dr. Mike doesn't know about yet?

OK, I ALWAYS encourage people to take phone pics of themselves holding the syringe and getting the shot when I'm vaccinating, if they seem interested. Vaccine hesitancy is a real problem, which fortunately seems to be getting a bit better. However, we still need to do what we can to get reluctant people - who are open to reason and persuasion - to come in and get immunized. A great way of doing that is letting them see their friends enthusiastically participating in the process, because one high school buddy posting a vaccine pic on social media is worth 10 lectures from Anthony Fauci.

Not everyone has that opportunity for a photo when they get their vaccine, so the next best thing is to take a pic of your card and post that. And that's fine too, as long as you take the time to crop out, block out or blur your identifying information. Yeah, you might say that ship has sailed, and your real birthday is on your public profile, but these cards also have other information on them. No reason to make it easy for the creative identity thieves out there. In addition to making a fake paper card, if someone has your name and birthdate, and the location, manufacturer and date of your shots, that could help them create a fraudulent account on a digital system as well.

6) Why would I need to show evidence of vaccination anyway?

There are probably going to be a lot of legal and ethical arguments about this as COVID vaccination status becomes more and more prevalent in the adult population over the next few months. Some health care facilities and universities have already stated that they will require vaccination of all employees and students, presumably with exemptions for health and religious reasons. There are clearly HR issues in making it a condition of employment, especially since none of the current vaccines are fully FDA approved and are only authorized for emergency use. The courts may ultimately decide on this. I can certainly see if being hard to legally mandate an “unapproved” vaccine in the workplace, even though I personally feel that the Emergency Use Authorization standard is very high and these vaccines are extremely safe (and lifesaving!).

Just to give you some perspective, however, there is plenty of historical precedent for the government mandating vaccination or other proof of immunity after recovery from contagious diseases. Forced quarantine has been used since the 14th century during the plague, and certificates of health have been around since the 1700s.

These legal arguments should be less of an issue for recreational activities run by private organizations. For example, some cruise ships have already begun requiring proof of vaccination for all passengers and crew. And while testing and quarantine are currently options at most travel destinations and border crossings, as vaccination becomes more common, that may change. There is already political pushback to such potential vaccine requirements. But even if they don't ever become absolutely necessary for participation in these activities, proof of immunity still will be useful for both entertainment providers and customers.

Sports, theater, and music venues have every incentive to streamline entry with vaccine passports. Travel is also going to be a big reason to have some sort of proof of immunization. On April 2nd, the CDC announced that fully vaccinated people - two weeks after their last shot - no longer have to get tested or self quarantine before or after domestic travel, unless their destination requires it. It is far easier and safer to check vaccination status than to obtain and report multiple tests, while relying on honor system quarantines.

And of course, there is one incredibly important reason to get vaccinated, and to carry proof of your vaccination status. I think that many of us already know what that is. That card entitles you to a free Krispy Kreme doughnut, EVERY day, for the REST of 2021.

Oh, yeah, and it will keep you from dying of COVID-19, so there’s that too…