Public Health in Practice 2 (2021) 100136

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Public Health in Practice

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Letter to the Editor

Emerging technologies and COVID-19 digital vaccination certificates and passports

A R T I C L E I N F O

Keywords
Emerging technologies
COVID-19
Electronic vaccination certificates
Passports
Immunization

Dear Editor Internet of Things, Internet of Medical Things, 5G technology, Block­

chain, additive manufacturing, robotics and virtual reality [12,13]. Such
The coronavirus disease (COVID-19) continues to overburden many
technologies have been utilized to develop smart applications such as
health systems despite the successful development and distribution of
contact tracing apps [14], social distancing tools, and smart wearable
World Health Organization (WHO) approved vaccines [1]. Several
devices.
measures and restrictions including social distancing [2], face masking,
In the context of COVID-19 electronic vaccination certificates, these
blanket lockdown [3] and travelling ban have been implemented but the
technologies could be utilized to perform various functions. Firstly,
emphasis now shifted towards immunization of populations, targeting
artificial intelligence could be used to detect fake COVID-19 vaccination
priority groups to reduce secondary transmission and to accelerate
certificates, easily identify and map non-vaccinated regions or pop­
post-pandemic recovery, especially when restrictions are relaxed.
ulations for strategic planning, cluster migrants’ migration patterns
However, the universal immunization of populations faces tremendous
based on data stored in the verification app(s) and aid in contact tracing.
challenges such as inequitable vaccine distribution [4], weak health
Secondly, Internet of Medical Things and blockchain technology will be
systems, shortage of healthcare professionals to administer the vaccines,
useful in remote access to COVID-19 vaccination certificates while
lack of awareness and lack of public trust among the affected populace,
allowing for additional health services such as remote counselling to be
limited financial resources to secure vaccines [5], pre-existing health
integrated into apps that generate electronic certificates. Blockchain
inequalities [6], vaccine refusal, inequalities in vaccine coverage,
technology specifically associates person’s identification with block­
ignorance, COVID-19 conspiracy theories [7] as well as short supply of
chain records for authentication purposes [9] and improves electronic
vaccines and emerging of new variants that are partially resistant to
health data and communication link security using blockchain-based
vaccines [8]. Despite all these impediments, vaccination is in progress in
systems, especially when accessing and sharing COVID-19 data. Thirdly,
at least 171 countries as of April 14, 2021. The vaccinated people are
5G cellular technology can support high bandwidth and data transfer
given COVID-19 vaccination certificates or cards that contain informa­
rate to support real-time verification of COVID-19 vaccination certifi­
tion such as personal details, health facility, vaccination dates and
cates and sharing of health data while big data can store and process
dosage [9]. Historically, immunization was successfully implemented to
COVID-19 certificates verification data with real-time updates and
alleviate the upsurge of diseases such as smallpox, yellow fever (which is
remote access. Fourthly, Quick Response (QR) technology will allow
mandatory for travellers to and from endemic countries) and
authorities to check people’s health status record and verify COVID-19
diphtheria-tetanus-pertussis for children [10]. However, these tradi­
digital certificates by using quick response [12,15,16]. The role of
tional immunization card or certificates are vulnerable to forgery [11],
emerging technology in supporting regional and international syn­
corruption, alterations, difficult to read by non-health experts, they can
chronization of health data and verification of COVID-19 digital vacci­
easily get lost, and also susceptible to weather conditions such as rain
nation certificates is therefore evident.
[10].
Notably, several countries have been utilizing emerging technologies
Therefore, there is a need to develop secure COVID-19 electronic-
to develop applications (apps) that generate and validate COVID-19
based vaccination certificates or passports to counter the limitations of
electronic vaccination certificates. For instance, in the context of
traditional vaccination cards. COVID-19 digital vaccination certificates
COVID-19, the United Kingdom developed a mobile phone application
should be tamper-proof, remotely accessible, secured and preserving the
to document people that have been tested for COVID-19 and soon to be
privacy of people (design-by-ethics). This is achieved by incorporating
used to keep the track record of people immunized against the virus
emerging technologies in the development processes as they have been
[15]. Also, China launched a digital COVID-19 vaccination certificate for
implemented to tackle COVID-19 in various domains. These technolo­
its citizens planning cross-border travels [16]. WHO launched the Smart
gies include artificial intelligence, geographical information systems,
Vaccination Certificate consortium to monitor national COVID-19

https://doi.org/10.1016/j.puhip.2021.100136
Received 9 March 2021; Received in revised form 19 April 2021; Accepted 3 May 2021
Available online 7 May 2021
2666-5352/© 2021 The Author(s). Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is an open access article under the CC
BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Letter to the Editor Public Health in Practice 2 (2021) 100136

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is imperative to develop a framework and policies guiding the integra­
tion and synchronization of digital solutions especially digital vaccina­ Elliot Mbunge*
tion certificates in case of international public health emergencies. Department of Information Technology, Faculty of Accounting and
However, such technological interventions should be guided by ethical Informatics, Durban University of Technology, P O Box 1334, Durban,
guidelines. 4000, South Africa
Department of Computer Science, Faculty of Science and Engineering,
Funding University of Eswatini (formerly Swaziland), Kingdom of Eswatini
Tafadzwa Dzinamarira
None.
Department of Public Health Medicine, School of Nursing and Public Health,
University of KwaZulu-Natal, Durban, 4001, South Africa
Declaration of competing interest
Stephen G. Fashoto
Authors declares no competing interests. Department of Information Technology, Faculty of Accounting and
Informatics, Durban University of Technology, P O Box 1334, Durban,
Acknowledgements 4000, South Africa
John Batani
Not applicable.
Faculty of Engineering and Technology, Botho University, P. Bag A7156,
Maseru, 100, Lesotho
References
*
[1] COVID-19 vaccines n.d. https://www.who.int/emergencies/diseases/novel-coron Corresponding author. Department of Information Technology,
avirus-2019/covid-19-vaccines (accessed March 9, 2021). Faculty of Accounting and Informatics, Durban University of
[2] E. Mbunge, Effects of COVID-19 in South African health system and society: an
explanatory study, Diabetes Metab Syndr Clin Res Rev 14 (6) (2020), https://doi.
Technology, P O Box 1334, Durban, 4000, South Africa.
org/10.1016/j.dsx.2020.09.016. E-mail address: [email protected] (E. Mbunge).