With the rollout of the COVID-19 vaccine, more and more countries and companies are turning to immunity passports (or certificates) to verify whether one has been vaccinated. The purpose of these passports is to expedite a return to ‘normalcy.’ For instance, in Israel, “green passes” (or “green booklets”) are required for entry into bars and gyms. In Britain, residents may use the National Health Service (NHS) app to verify their vaccine status in order to travel internationally. In Chile, inoculated residents may use a “mobility pass” to travel more freely across the country, including in places that still have active lockdown measures.
The use of immunity passports to restrict access to certain services has raised concerns regarding equity, fairness, and social justice. Some scholars, such as Insa Marie Schmidt and Btihaj Ajana, have warned that immunity passports may exacerbate existing social, political, and economic inequalities by creating new forms of discrimination and privilege. Under this system, those who lack “immunoprivilege” may be justly refused service as well as denied entry into other countries. This is particularly concerning given racial disparities in vaccine distribution. Within the US, Blacks and Hispanics have received disproportionately smaller shares of the vaccine given both their population size and their share of COVID-19 cases (though the disparity is gradually shrinking in many states). Internationally, the situation is more dire with so-called “developing” countries lagging drastically behind wealthier nations in terms of both vaccine access and distribution. (To be sure, there are other concerns here as well. For instance, people who are immunocompromised may not be able to get vaccinated at all. As such, they will be barred from the benefits restricted to immunity passport bearers.)
Now, in principle, immunity-based discrimination may be justifiable. Not only can it be based on empirically verifiable criteria (e.g., vaccination records, presence of COVID-19 antibodies, etc.), but there are also important practical justifications. For instance, allowing those who are vaccinated to return to in-person work could help bolster economic recovery efforts. Within nursing homes, restricting access to only those who have been vaccinated could be vital in protecting the high-risk elderly population. These considerations are important and worth keeping in mind. However, we should proceed with caution. While immunity passports could benefit many, they could also serve to mask discrimination under the veneer of reasonable and necessary public health measures. Immunity status may become the new justification for continuing to deny marginalized groups access to services and equal opportunities.
This possibility should prompt us to think carefully about what constitutes immunoprivilege: what forms it may take? how it might worsen existing inequalities? how it may undermine current and future social justice initiatives? how immunoprivilege may normalize current forms and even establish new forms of oppression, marginalization, and stigmatization? Etc. These worries should also prompt us to think more critically about the ways in which immunoprivilege already exists within our society, and how it may evolve with the implementation of immunity passports.
One place to start addressing these issues is with the history of immunoprivilege. As Kathryn Olivarius, among others, have argued, immunity passports could create a system similar to what emerged in the Deep South during the 18th and 19th century in response to persistent yellow fever outbreaks. During this period, many Southern cities and towns became divided between two groups: the “acclimated” (or “seasoned”) and the “unacclimated.” The acclimated were those who had been infected, survived, and thus presumed immune to the disease. As Olivarius notes, the acclimated leveraged their immune status to acquire “immunocapital.” Because no one worried about them succumbing to the almost yearly pestilence, most employment and political opportunities were restricted to the acclimated. The unacclimated, by contrast, were barred from living in certain neighborhoods, and they were denied loans, credit and even health insurance (or were forced to pay a hefty “climate premium”). Unacclimated men also faced difficulties in getting married as many fathers forbade their daughters from marrying anyone who was not acclimated. Given the centrality of acclimation to Southern living, immigrants and the unacclimated poor would willingly attempt to infect themselves in the hopes of becoming acclimated.
Acclimation was also importantly tied to racism and chattel slavery. During the period, Blacks were thought to be immune to yellow fever. For some, like the physician John Lining, this immunity was innate. In 1748, Lining wrote, “There is something very singular in the constitution of the Negroes, which renders them not liable to this fever.” For others, this immunity was the byproduct of slavery itself. Following a particularly deadly outbreak in 1853 in New Orleans, the editors of the then popular Weekly Delta argued that slavery “exempts him [Blacks] from a destructive disease, to which he would render himself liable by the exercise of his freedom.” Samuel Cartwright similarly argued that higher mortality rates of yellow fever among whites were due to them performing labor best suited for Blacks. These arguments were used as justification for the necessity of slavery within the South. Their presumed immunity made them too essential to liberate.
Indeed, during particularly severe outbreaks, many whites would flee the cities and set up temporary camps elsewhere. During these crises, Blacks, both freed and in bondage, were called upon to help treat patients and perform other essential services. For instance, during the 1793 yellow fever outbreak in Philadelphia, Benjamin Rush wrote to Richard Allen, one of the founders of the Free African Society and the African Methodist Episcopal Church, urging him to tell Blacks to stay and help combat the disease. Rush alleged that Allen and his people would be safe as the disease would “pass by” their communities. Rush was, of course, wrong. Allen himself contracted yellow fever, though he recovered. As Olivarius writes, “The professed belief in slave immunity emphasized black people’s statelessness, movability, and malleability – at once sub- and superhuman, incapable of living in freedom. Moreover, slave status was an epidemiological blessing for blacks – God’s gift to the South’s designated laborers.” Importantly, despite the narrative of slave immunity, slave holders acknowledged that Blacks were not immune to yellow fever. Slave ads would contain language indicating whether slaves had survived a yellow fever infection. This increased the price one could charge for a slave at auction.
Even after the abolition of slavery, whites continued to rely on Black labor during outbreaks. For instance, during the 1878 outbreak, local officials in the city of Memphis and the rural Grenada county of Mississippi were forced to integrate their police departments to maintain public order during the outbreak. Additionally, Blacks continued to provide other essential services, including as gravediggers, wagon drivers, nurses and even preventing burglars from robbing the abandoned homes of whites.
Though brief, this historical overview provides us with several important insights for understanding how immunoprivilege functions. Here, I will focus on two. First, the breath of immunoprivilege and its relationship to racial capitalism. Importantly, while acclimation served as the means of acquiring immunocapital, it was not the sole form of immunoprivilege during the period. Whites, regardless of acclimation status, were able to flee cities and towns, and maintain social distancing, because Black laborers kept working to keep the basic social, political, and economic infrastructure intact. This allowed whites to return to their homes and restart their lives after the outbreak was over. The ability to social distance and the ability to acquire immunocapital are both instances of immunoprivilege. While some, especially those in the upper classes of society, enjoyed both, in either instance, it was the labor of Black people that made these privileges possible.
The same is true of the COVID-19 pandemic. The pandemic has been a financial windfall for the ultrawealthy. By the end of October 2020, billionaires in the US had increased their total net worth by an estimated $637 billion. Such ludicrous financial gains were largely owing to the work of essential workers – workers who are disproportionately people of color. Their labor also made it possible for millions to shelter in place, while they continued the work of maintaining the nation’s basic infrastructure. By saying that sheltering in place is a privilege, I am not denying that it is a useful public health measure. The point, rather, is to highlight the inequalities regarding both who benefits from such measures and who is ultimately able to engage in such practices. As I have written elsewhere, “This is immunoprivilege. The privilege of those able to work from home, while others continue the vital work needed to keep the country going – a privilege largely enjoyed by white middle and upper-class men. It is the privilege of remaining gainfully employed while isolating oneself from risk of contagion and death.” This is a privilege that many people of color have lacked throughout the COVID-19 pandemic. And, as the yellow fever case illustrates, this has been the historical norm in the US.
A second major insight is the relationship between immunoprivilege and racialized forms of knowledge. Acclimation rested upon a series of claims about Black immunity to yellow fever, and the necessity of slavery to maintain the Southern economy and way of life. These claims also shifted depending on the circumstances. During the 18th century, accounts of Black immunity focused predominately on biological differences. Then, during the pre-Civil War period, the focus shifted to the ‘acquired’ immunity that Black gained from the labor of slavery. Importantly, these claims were not mere historical coincidences. The belief in Black immunity normalized and justified their exposure to yellow fever. Similar claims can be found during the COVID-19 pandemic. As Angela Saini notes, some biologists, especially towards the early parts of the pandemic, speculated that Black and Brown people were more genetically susceptible to the virus. This was intended to explain (and ultimately normalize) the higher mortality rates among those groups compared to whites.
Such biological claims however were not as prevalent during the COVID-19 pandemic as they were during the yellow fever outbreaks. Instead, essential workers are being cast as heroes sacrificing their own personal wellbeing for the sake of the nation and others. To be clear, those working front-line jobs are indeed performing essential and crucially important services. Without their labor, the social, political, and economic effects of the COVID-19 pandemic would have been far harsher. Their labor, then, is justifiably and deservingly applauded and celebrated. However, the designation of ‘heroism’ comes with a number of key assumptions – most notably, the hero is one who willingly sacrifices themselves for others. In and of itself, this is not controversial. The problem is that this narrative may conceal how the situation facing nonwhite essential workers has been historically conditioned by systematic racism with regards to employment and educational opportunities. Their continuing labor is praiseworthy, but labeling their sacrifice as heroism risks masquerading their exploitation under the guise of a colorblind ‘free choice’ discourse.
These insights are important for understanding how some have benefitted, in various ways, from immunoprivilege during the COVID-19 pandemic. It can also help us think through the sorts of problems that may arise from widespread adoption and use of immunity passports. Regardless of whether one believes they are justifiable or sound public health policy, such passports may serve to further obscure and normalize the machinations of racial capitalism, especially with regards migrant laborers. The pandemic has already widened many inequalities, both within the US and abroad. Such inequalities will only deepen if we are not mindful of how the steps taken to overcome the pandemic may disproportionately benefit some at the expense of others.
In the end, immunoprivilege is, and has been, a constitutive feature of systematic racism and capitalism within the US. Whether this continues to be true will depend on what all of us do next.
Jordan Liz
Jordan Liz is an Assistant Professor of the Department of Philosophy at San José State University, where his research focuses on biomedical ethics, philosophy of medicine and philosophy of race. In 2017, he earned his PhD in Philosophy and Graduate Certificate in Population Health from the University of Memphis. His primary research focuses on contemporary genetic understandings of race and racial classifications; as well as studies on the genetic susceptibility of specific racial groups to certain diseases, such as cancer and diabetes. More recently, his research focuses on the impact of COVID-19 on racial minorities and other marginalized groups.
