Recovery, Renewal, Resilience

TMB Issue 30 discussed the potential ethical issues associated with varying restrictions on individual liberties based on possession of a vaccine certificate. Digital vaccination passports have generated a complex debate across the world, as understanding of the COVID-19 virus and the effectiveness of current vaccines is still developing and digital vaccine passports are an “evolving science”. Introducing infrastructure that has the potential to create “segregation and risk scoring at an individual level, enables third-party access to health information, brings profound risks to individual rights and concepts of equity in society” [1].

The Ada Lovelace Institute[2] recently released ‘Checkpoints for vaccine passports’ which strives to support governments and developers to work through the important steps to examine the evidence available, understand the design choices and the societal impacts, and assess whether a roll-out of vaccine passports could navigate risks to play a socially beneficial role. Below we replicate content from that report which explains their six vaccine passport system requirements[3]:

Scientific confidence in the impact on public health

As scientific knowledge on the effectiveness of current COVID-19 tests, vaccines and antibodies is still developing, governments and public health experts should:

• “Establish scientific pre-conditions’, to include the level of reduced transmission from vaccination that would be deemed acceptable to permit their use;
• Create a model and test the behavioural impacts of different digital vaccination passport programmes (e.g. in combination with or in place of social distancing);
• Conduct a comparative analysis of different vaccine passport schemes to other public health measures in terms of necessity, benefits, risks and costs;
• Develop and test public communications with regards to what certification should be understood to mean in terms of uncertainty and risk;
• Set out the permitted pathways for calculating what constitutes lower risk individuals, including vaccine type, test types, antibody protection and duration of reduced risk following vaccination, testing and infection;
• Outline public health infrastructure requirements for successful use of a passport scheme, which may include access to vaccine, vaccine rate, access to tests, testing accuracy, or testing turnaround

Clear, specific and delimited purpose

To mitigate the potential risks of vaccine passports (e.g. barriers to employment, stigma and discrimination), the following measures should be considered:

• “Specify the purpose of a vaccine passport and clearly communicate the specific problems it aims to address;
• Conduct a comparison of alternative options and existing infrastructure, policy or practice to evaluate if any new system and its overheads are proportionate for specific use cases (e.g. care home visitations);
• Clearly define where certification will be permitted and set out the scientific evidence on the impact of these systems;
• Clearly define where the use of certification will not be acceptable, and whether any population groups should be exempted (e.g. children, pregnant women or those with health conditions);
• Consult with representatives of workers and employers, and issue clear guidance on the use of vaccine passports in the workplace;
• Establish clear aims, measures to assess success and a model for evaluation”

Ethical consideration and clear legal guidance

Ethics and law relating to the permitted and restricted uses of vaccine passports, and mechanisms to support rights and redress and table illegal use should be considered:

• “Publish and require the publication of, impact assessments – on issues including data protections, equality and human rights;
• Offer clarity on the current legality of any uses, specifically laws regarding employment, equalities, data protection, policing, migration and asylum, and health regulations;
• Create clear and specific laws, and develop guidelines for all potential user groups about the legality of use, mechanisms for enforcement and methods of legal redress for any vaccine passport scheme;
• Support cooperation between relevant regulators that need to work cooperatively and pre-emptively;
• Make any changes via primary legislation, to ensure due process, proper scrutiny and public confidence;
• Develop suitable policy architecture around ay vaccine passport scheme, to mitigate harms identified in impact assessments – which may require employment protection and financial support for those facing barriers to work on the basis of health status”

Sociotechnical system design, including operational infrastructure

Consider how the vaccine passport system design will function in practice and link with other systems:

• “Outline the vision for any role vaccine passports should play in COVID-19 strategies, e.g. whether developing own systems or permitting others to develop and use passports;
• Outline a set of best-practice design principles any technical design should embody – including data minimisation, openness, ethics by design and privacy by design – and conduct small-scale pilots before further deployment;
• Protect against digital discrimination, by creating a non-digital (paper) alternative;
• Be clear about how vaccine passports link or expand existing data systems (in particular health records and identity);
• Clarify broader societal issues relating to the system, including the duration of any planned system, practical expectations of other actors in the system and technological requirements, aims, costs, and the possible impacts of other parts of the public health system or economy informed by public deliberation;
• Incorporate policy measures to mitigate ethical and social risks or harms identified"

Public legitimacy

Public confidence in vaccine passports will be crucial and consideration should be given to local contexts:

• “Undertake rapid and ongoing public deliberations as a complement to, and not a replacement for, existing guidance, legislation and proper consideration of issues;
• Undertake public deliberation with groups who may have particular interest or concerns from such a systems, e.g. those who are unable to have the vaccine, those unable to open businesses due to risk, groups who have experienced discrimination or stigma;
• Engage key actors in the successful delivery of these systems (business owners, border control, public health experts)”

Protection against future risks and mitigation strategies for global harms

Consider the longer-term effects of vaccine passport systems and how they might shape future decisions or be used by future governments:

• “Be up front as to whether any systems are intended to be used long term, and design and consult accordingly;
• Establish clear, published criteria for the success of a system and for ongoing evaluation;
• Ensure legislation includes a time-limited period with sunset clauses or conditions under which use is restricted and any dataset deleted – and structures or guidance to support deletion where data has been integrated into work systems for example;
• Ensure legislation includes purpose limitation, with clear guidance on application and enforcement, and include safeguards outlining uses which would be illegal;
• Work through international bodies like WHO, GAVI and COVAX to seek international agreement on vaccine passports and mechanisms to counteract inequalities and promote vaccine sharing”

References:

[1] https://www.adalovelaceinstitute.org/report/checkpoints-vaccine-passports/

[2] https://www.adalovelaceinstitute.org/

[3] Ibid.

The 2021 UK Census offers a unique opportunity to increase our long-term understanding of the health, social and economic impacts of COVID-19 on different communities. In due course, local government can use the insight that the Census provides to plan and provide funding for services that will be critical in recovery and renewal, such as changes in housing, education and healthcare. Grassroots organisations, charities and businesses can also use this information to inform their future work and to secure funding. Consider:

• A targeted and localised communications campaign that highlights issues that are relevant for local people in their community:
  • Engage local community members/groups that may have influence and knowledge on the priorities of specific communities to inform communications and support the encouragement of people to take part
• Partner with organisations that work with different communities to promote the value and benefits that the information gained through the Census will bring
• Tailor communications and ensure that the value and benefits detailed are relevant to particular groups (e.g. people with disabilities, ethnic communities)
• Develop a variety of resources that support people to take part, for example:
  • Create a variety of resources (e.g. animation films) that explain how to complete the Census and where people can get support with filling out the Census form, signpost people to organisations that can help
• Ensure all resources are accessible in terms of language and consider access needs of people with disabilities

The outbreak of COVID-19 has resulted in countries closing their borders at short notice, and the suspension or severe curtailing of transport. These measures have implications for those who are not in their country of residence including those working, temporarily living, or holidaying abroad. At the time of the first outbreak, over 200,000 EU citizens were estimated to be stranded outside of the EU, and faced difficulties returning home[1].

As travel restrictions for work and holidays ease amidst the ongoing pandemic, but as the possibility of overnight changes to such easements, there is an increased need to consider how repatriations may be managed. This includes COVID-safe travel arrangements for returning citizens, the safety of staff, and the effective test and trace of those returning home. Facilitating the swift and safe repatriation of people via evacuation flights or ground transport requires multiple state and non-state actors. Significant attention has been given to the amazing efforts of commercial and chartered flights in repatriating citizens, but less focus has been paid to the important role that emergency services can play in supporting repatriation efforts.

In the US, air ambulance teams were deployed to support 39 flights, repatriating over 2,000 individuals. Air ambulance teams were able to supplement flights and reduced over reliance on commercial flights for repatriations (a critique of the UK response[2]). This required monumental effort from emergency service providers. After medical screening or treatment at specific facilities, emergency services (such as police) helped to escort people to their homes to ensure they had accurate public health information and that they understood they should self-isolate.

Authorities should consider how to work with emergency services to develop plans for COVID-19 travel scenarios, to better understand how to capitalise on and protect the capacity and resources of emergency services. Consider how to:

• Develop emergency plans that include a host of emergency service personnel who have technical expertise, and know their communities. Plans should[3]:
  • Be trained and practiced
  • Regularly incorporate best practices gained from previous lessons learned
• Build capacity in emergency services to support COVID-19 operations through increased staffing and resources
• Anticipate and plan for adequate rest periods for emergency service staff before they go back on call during an emergency period
• Protect emergency service staff. Pay special attention to safe removal and disposal of PPE to avoid contamination, including use of a trained observer[4] / “spotter”[5] who:
  • is vigilant in spotting defects in equipment;
  • is proactive in identifying upcoming risks;
  • follows the provided checklist, but focuses on the big picture;
  • is informative, supportive and well-paced in issuing instructions or advice;
  • always practices hand hygiene immediately after providing assistance

Consideration can also be given to what happens to repatriated citizens when they arrive in their country of origin. In Victoria (Australia), research determined that 99% of COVID-19 cases since the end of May could be traced to two hotels housing returning travellers in quarantine[6]. Lesson learnt from this case suggest the need to:

• Ensure clear and appropriate advice for any personnel involved in repatriation and subsequent quarantine of citizens
• Ensure training modules for personnel specifically relates to issues of repatriation and subsequent quarantine and is not generalised. Ensure training materials are overseen by experts and are up-to-date
• Strategically use law enforcement (and army personnel) to provide assistance to a locale when mandatory quarantine is required
• Be aware that some citizens being asked to quarantine may have competing priorities such as the need to provide financially.
• Consider how to understand these needs and provide localised assistance to ensure quarantine is not broken

References:

[1] https://www.europarl.europa.eu/RegData/etudes/BRIE/2020/649359/EPRS_BRI(2020)649359_EN.pdf

[2] https://www.bbc.co.uk/news/uk-politics-53561756

[3] https://ancile.tech/how-to-manage-repatriation-in-a-world-crisis/

[4] https://www.cdc.gov/vhf/ebola/hcp/ppe-training/trained-observer/observer_01.html

[5] https://www.airmedicaljournal.com/article/S1067-991X(20)30076-6/fulltext

[6] https://www.theguardian.com/australia-news/2020/aug/18/hotel-quarantine-linked-to-99-of-victorias-covid-cases-inquiry-told

To read this case study in its original format follow the source link below to TMB Issue 21 (p.20-21)

A guest briefing, by Michael Palin (GC Consulting), outlines the key challenges and considerations for local government in advance of the 'Recovery and Devolution' White Paper 2020.

To read this briefing in full, follow the source link below to TMB Issue 20 (p.2-9).

Government may consider an industry-led recovery that draws on close partnerships with industry leaders to re-evaluate local, regional and national legislation on business applications to facilitate recovery. This may include making applications for businesses easier, easing legislation and increased legal support for businesses to expedite business renewal.

This lesson was contributed by a Risk Manager in Australia during project data collection.

For example:

• Consider sustainable recovery schemes that end fossil fuel subsidies in developed countries
• Consider whether specific growth targets which have been harmful to the environment are the most appropriate goal at this time
• Encourage a shift in hierarchy from GDP to the UN's 17 Sustainable Development Goals and the Paris Agreement, CITES or the Convention on Biodiversity

Workers' compensation benefits may be required for registered volunteers that are injured while participating in authorized disaster-related activities. This can include injury sustained during pre-approved training, and covers activities undertaken in the response or recovery phases of a disaster or emergency. It does not include the day-to-day emergency response activities typically associated with, for example, law enforcement, fire services or emergency medical services. This may need to be supported by appropriate legislation.

This lesson was contributed by a Disaster Management expert in the USA during project data collection.

And ensure the consistency of all planning. For example:

Consider a national emergency plan with uniform standards for the gradual return to normality that:

1. Supports hospital systems and expand surge and testing capacity
2. Protects vulnerable populations, including seniors and those with access and functional needs
3. Supports homeless population and shelters through emergency protective measures
4. Ensures continuity of first responders and healthcare workforce
5. Provides state and federal economic impact assistance, including financial support for those economical areas that may only be allowed to resume operations at the last moment
6. Executes task force objectives and continue mid and long-term advance planning

Reference: Civil Protection experts in Germany and the USA.

In the context of COVID-19 to ensure preparedness. Consider the development of Standard Operating Procedures to address this risk.

Consider how first responders can develop a 'code compliant, agile public safety office' that can support the public through shared responsibilities.

This lesson was offered by a Chief Resilience Officer in the USA during project data collection.

By moving as many official documents and applications that require physical presence online to change the nature of citizen's interactions with the state or organization. Build trust in this process to enable it to be sustained during recovery or ramped up in case of resurgence. Speed is paramount in limiting contact and contagion.