The latest outbreak of mpox in central Africa is serving as a reminder of the disruptive potential of public health crises.
Fortunately, experts say that vaccine credential work done during and since the Covid-19 pandemic should ease the path for the resumption of cross-border travel when another crisis occurs.
"I think once you do something hard the first time, it is a lot cheaper and easier to replicate in the future," said Heather Roth, immunization branch director for the Colorado Department of Public Health & Environment.
Roth was referring to the standardization and dissemination of digital immunization credentials, which took place in earnest during the second half of the pandemic and continues to achieve adoption today.
So far, the public health departments of 25 states, including Colorado, issue digital vaccination records called Smart Health Cards. The cards present as a QR code and are encoded with standardized and secure data sets that can be readily accepted by whoever needs to see them, including airlines, cruise lines or border control entities.
In places in which the states themselves don't issue Smart Health Cards, pharmacies and other health care providers often do. Those records can be retained on a cellphone and shared when needed.
JP Pollak
Canada, Japan and a few other countries have also adopted Smart Health Cards. And the World Health Organization (WHO) has recognized Smart Health Cards as a compliant vaccine credential, alongside parallel standards adopted in other parts of the world including the EU and South America, said JP Pollak, the chief product officer and co-founder of the Commons Project, which is among the organizations that helped develop the Smart Health Cards standards.
At present, available QR codes are mostly for Covid, a byproduct of the urgent efforts to make those vaccination records readily available while restrictions on travel and public gatherings were widespread during the pandemic. But the state of New York, for example, now issues Smart Health Card QR codes for flu vaccinations.
Public health experts say that it's not a question of if but when for the next public health emergency. Last month the WHO declared the mpox outbreak, centered in the Democratic Republic of Congo and its neighbor nations, a public health emergency of international concern.
"With mpox, or if bird flu becomes a thing, it would be relatively easy for these systems to just add one additional QR code that you can download," Pollak said.
During Covid, airlines, governments, nonprofits and other entities rolled out digital health passes in efforts to speed the resumption of global travel.
United, for example, incorporated a health passport into its own app, while American and Alaska Airlines partnered with the Verifly app. Those digital solutions have mostly been mothballed, but Pollak said it would be straightforward to update and adapt them to accept Smart Health Cards when needed. Alternatively, travelers would likely be able to simply present Smart Health Pass QR codes held on their phones to be read at border crossings.
While for now vaccination records other than Covid aren't generally obtainable in QR code form, travelers in many states are able to benefit from the growing ease of obtaining digital PDF records of their entire vaccination history. Colorado, for example, launched its online immunization records portal in 2021, making such PDFs obtainable almost instantly, Roth said.
Even though global travel has normalized, such ease of access can be helpful today in places like South America and sub-Saharan Africa, where proof of yellow fever vaccination is sometimes required.
The growth of digitally accessible immunization records can be a trip-saver for procrastinators or those who haven't done their research in advance. Michael Perretta, CEO of Docket, a digital immunization records app that has contracts with Alaska, Idaho, Maine, Minnesota, New Jersey, Utah and Wyoming, said the app has received downloads from people already at the airport preparing to fly. Within a couple minutes, they can access the required records.
A digital standard has also been developed to enable individuals to provide their full health records to medical providers in countries around the world in the event unexpected treatment is needed during international travel. The International Patient Summary (IPS) initiative has participation from the 40 countries that are collaborating in the Global Digital Health Initiative in conjunction with the WHO. The emerging IPS standard is geared toward making various data formats used by medical communities around the world interoperable so that medical histories can be easily imported, in the proper language, wherever the digital record is presented.
John D'Amore
Individuals can currently obtain IPS QR codes through partner organizations, such as Commons Project and Rhode Island-based Patient Centric Solutions, said John D'Amore, who is the technical lead on the IPS project. Then, when they need unexpected foreign medical care, they can present the QR code at the medical facility.
Thus far, few facilities are equipped to fully decipher and import an IPS, but doctors are able to scan the code and read the records in the language of the traveler.
In an early-use case, health examination results of the 32,000 Malaysians who went to Saudi Arabia this past spring for the Hajj were digitized with the IPS standard by Malaysia's health ministry. The ministry then coordinated with Saudi officials to make sure healthcare facilities in that country could read the data, enabling Hajj pilgrims to easily share their health information.
"I think people are surprised sometimes that they can do this today," D'Amore said. "We are trying to build momentum."