COVID-19 antibody testing and ‘immunity certification’

Conclusions and implications

The following conclusions draw on previous Council inquiries and discussions at an online meeting of experts on 24 April.

1. Research into the immunology of SARS-CoV-2, such as that proposed by the British Society for Immunology and Academy of Medical Sciences expert advisory group, is an urgent priority.
   
2. In the present state of knowledge, there is too much scientific uncertainty and there are too many unresolved ethical concerns to support the use of immunity certification as a way of managing the selective modification of general restrictions on public movement and assembly. The likely, relatively low population prevalence of SARS-CoV-2 infection makes this impractical in any case.
   
3. It is nevertheless foreseeable that private individuals, businesses and organisations will seek to make use of biomedical tests (e.g. antibody tests) to inform their practices and decisions. Existing legal provisions and guidance from the Government and the Information Commissioner’s Office address, to some extent, the impacts on individuals but they do not address the wider implications for structural disadvantage, technological change and public good.
   
4. Substantial concerns exist about the differential impact of a selective modification of restrictions based on risk profiling (as there are about the impact of restrictions themselves): that benefits will be pursued by individuals at some risk to public health; and that those benefits will be captured by those already privileged and the costs borne by those who are already structurally disadvantaged. These impacts need to be identified and monitored by engaging with and supporting those in positions of vulnerability and disadvantage.
   
5. The likelihood of adverse impacts may be sufficient to warrant the use of regulatory measures specifically to control the private use of testing and certification technologies and/or to avert or redress their effects. Urgent policy consideration is needed.
   
6. There is a need to give anticipatory ethical consideration to the development of technologies and services around testing, and to the potential for innovation that takes place in circumstances of national emergency inadvertently to embed approaches, research infrastructures and relationships that may limit future options.
   
7. There is, similarly, a need for public debate about how well the proposed infrastructures and the possible involvement of private actors promote the public good, taking into account the diversity of generations, genders, localities, and socio-cultural groupings, and how these approaches compare with possible alternatives, before they become the default model for the future expansion of testing, profiling and surveillance.