COVID-19 proof of vaccination: Alternatives to paper cards

August 30, 2021 / By Adam Rothschild, MD

As the SARS-CoV-2 delta variant spreads rampantly through the unvaccinated population, an increasing number of businesses (e.g., restaurants, concerts, gyms) are requiring customers to show proof of vaccination for entry. So, how does one prove their vaccination status?

Right now, the default proof of vaccination is the official Centers for Disease Control and Prevention (CDC) COVID-19 Vaccination Record Card, which is a simple piece of unlaminated cardstock paper. In this day and age, when people can make or lose fortunes investing in cryptocurrencies and buy and sell an entirely digital piece of property as a non-fungible token, is this really the default source of evidence that an American has been vaccinated against the virus causing the most deadly global pandemic in 100 years? My inner informatician is crying.

This is not to say that there are no other authoritative sources of proof of vaccination. Indeed, all states and some large cities have their own immunization information system (IIS), which is a centralized repository of vaccines administered. New York State has even leveraged its IIS in its Excelsior Pass project to operationalize a vaccine passport that produces instantaneous, trustworthy verification of a New York State resident’s COVID-19 vaccination status. In contrast, other states including Georgia, Alabama, Arizona and Florida have banned the use of vaccine passports.

Unfortunately, submission of vaccine administrations to an IIS is not universally mandated, as state laws that govern this issue vary widely across jurisdictions, age groups and vaccine types. In addition, even though individuals can request their own immunization records from an IIS, the ability to share this information electronically—including across state lines—varies across individual implementations.

Furthermore, when individuals request their own immunization records from an IIS, these records are typically delivered as either a paper print out or an emailed document, both easily counterfeited. In short, while an alternative to the CDC COVID-19 Vaccination Record Card as proof of COVID-19 vaccination exists, its many shortcomings prevent its practical, on-demand use to confirm COVID-19 vaccination on a nationwide basis.

Many of us—myself included—have thought that there must be a more reliable and convenient way to confirm COVID-19 vaccination status. Surely the U.S. could instead have a single, centralized digital registry of COVID-19 vaccination? Although the technology to solve this problem would be straightforward to implement, non-technical barriers, especially many American citizens’ and politicians’ fervent devotion to individual privacy, make this approach a political non-starter. Sadly, it seems that we can’t get there from here despite this solution’s practicality and technological feasibility. For the time being, wear a mask, wash your hands, and hold on tight to your vaccination card. If you lose your vaccination card, contact your state’s IIS; there is a good chance that they can provide you with replacement documentation of your COVID-19 vaccination status.

Adam Rothschild is a clinical informaticist with 3M Health Information Systems.


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