Writing for the New York Times, former CDC Director Tom Frieden explains how to address the growing need to verify Covid-19 vaccination status quickly and accurately—particularly as mandates become more common across the country.

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Vaccination verification efforts so far

Even after mandating Covid-19 vaccinations for millions of public and private employees, the Biden administration has not yet issued federal vaccination verification guidelines, Frieden writes. Instead, businesses and other entities affected by vaccine mandates have turned to a variety of verification services and software tools to check their employees' vaccination status.

For example, Google is using One Medical, a membership-based health care provider, to verify vaccination records of its employees and contract workers in the United States, the Washington Post reports. Workers are asked to upload proof of vaccination through One Medical's app or website, which is then manually checked by a team of human reviewers.

Other businesses and organizations, such as startup Superhuman, the San Antonio Spurs basketball team, and Telluride Ski Resort in Colorado, have partnered with ReturnSafe to verify Covid-19 vaccinations. Employees are required to upload a vaccination card to the ReturnSafe app, where it is checked by a human reviewer. Employers are then notified of an employee's vaccination status within 24 hours.

In addition to outside verification services, Nick Frenzer, an implementation executive at Epic, said EHRs have become a critical source of vaccine information throughout the pandemic. In particular, EHRs have been utilized in many non-traditional settings to record and track vaccination data, such as mass vaccination clinics, community outreach clinics, jails, and homeless shelters.

Epic has also provided vaccination QR codes through its MyChart service, which patients can easily access through an app or online, Frenzer said. Instead of being EHR-specific, these codes can be used in everyday settings, such as airlines, stadiums, and other businesses where proof of vaccination is required.

On the other hand, some technology companies, such as Twitter, Pinterest, and Lyft, have decided not to verify their employees' vaccination status. According to the Post, these companies are instead relying on an "honor system" and trusting that employees will provide valid proof of vaccination.

"Since there's no standardized way to prove or disprove the validity of vaccination cards … we're relying on the trust we have in our team members," Ashley Adams, a spokesperson for Lyft, said.

How the US should verify Covid-19 vaccination status

According to Frieden, the use of several Covid-19 vaccination verification systems will make it difficult to verify people's vaccination status quickly and securely. In particular, he notes that without federal guidance, verification services can use different methods to confirm people's identity and vaccination status and protect users' privacy and health information.

Without a standardized approach to verifying vaccine data, Frieden writes that verification will be "inaccurate, inconsistent, and potentially insecure."

For a vaccine verification system to be effective, Frieden writes that it should meet five requirements, including:

1. Accuracy. Vaccination data should be stored in and verified by a computerized immunization system that allows for information to be shared between systems.
2. Security and privacy. Individuals should be able to able to determine how their personal data is collected, stored, and used, Frieden writes. In addition, there should be safeguards to prevent the data from being sold or misused.
3. Flexibility. For those who don't want to or can't use an electronic verification system, they should be able to use paper vaccination records along with additional verification, such as a photo ID, that verifiers can check against existing databases.
4. Real-time access. For example, people should be able to easily access their vaccination status when going through airport security.
5. Specificity. According to Frieden, including other health information, such as past infection status or Covid-19 test results, would complicate the system and increases the risk of security breaches for other health data. The system should only be used to verify Covid-19 vaccination.

Fortunately, Frieden writes, there are existing verification tools that meet the listed requirements.

Frieden highlights the work of two organizations, the Vaccine Credential Initiative, which created the SMART Health Card framework, and the Covid Credential Initiative, which developed a standard credentialing framework that protects data privacy and security.

Currently, the Department of Defense, the Department of Veterans Affairs, several state governments, and major corporations are using technologies developed by these two initiatives, Frieden writes, and other organizations could adopt them in the future,

Ultimately, Frieden writes, "Vaccination requirements are already here and will continue to expand. We need to make verification systems accurate, secure, and fair. To create such systems, we need appropriate, trustworthy, and consistent national standards to guide them—and we need those standards soon." (Frieden, New York Times, 9/21; Abril, Washington Post, 8/19; Siwicki, Healthcare IT News, 8/5)