"Vaccine passports" are a system that requires proof of a COVID-19 vaccination as a condition of engaging in activities that pose a risk of transmitted SARS-CoV-2. Digital Health Passes (DHPs) are typically a smartphone application with a code that verifies whether someone has been vaccinated.
Vaccine passports could very much be in our future. Many businesses are implementing or planning to require proof of vaccination as a condition of returning to the workplace. Colleges and universities have announced vaccine requirements for students, staff, and faculty. It may not be long before the private sector requires a vaccination card or image to attend an entertainment or sporting event, to travel, or even to dine or shop indoors, at least in some venues.
But it's unlikely the federal government or the states will launch DHPs, at least not in the near-term. President Biden announced the White House has no intention of requiring proof of vaccination. While no state has mandated DHPs, New York is piloting its Excelsior Pass on a voluntary basis, partnering with IBM. Other nations are not so hesitant. Israel's "Green Pass" has gotten the nation back to normal in record time. And various countries and regions are planning DHPs, including the European Union and the United Kingdom. Foreign airlines are likely to require proof of vaccination as a condition of flying internationally.
DHPs could emerge as a way to get us back to normal more quickly, but are they ethical? Let's start with the law. The US Equal Opportunity Commission (EEOC) has specifically said that employers have the legal right to require proof of vaccination as a condition of returning to work. Colleges and universities already require several vaccines for students living in dorms. Hospitals and nursing homes often mandate influenza vaccinations. And, of course, all states require childhood vaccinations for school attendance. Vaccine passports are lawful but are they ethical? The short answer is "yes" but only if we ensure no one is left behind.
Vaccine passports "don't force anyone to be vaccinated against his or her will. They simply say to individuals that if you choose not to be vaccinated, you can't work or recreate in public spaces that risk transmission of the virus."
Why are vaccine passports ethical? Vaccines are a miracle of modern science, but they have become a political symbol, and a significant part of the population doesn't want to get a jab. The rare cases of blood clots associated with the Johnson & Johnson and AstraZeneca vaccines have only created more distrust.
Most opposition to vaccine passports hinges on the claim that they infringe personal autonomy and liberty. But this argument misses the point. Of course, every competent adult has the right to make decisions that affect his or her own health and safety. But no one has a right to infringe on the rights of others, such as by exposing them to a potentially serious or deadly infectious disease. An individual can't claim the right to attend a crowded event mask-less and unvaccinated. This was once accepted across the political spectrum. Conservative economists called it an "externality," that is a person has no right to harm others. The U.S. has lost the tradition of the common good. We have become so focused on our own individual rights that we forget about our ethical obligations to our neighbors and to our community.
In fact, DHPs actually don't force anyone to be vaccinated against his or her will. They simply say to individuals that if you choose not to be vaccinated, you can't work or recreate in public spaces that risk transmission of the virus.
DHPs also don't infringe on privacy. Again, everyone has the choice whether to show proof of vaccination. It isn't required. Moreover, DHPs may actually protect privacy because all they do is show whether or not you have been vaccinated. They don't disclose any other personal medical information. All of us actually have already had to show proof of vaccination as a condition of going to school. Thus, DHPs are well established in the United States.
But there is one ethical argument against DHPs that I find to be powerful, and that is equity. If we require proof of vaccination while doses are scarce, we will give the already privileged even more privilege. And that would be unconscionable. Thus, DHPs should not be implemented until everyone who wants a vaccine is able to get a vaccine. Equity isn't a side issue. It needs to be front and center.
As of today, all adults in the U.S. are eligible to get vaccinated, and President Biden has pledged that by the end of May there will be enough doses to vaccinate the entire U.S. population. It is a realistic promise. Once vaccines become plentiful, everyone should get their shot. All Food and Drug Administration authorized vaccines are highly safe and effective, even the Johnson & Johnson vaccine that the FDA has just put on pause.
Businesses have an economic incentive to require proof of vaccination. Very few of us would feel comfortable returning to our jobs, shops, theaters, or restaurants unless we feel safe. Businesses understand the duty to create safer places for work, recreation, and commerce.
One question has dominated national conversation since the pandemic began. "When will we get back to normal?" There is a deep human yearning to hug family and friends, see our work colleagues, recreate, and be entertained. One day we will have defeated this wily virus and get back to normal. But vaccine passports can help us get back to the things we love faster and more safely. As long as we don't leave anyone behind, using this miracle of modern science to make our lives better is both lawful and ethical.
Editor's Note: This op/ed is part of a "Big Question" series on the ethics of vaccine passports. Read the flip-side argument here.
Genomics has begun its golden age. Just 20 years ago, sequencing a single genome cost nearly $3 billion and took over a decade. Today, the same feat can be achieved for a few hundred dollars and the better part of a day . Suddenly, the prospect of sequencing not just individuals, but whole populations, has become feasible.
The genetic differences between humans may seem meager, only around 0.1 percent of the genome on average, but this variation can have profound effects on an individual's risk of disease, responsiveness to medication, and even the dosage level that would work best.
Already, initiatives like the U.K.'s 100,000 Genomes Project - now expanding to 1 million genomes - and other similarly massive sequencing projects in Iceland and the U.S., have begun collecting population-scale data in order to capture and study this variation.
The resulting data sets are immensely valuable to researchers and drug developers working to design new 'precision' medicines and diagnostics, and to gain insights that may benefit patients. Yet, because the majority of this data comes from developed countries with well-established scientific and medical infrastructure, the data collected so far is heavily biased towards Western populations with largely European ancestry.
This presents a startling and fast-emerging problem: groups that are under-represented in these datasets are likely to benefit less from the new wave of therapeutics, diagnostics, and insights, simply because they were tailored for the genetic profiles of people with European ancestry.
We may indeed be approaching a golden age of genomics-enabled precision medicine. But if the data bias persists then there is a risk, as with most golden ages throughout history, that the benefits will not be equally accessible to all, and existing inequalities will only be exacerbated.
To remedy the situation, a number of initiatives have sprung up to sequence genomes of under-represented groups, adding them to the datasets and ensuring that they too will benefit from the rapidly unfolding genomic revolution.
Global Gene Corp
The idea behind Global Gene Corp was born eight years ago in Harvard when Sumit Jamuar, co-founder and CEO, met up with his two other co-founders, both experienced geneticists, for a coffee.
"They were discussing the limitless applications of understanding your genetic code," said Jamuar, a business executive from New Delhi.
"And so, being a technology enthusiast type, I was excited and I turned to them and said hey, this is incredible! Could you sequence me and give me some insights? And they actually just turned around and said no, because it's not going to be useful for you - there's not enough reference for what a good Sumit looks like."
What started as a curiosity-driven conversation on the power of genomics ended with a commitment to tackle one of the field's biggest roadblocks - its lack of global representation.
Jamuar set out to begin with India, which has about 20 percent of the world's population, including over 4000 different ethnicities, but contributes less than 2 percent of genomic data, he told Leaps.org.
Eight years later, Global Gene Corp's sequencing initiative is well underway, and is the largest in the history of the Indian subcontinent. The program is being carried out in collaboration with biotech giant Regeneron, with support from the Indian government, local communities, and the Indian healthcare ecosystem. In August 2020, Global Gene Corp's work was recognized through the $1 million 2020 Roddenberry award for organizations that advance the vision of 'Star Trek' creator Gene Roddenberry to better humanity.
This problem has already begun to manifest itself in, for example, much higher levels of genetic misdiagnosis among non-Europeans tested for their risk of certain diseases, such as hypertrophic cardiomyopathy - an inherited disease of the heart muscle.
Global Gene Corp also focuses on developing and implementing AI and machine learning tools to make sense of the deluge of genomic data. These tools are increasingly used by both industry and academia to guide future research by identifying particularly promising or clinically interesting genetic variants. But if the underlying data is skewed European, then the effectiveness of the computational analysis - along with the future advances and avenues of research that emerge from it - will be skewed towards Europeans too.
This problem has already begun to manifest itself in, for example, much higher levels of genetic misdiagnosis among non-Europeans tested for their risk of certain diseases, such as hypertrophic cardiomyopathy - an inherited disease of the heart muscle. Most of the genetic variants used in these tests were identified as being causal for the disease from studies of European genomes. However, many of these variants differ both in their distribution and clinical significance across populations, leading to many patients of non-European ancestry receiving false-positive test results - as their benign genetic variants were misclassified as pathogenic. Had even a small number of genomes from other ethnicities been included in the initial studies, these misdiagnoses could have been avoided.
"Unless we have a data set which is unbiased and representative, we're never going to achieve the success that we want," Jamuar says.
"When Siri was first launched, she could hardly recognize an accent which was not of a certain type, so if I was trying to speak to Siri, I would have to repeat myself multiple times and try to mimic an accent which wasn't my accent so that she could understand it.
"But over time the voice recognition technology improved tremendously because the training data was expanded to include people of very diverse backgrounds and their accents, so the algorithms were trained to be able to pick that up and it dramatically improved the technology. That's the way we have to think about it - without that good-quality diverse data, we will never be able to achieve the full potential of the computational tools."
While mapping India's rich genetic diversity has been the organization's primary focus so far, they plan, in time, to expand their work to other under-represented groups in Asia, the Middle East, Africa, and Latin America.
"As other like-minded people and partners join the mission, it just accelerates the achievement of what we have set out to do, which is to map out and organize the world's genomic diversity so that we can enable high-quality life and longevity benefits for everyone, everywhere," Jamuar says.
Empowering African Genomics
Africa is the birthplace of our species, and today still retains an inordinate amount of total human genetic diversity. Groups that left Africa and went on to populate the rest of the world, some 50 to 100,000 years ago, were likely small in number and only took a fraction of the total genetic diversity with them. This ancient bottleneck means that no other group in the world can match the level of genetic diversity seen in modern African populations.
Despite Africa's central importance in understanding the history and extent of human genetic diversity, the genomics of African populations remains wildly understudied. Addressing this disparity has become a central focus of the H3Africa Consortium, an initiative formally launched in 2012 with support from the African Academy of Sciences, the U.S. National Institutes of Health, and the UK's Wellcome Trust. Today, H3Africa supports over 50 projects across the continent, on an array of different research areas in genetics relevant to the health and heredity of Africans.
"Africa is the cradle of Humankind. So what that really means is that the populations that are currently living in Africa are among some of the oldest populations on the globe, and we know that the longer populations have had to go through evolutionary phases, the more variation there is in the genomes of people who live presently," says Zane Lombard, a principal investigator at H3Africa and Associate Professor of Human Genetics at the University of the Witwatersrand in Johannesburg, South Africa.
"So for that reason, African populations carry a huge amount of genetic variation and diversity, which is pretty much uncaptured. There's still a lot to learn as far as novel variation is concerned by looking at and studying African genomes."
A recent landmark H3Africa study, led by Lombard and published in Nature in October, sequenced the genomes of over 400 African individuals from 50 ethno-linguistic groups - many of which had never been sampled before.
Despite the relatively modest number of individuals sequenced in the study, over three million previously undescribed genetic variants were found, and complex patterns of ancestral migration were uncovered.
"In some of these ethno-linguistic groups they don't have a word for DNA, so we've had to really think about how to make sure that we communicate the purposes of different studies to participants so that you have true informed consent," says Lombard.
"The objective," she explained, "was to try and fill some of the gaps for many of these populations for which we didn't have any whole genome sequences or any genetic variation data...because if we're thinking about the future of precision medicine, if the patient is a member of a specific group where we don't know a lot about the genomic variation that exists in that group, it makes it really difficult to start thinking about clinical interpretation of their data."
From H3Africa's conception, the consortium's goal has not only been to better represent Africa's staggering genetic diversity in genomic data sets, but also to build Africa's domestic genomics capabilities and empower a new generation of African researchers. By doing so, the hope is that Africans will be able to set their own genomics agenda, and leapfrog to new and better ways of doing the work.
"The training that has happened on the continent and the number of new scientists, new students, and fellows that have come through the process and are now enabled to start their own research groups, to grow their own research in their countries, to be a spokesperson for genomics research in their countries, and to build that political will to do these larger types of sequencing initiatives - that is really a significant outcome from H3Africa as well. Over and above all the science that's coming out," Lombard says.
"What has been created through H3Africa is just this locus of researchers and scientists and bioethicists who have the same goal at heart - to work towards adjusting the data bias and making sure that all global populations are represented in genomics."
This article is part of the magazine, "The Future of Science In America: The Election Issue," co-published by LeapsMag, the Aspen Institute Science & Society Program, and GOOD.
Whenever you hear something repeated, it feels more true. In other words, repetition makes any statement seem more accurate. So anything you hear again will resonate more each time it's said.
Do you see what I did there? Each of the three sentences above conveyed the same message. Yet each time you read the next sentence, it felt more and more true. Cognitive neuroscientists and behavioral economists like myself call this the "illusory truth effect."
Go back and recall your experience reading the first sentence. It probably felt strange and disconcerting, perhaps with a note of resistance, as in "I don't believe things more if they're repeated!"
Reading the second sentence did not inspire such a strong reaction. Your reaction to the third sentence was tame by comparison.
Why? Because of a phenomenon called "cognitive fluency," meaning how easily we process information. Much of our vulnerability to deception in all areas of life—including to fake news and misinformation—revolves around cognitive fluency in one way or another. And unfortunately, such misinformation can swing major elections.
The Lazy Brain
Our brains are lazy. The more effort it takes to process information, the more uncomfortable we feel about it and the more we dislike and distrust it.
By contrast, the more we like certain data and are comfortable with it, the more we feel that it's accurate. This intuitive feeling in our gut is what we use to judge what's true and false.
Yet no matter how often you heard that you should trust your gut and follow your intuition, that advice is wrong. You should not trust your gut when evaluating information where you don't have expert-level knowledge, at least when you don't want to screw up. Structured information gathering and decision-making processes help us avoid the numerous errors we make when we follow our intuition. And even experts can make serious errors when they don't rely on such decision aids.
These mistakes happen due to mental errors that scholars call "cognitive biases." The illusory truth effect is one of these mental blindspots; there are over 100 altogether. These mental blindspots impact all areas of our life, from health and politics to relationships and even shopping.
We pay the most attention to whatever we find most emotionally salient in our environment, as that's the information easiest for us to process.
The Maladapted Brain
Why do we have so many cognitive biases? It turns out that our intuitive judgments—our gut reactions, our instincts, whatever you call them—aren't adapted for the modern environment. They evolved from the ancestral savanna environment, when we lived in small tribes of 15–150 people and spent our time hunting and foraging.
It's not a surprise, when you think about it. Evolution works on time scales of many thousands of years; our modern informational environment has been around for only a couple of decades, with the rise of the internet and social media.
Unfortunately, that means we're using brains adapted for the primitive conditions of hunting and foraging to judge information and make decisions in a very different world. In the ancestral environment, we had to make quick snap judgments in order to survive, thrive, and reproduce; we're the descendants of those who did so most effectively.
In the modern environment, we can take our time to make much better judgments by using structured evaluation processes to protect yourself from cognitive biases. We have to train our minds to go against our intuitions if we want to figure out the truth and avoid falling for misinformation.
Yet it feels very counterintuitive to do so. Again, not a surprise: by definition, you have to go against your intuitions. It's not easy, but it's truly the only path if you don't want to be vulnerable to fake news.
The Danger of Cognitive Fluency and Illusory Truth
We already make plenty of mistakes by ourselves, without outside intervention. It's especially difficult to protect ourselves against those who know how to manipulate us. Unfortunately, the purveyors of misinformation excel at exploiting our cognitive biases to get us to buy into fake news.
Consider the illusory truth effect. Our vulnerability to it stems from how our brain processes novel stimuli. The first time we hear something new to us, it's difficult to process mentally. It has to integrate with our existing knowledge framework, and we have to build new neural pathways to make that happen. Doing so feels uncomfortable for our lazy brain, so the statement that we heard seems difficult to swallow to us.
The next time we hear that same thing, our mind doesn't have to build new pathways. It just has to go down the same ones it built earlier. Granted, those pathways are little more than trails, newly laid down and barely used. It's hard to travel down that newly established neural path, but much easier than when your brain had to lay down that trail. As a result, the statement is somewhat easier to swallow.
Each repetition widens and deepens the trail. Each time you hear the same thing, it feels more true, comfortable, and intuitive.
Does it work for information that seems very unlikely? Science says yes! Researchers found that the illusory truth effect applies strongly to implausible as well as plausible statements.
What about if you know better? Surely prior knowledge prevents this illusory truth! Unfortunately not: even if you know better, research shows you're still vulnerable to this cognitive bias, though less than those who don't have prior knowledge.
Sadly, people who are predisposed to more elaborate and sophisticated thinking—likely you, if you're reading the article—are more likely to fall for the illusory truth effect. And guess what: more sophisticated thinkers are also likelier than less sophisticated ones to fall for the cognitive bias known as the bias blind spot, where you ignore your own cognitive biases. So if you think that cognitive biases such as the illusory truth effect don't apply to you, you're likely deluding yourself.
That's why the purveyors of misinformation rely on repeating the same thing over and over and over and over again. They know that despite fact-checking, their repetition will sway people, even some of those who think they're invulnerable. In fact, believing that you're invulnerable will make you more likely to fall for this and other cognitive biases, since you won't be taking the steps necessary to address them.
Other Important Cognitive Biases
What are some other cognitive biases you need to beware? If you've heard of any cognitive biases, you've likely heard of the "confirmation bias." That refers to our tendency to look for and interpret information in ways that conform to our prior beliefs, intuitions, feelings, desires, and preferences, as opposed to the facts.
Again, cognitive fluency deserves blame. It's much easier to build neural pathways to information that we already possess, especially that around which we have strong emotions; it's much more difficult to break well-established neural pathways if we need to change our mind based on new information. Consequently, we instead look for information that's easy to accept, that which fits our prior beliefs. In turn, we ignore and even actively reject information that doesn't fit our beliefs.
Moreover, the more educated we are, the more likely we are to engage in such active rejection. After all, our smarts give us more ways of arguing against new information that counters our beliefs. That's why research demonstrates that the more educated you are, the more polarized your beliefs will be around scientific issues that have religious or political value overtones, such as stem cell research, human evolution, and climate change. Where might you be letting your smarts get in the way of the facts?
Our minds like to interpret the world through stories, meaning explanatory narratives that link cause and effect in a clear and simple manner. Such stories are a balm to our cognitive fluency, as our mind constantly looks for patterns that explain the world around us in an easy-to-process manner. That leads to the "narrative fallacy," where we fall for convincing-sounding narratives regardless of the facts, especially if the story fits our predispositions and our emotions.
You ever wonder why politicians tell so many stories? What about the advertisements you see on TV or video advertisements on websites, which tell very quick visual stories? How about salespeople or fundraisers? Sure, sometimes they cite statistics and scientific reports, but they spend much, much more time telling stories: simple, clear, compelling narratives that seem to make sense and tug at our heartstrings.
Now, here's something that's actually true: the world doesn't make sense. The world is not simple, clear, and compelling. The world is complex, confusing, and contradictory. Beware of simple stories! Look for complex, confusing, and contradictory scientific reports and high-quality statistics: they're much more likely to contain the truth than the easy-to-process stories.
Another big problem that comes from cognitive fluency: the "attentional bias." We pay the most attention to whatever we find most emotionally salient in our environment, as that's the information easiest for us to process. Most often, such stimuli are negative; we feel a lesser but real attentional bias to positive information.
That's why fear, anger, and resentment represent such powerful tools of misinformers. They know that people will focus on and feel more swayed by emotionally salient negative stimuli, so be suspicious of negative, emotionally laden data.
You should be especially wary of such information in the form of stories framed to fit your preconceptions and repeated. That's because cognitive biases build on top of each other. You need to learn about the most dangerous ones for evaluating reality clearly and making wise decisions, and watch out for them when you consume news, and in other life areas where you don't want to make poor choices.
Fixing Our Brains
Unfortunately, knowledge only weakly protects us from cognitive biases; it's important, but far from sufficient, as the study I cited earlier on the illusory truth effect reveals.
What can we do?
The easiest decision aid is a personal commitment to twelve truth-oriented behaviors called the Pro-Truth Pledge, which you can make by signing the pledge at ProTruthPledge.org. All of these behaviors stem from cognitive neuroscience and behavioral economics research in the field called debiasing, which refers to counterintuitive, uncomfortable, but effective strategies to protect yourself from cognitive biases.
What are these behaviors? The first four relate to you being truthful yourself, under the category "share truth." They're the most important for avoiding falling for cognitive biases when you share information:
- Verify: fact-check information to confirm it is true before accepting and sharing it
- Balance: share the whole truth, even if some aspects do not support my opinion
- Cite: share my sources so that others can verify my information
- Clarify: distinguish between my opinion and the facts
The second set of four are about how you can best "honor truth" to protect yourself from cognitive biases in discussions with others:
- Acknowledge: when others share true information, even when we disagree otherwise
- Reevaluate: if my information is challenged, retract it if I cannot verify it
- Defend: defend others when they come under attack for sharing true information, even when we disagree otherwise
- Align: align my opinions and my actions with true information
The last four, under the category "encourage truth," promote broader patterns of truth-telling in our society by providing incentives for truth-telling and disincentives for deception:
- Fix: ask people to retract information that reliable sources have disproved even if they are my allies
- Educate: compassionately inform those around me to stop using unreliable sources even if these sources support my opinion
- Defer: recognize the opinions of experts as more likely to be accurate when the facts are disputed
- Celebrate: those who retract incorrect statements and update their beliefs toward the truth
Peer-reviewed research has shown that taking the Pro-Truth Pledge is effective for changing people's behavior to be more truthful, both in their own statements and in interactions with others. I hope you choose to join the many thousands of ordinary citizens—and over 1,000 politicians and officials—who committed to this decision aid, as opposed to going with their gut.
[Adapted from: Dr. Gleb Tsipursky and Tim Ward, Pro Truth: A Practical Plan for Putting Truth Back Into Politics (Changemakers Books, 2020).]
[Editor's Note: To read other articles in this special magazine issue, visit the beautifully designed e-reader version.]