China on March 9 rolled out its own “vaccine passport” amid global controversy around potential equality and privacy issues of the health document.

China’s vaccine passport, the International Travel Health Certificate (ITHC), serves as an international version of China’s year-old health code system that helped the country resume domestic travel after the initial outbreak early last year. It contains information such as the holder’s coronavirus test results, vaccination records, and antibody test results, according to China’s foreign ministry (in Chinese). 

To sign up, users enter their passport number in a foreign ministry-owned mini program on Tencent’s WeChat instant-messaging platform. Verify your identity using face recognition, and the certificate is instantly available. It is currently only available for Chinese nationals. China hasn’t revealed plans to issue the certificate to foreign nationals living inside or outside of the country.

(Image credit: Ministry of Foreign Affairs of the People’s Republic of China)

The health code system began as a patchwork of different apps rolled out by local governments to track residents’ travel history and body temperatures, often with varying standards. It has since evolved into a nationwide database network of individuals’ health information. It appears that the newly launched vaccine passport also has access to the same data.

READ MORE: We read the technical standards for China’s ‘health code.’ Here’s what we learned.

Like the health code system, China’s vaccine passport may provide the world with a new option in the quest to resume normal international travel. China is promoting its standards for post-Covid travel documents. Experts have expressed concerns that the use of such certificates may exceed the scope of containing the coronavirus and empower governments to reinforce social control.

International health code 

China joins a host of countries experimenting with vaccine-certificate systems. The EU and the G7 are developing a regional system that will allow vaccinated travelers between participating countries to cross borders without quarantines. Thailand is issuing single-country certificates to enter—a vaccine visa, if you will. Israel and Bahrain have deployed digital certificates for domestic re-opening. China, with mostly closed borders and a largely re-opened domestic economy, is deploying a one-country system to vouch for outbound citizens

Beijing hopes to persuade other countries to accept its system as proof of vaccination. Wang Yi, China’s foreign minister, said at the announcement of the ITHC last Tuesday that the document “fulfills Chinese President Xi Jinping’s proposal to inter-recognize health codes internationally” (our translation).

Xi first made the comment about a “global mechanism” of the health code system to allow international travel at an online meeting at the G-20 summit in November. “We need to further harmonize policies and standards and establish ‘fast tracks’ to facilitate the orderly flow of people,” he said at the time.

A spokesman for China’s foreign ministry Zhao Lijian told reporters (in Chinese) on Thursday that the country had promoted and introduced the ITHC to “countries and relevant international organizations.” He added that some countries and international organizations had “expressed willingness” to cooperate with China, without naming them.

Nations are scrambling to set up standards for vaccine passports. The British government said last month that it would work with other countries through the World Health Organization (WHO) and the G-7 on “a clear international framework with standards that provide consistency for passengers and industry alike.” The European Commission said earlier this month that it would put forward legislation this month that will lay out the details on the format of a common EU vaccination certificate.

But unlike the EU and G7 nations, which are discussing regional vaccine passports that will allow people to travel freely, China seems to be unilaterally pushing for recognition of its vaccine passport for its citizens, said Nicole Hassoun, a professor at Binghamton University and the author of the book Health Impact: Extending Access on Essential Medicines for the Poor.

Hassoun suggested that China will need reciprocal arrangements. “They hope that other countries will eventually recognize their citizens’ certificates and allow them to skip quarantine, but right now China does not have a plan to let visitors skip quarantine,” she told TechNode. 

Will it work?

It’s too early to say if China’s vaccine passport will be a success, but it used a similar health code system to tackle the virus and resume domestic travel. The effectiveness of the system and other key measures—including its strict mandatory lockdown in early 2020—is difficult to deny, as life within China nears normalcy while many other countries struggle to contain the virus a year later. 

The eastern city of Hangzhou was the first city in China to roll out the health code system in January 2020.

The QR code-based system allowed people to travel inside China with greater freedom. A green code usually meant that the holder was a low risk for carrying the coronavirus and could thus be freed from quarantine after traveling. Accordingly, a yellow code meant medium risk and a red code, high. 

In the early stages of the system, code colors were given based on individuals’ self-declaration of Covid-related symptoms, travel history, and body temperatures. Now, the system has become a nationwide network of databases that contains information like Covid test results and vaccination history.

For the past year, China’s domestic public transportation system, which was one of the busiest in the world, has relied on those codes to manage and track travelers.

What are the concerns?

Experts have warned that vaccine passports could deepen inequality as residents of countries with access to vaccines can now do things that others cannot, including traveling.

Michael Ryan, executive director of the World Health Organization’s Health Emergencies Programme, said on March 8 that “vaccine passports” for Covid-19 should not be used for international travel because of ethical considerations that coronavirus vaccines are not easily available globally.

“Immunity passports inherit all the inequity in vaccine distribution,” said Hassoun of Binghamton University. “Most people are not eligible because most people cannot access the vaccines.”

China’s vaccine passport also inherits the health code system’s privacy concerns. While the health code system is widely used to track the spread of the virus, it also captures data about people’s whereabouts on a vast scale. 

In Beijing, people are now required to scan and register using health code mini-apps embedded in the WeChat and Alipay smartphone apps every time they enter a shopping mall or take a taxi. But in most Chinese cities, people are only required to show their health code at checkpoints, and their location information is not logged. 

Nonetheless, governments around the world are introducing or considering such systems. Their attraction is that they “may provide validated clinical information to facilitate expanded social engagement including travel,” John Nosta, president of healthcare think tank NostaLab and a member of the WHO’s Digital Health Roster of Experts, wrote in an email. “The danger is that some assessments go beyond Covid-19 and reveal other clinical realities that the individual may not wish to reveal.” He also warned that countries may limit the entry of people with other conditions such as mental health issues.

A city in eastern China had sought to make the health code system the norm even beyond the pandemic, but was met with backlash from netizens. In May, Hangzhou revealed plans to “normalize” (in Chinese) the city’s health code, monitoring people’s medical records, physical examination results, and lifestyle. 

Behaviors such as consuming alcohol would degrade the holder’s “health score,” while physical exertion such as long-distance walking would increase the score, according to local media reports about plans for the system. The plan was widely criticized on social media and has not been mentioned ever since.

“I’m fearful that once the toothpaste of a vaccine passport is out of the tube, there’s no putting it back,” Nosta said. “Other diseases and conditions may be flagged and establish new restrictions—from mental health to other infectious diseases—that can excessively empower governments for a new level of social engineering.”

Writing about semiconductors and telecommunications.