Marcio Jose Sanchez/AP

You’ve Been Vaccinated. Now Prove It.

Critics raise logistical and privacy concerns over vaccine documentation.

This story was originally posted by Stateline, an initiative of the Pew Charitable Trusts.

This Sunday, Broadway will officially open its first play since the start of the pandemic 18 months ago: the drama “Pass Over,” about the precarious lives and hopes of two young Black men in Chicago.

To get inside the August Wilson Theatre, patrons will need more than their tickets. They’ll also have to present a federal card or use an app on their phone and an ID to prove that they’ve been vaccinated against COVID-19.

The extra credentials stem from an order issued earlier this month by New York City Democratic Mayor Bill de Blasio requiring anyone eating inside restaurants, working out in gyms or attending movies, concerts and theatrical productions to show proof that they have received at least one dose of a COVID-19 vaccine.

San Francisco issued a similar directive, and other jurisdictions are requiring at least some public employees and health care workers show proof of vaccination. An increasing number of businesses and universities are asking the same of their workers and patrons.

These new requirements come with logistical challenges, such as adding staff to entrances, as well as privacy and fraud concerns about how information is stored and shared. That’s in addition to widespread opposition, especially in conservative areas, to any vaccine mandates. At least 20 Republican-led states have banned or limited the use of vaccine passports.

Vaccine verifications survived an early legal challenge this month when U.S. Supreme Court Justice Amy Coney Barrett rejected a request from eight Indiana University students to stop the school from imposing a vaccine requirement.

More challenges loom. An anti-vaccine organization and a group of Rutgers University students filed a lawsuit to stop the university from imposing a vaccine mandate, which the students say in the lawsuit is an "affront to human dignity and personal freedom because it violates our basic right to control our bodies."

But proponents of vaccine passports say the credentials give vaccinated people more assurance as they resume going out and could spur the reluctant to get vaccinated.

“It’s sort of like when we created smoking areas,” said James Hodge, director of the Center for Public Health Law and Policy at Arizona State University. “A lot more people stopped smoking because they didn’t want to be outside looking in.”

New York City is serving as a real-world test of vaccine validation. Broadway embraces the policy, and had already decided to adopt it before the city’s mandate. Matt Ross, the producer of “Pass Over,” said he was convinced that audiences would likely stay away without it.

“I don’t think there are a lot of people who would set foot in a theater if that policy wasn’t in place,” Ross said. “That and masks. Those are the things that are allowing people to feel safe and comfortable in the theater.”

In the two weeks of “Pass Over” previews, Ross said, the requirement worked without any logjams or objections from theatergoers. “It’s been very smooth,” he said. “I haven’t heard any complaints, and people seem happy with the safeguards.”

Enthusiasm among New York businesses wasn’t universal. While the restaurant industry has expressed support for vaccine validation, it complained that the city’s order would put the burden of checking vaccine status on employees, who would bear the brunt of a backlash. Throughout the pandemic, masking requirements have led to frequent conflicts between customers and staff.

“Checking vaccination status isn’t like ID-ing a customer before serving them a drink,” Larry Lynch, a senior vice president with the National Restaurant Association, said in a statement after New York City’s announcement. Despite repeated requests, the national and New York restaurant associations declined to answer questions from Stateline.

Other jurisdictions have imposed limited vaccine requirements. Washington state announced this week that all school employees must be vaccinated. California has ordered all state workers and those in health care to be vaccinated or be tested at least weekly. Washington, D.C., requires vaccinations or weekly tests for all its employees, contractors, interns and grantees.

Maine will require health care facility workers to be vaccinated. Connecticut and Delaware, among other states, require nursing home workers to be vaccinated or undergo regular testing. Maryland announced this week that anyone working in a hospital or nursing home must be vaccinated or get regularly tested. And the Biden administration this week announced that employees at all nursing homes receiving federal funds must be vaccinated.

Jurisdictions generally haven’t announced how they will verify vaccinations; public health experts predict the cards issued by the Centers for Disease Control and Prevention will become the standard.

Some states that have not issued broad vaccine mandates for private employers have encouraged businesses to voluntarily adopt such policies.

“What we really need are employers to take charge,” Maryland Health Secretary Dennis Schrader told state senators this week, according to The Baltimore Sun. “They have the ability to do that. It is disappointing that more haven’t done that and are basically saying, ‘We prefer government control.’”

CDC Cards

Many businesses and government agencies requiring proof of COVID-19 vaccines accept the CDC cards or photos of those cards. But Neil Jay Sehgal, an assistant professor of health policy and management at the University of Maryland School of Public Health, said that those cards can easily be lost, damaged or counterfeited.

“They were never meant to be secure,” he said.

That vulnerability prompted Sehgal to write an op-ed in The Baltimore Sun earlier this month urging the creation of a national vaccination system that would give everyone access to their immunization records via download.

In April, White House officials said they would not pursue such a plan, citing public worries about the idea of a national ID card.

"The government is not now, nor will we be supporting a system that requires Americans to carry a credential," White House Press Secretary Jen Psaki said at the time. "There will be no federal vaccinations database and no federal mandate requiring everyone to obtain a single vaccination credential."

But Sehgal believes a national system like the one used by the European Union would provide a uniform and reliable process to authenticate COVID-19 vaccine status. The EU system stores data on everyone who has received COVID-19 vaccines in EU countries and enables them to download a digital certificate with a QR code recognized in all member nations.

The U.S. government already requires that all organizations that administer COVID-19 vaccines report to local public health authorities—which in turn report to state health departments—the details of shots given, including identities of recipients. The state departments aggregate that information and report it to the CDC without the identifying information. Because the states already have that data, it would be easy to make that available to a national database, Sehgal said.

States collect data on other immunizations. All states keep registries for child vaccines, said Dr. Marcus Plescia, chief medical officer of the Association of State and Territorial Health Officials. An increasing number of states also collect information on adult vaccinations, including those for COVID-19, although Plescia said the quality of those registries varies, as does their ability to share that data. He said many states have used federal COVID-19 dollars to vastly improve those registries.

Some states, such as Maryland, enable residents to download their vaccine information, including their COVID-19 vaccine status. Some venues in Maryland keep laptops handy where people without their cards can sign into the state vaccine registry.

While many business and government entities nationwide accept the CDC vaccine cards, in some places there are alternatives.

California, Hawaii and New York have all created apps. The New York state app, Excelsior, allows residents to tap state or city immunization databases. The users are then able to download a digital COVID-19 vaccination pass with a QR code, which can be verified by a business with a scanning app.

According to the New York State Health Department, as of early August, more than 3 million Excelsior passes had been downloaded.

New York City has its own verification app, NYC Covid Safe, which enables a user to photograph and digitally store a COVID-19 vaccination card. The app does not verify that the card is valid.

After Excelsior launched, many New York residents said that because of glitches, they couldn’t download their passes.

Some digital experts have raised privacy concerns about the apps, particularly when personal information is accessed by government or private entities.

“We object to a system that scans documents,” said Adam Schwartz, a lawyer with the Electronic Frontier Foundation, the digital rights group based in San Francisco. That data could be aggregated to show who attended events and could be marketed to others for purposes having nothing to do with COVID-19 or vaccines, he said.

“It’s one thing for this list to be using public health databases to promote public health. That, of course, has its own security risks,” Schwartz said. “But when you build around it a whole new system of dissemination you have new attack vectors for data thieves.”

Schwartz also said the system is far less reliable than it might seem. “Nothing is stopping me from getting vaccinated and getting it on my phone and handing it to my friend and he displays it to a bar bouncer,” he said. “It only works if the bouncer is also requiring to see a photo ID, which can also be faked.”

Universities Requiring Proof

Hundreds of colleges and universities are requiring students to upload images of their vaccine cards or vaccine documentation from their state’s database before they can return to campus.

At the University of Rhode Island, Ellen Reynolds, the school’s health director, said that her staff is working long hours verifying those records. She said compliance has been high, with about 94% of the students documenting their vaccines and the rest applying for medical or religious exemptions.

Without prompting, more businesses are requiring vaccine verification or proof of a recent negative test.

“We’ve noticed most patrons are really grateful for it,” said Marissa LaRose, managing director of the Everyman Theatre in Baltimore, which earlier this month opened its first play, “Steel Magnolias,” since the pandemic. “There’s definitely some sort of comfort in knowing that everyone around you is vaccinated or has had a negative test,” she said.

Tecla Tesnau, owner of Ottobar, a popular music venue in Baltimore, said she’s hired extra staff to help check vaccination status at the door after resuming shows a few weeks ago. She said she knew that imposing the policy could risk losing customers, but so far she believes that has been minimal.

“My hope is we are providing examples for others that we can continue to operate and avoid a shutdown which nobody wants and I’m not sure we can survive,” she said. “I don’t mind being the guinea pig to see if this is going to work.”