Paper Cards and Digital Codes Target Vaccination Chaos

Other than Israel and the United Arab Emirates, the COVID-19 vaccine rollout around the world has had a rocky start. Some like Canada and the European Union have suffered stumbles so far. Others like the United States have been in a state of chaos since the vaccines were first approved at the end of last year. Many in the U.S. have scrambled online for ephemeral appointment slots, while pharmacies desperately look to use up leftover doses before they expire.

One low-tech solution may help: An MIT-led coalition has unveiled an augmented vaccination card that works with or without user apps to help enable a much smoother vaccination process for everyone.

The simplest form of the vaccination card would include QR codes that can be applied as stickers to existing cards already distributed by the U.S. Centers for Disease Control. Such codes would contain encrypted digital information necessary for each stage of a person's vaccination process that can be scanned by the relevant authorities to check the person's status-but would also avoid storing personally identifiable information in central databases in an effort to respect individual privacy.

We should start sending these unique vaccination cards to everybody right now, like a mail-in ballot or census form," said Ramesh Raskar, an associate professor of media arts and sciences at the MIT Media Lab.

Much of the U.S. vaccine distribution mess has to do a prior lack of federal-state coordination on supply chain issues. Unlike the annual distribution of the flu vaccine, distribution of the COVID-19 vaccine is complicated by a phased rollout that aims to vaccinate the most vulnerable and exposed people first. Another complicating factor is the need to follow up the first dose with a second dose, including making sure the second dose matches whatever vaccine was used in the first dose.

The MIT team believes their vaccination card could help speed things up by eliminating the paperwork required to check on vaccination eligibility and status at vaccination sites such as pharmacies and clinics. That would free up workers to focus on putting the vaccine in people's arms after simply scanning the card's QR code. The MIT-led coalition-including the MIT-spinoff nonprofit PathCheck Foundation and the global design company IDEO-presented its work in a video conference held on 26 Jan 2021.

Photo: MIT

Each person would start out by receiving a coupon" QR code from either their employer or city officials that contains no personally identifying information-only a coupon number containing the CDC's digital signature along with information such as job and zip code that would restrict the coupon's usage to, say, a teacher in Springfield, Oklahoma during Phase 1 of vaccine distribution.

The person would then present that coupon QR code for scanning at a vaccination site to receive the vaccine. A worker would scan the person's coupon to verify the CDC's digital signature before giving the first dose of the vaccine.

The beauty of this is you let the logistics people do the logistics, and you let the issuing authority give you your coupon independently, and each can do it in a decoupled way," said Sanjay Sarma, a professor of mechanical engineering and vice president for Open Learning at MIT. He envisioned such a process making it easier to operate large mass vaccination sites.

Next, the worker would use the system to update the person's status and generate a badge" QR code for the person. The badge QR code would be based in part on personally identifying information-such as the person's name-that has been hashed" to generate a randomized and unique digital passkey.

That status and passkey information would be sent to a CDC server for verification of the badge, which means the CDC never gets the person's personally identifying information in the clear to store in a central database. At the same time, the CDC could still keep track of aggregated statistics on how many people are being vaccinated across the country. (The badge QR code could also provide digital authentication for later data uploads in case the person needs to report any unusual adverse events related to vaccination to the CDC.)

"At the first stage you have proof of eligibility, then you have proof of full vaccination, and if you potentially have symptoms you need proof that the symptoms you're submitting to the system are related to the relevant vaccine," said Anna Lysyanskaya, professor of computer science at Brown University and a member of the coalition.

This entire process would effectively repeat when the person goes back for the second vaccine dose. But beyond that point, the vaccination card's QR code could also serve as a health passport to show the person's vaccination status when entering certain public facilities, boarding mass transit such as buses, or getting on a flight at the airport.

The vaccination card could also potentially work in combination with a Boost19" app being developed by the PathCheck Foundation. Such a companion app for users would be able to accommodate much more potentially useful health-related information than what fits in a QR code, along with making it easier to verify the person's credentials during each check and helping to report any health side effects related to vaccination.

Still, the low-tech user approach of the paper-only vaccination card has its advantages, especially in coordinating vaccination for people who may not have mobile online connectivity and smartphones all the time.

This is far from the only tech coalition looking to help with the vaccination process. The MIT video conference also included speakers from outside groups such as the Vaccine Credential Initiative-including companies such as Microsoft, Oracle, and Salesforce-that aims to create a digital certificate standard to help people easily access their digital vaccination records through both iOS and Android phones.

Another presentation looked at the digital credentials approach being developed by the COVID-19 Credentials Initiative backed by the Linux Foundation Public Health, which includes corporate members such as Cisco, IBM, and Tencent.

It remains to be seen which, if any, of these proposals get adopted by the CDC or other authorities involved in U.S. vaccine distribution. But given the daunting complexity of the vaccination process and the haphazard coordination efforts so far, any approach that can cut through the chaos may yet prove helpful.