Blockchain: A Potential Solution to web-based vaccination records

via Jalal Awan

Blockchain is being floated as a potentially promising solution to the challenges of keeping track of vaccine records. One potential use-case is in streamlining what the California state’s Departments of Public Health and Technology is dubbing the ‘Digital COVID-19 Vaccine Record’. Unveiled June 18, the Digital COVID-19 Vaccine Record consists of a website that lets users who verify their identities get digital copies of their COVID-19 vaccination record. The site allows users to enter in some basic personal information and access a digital version of the Centers for Disease Control and Prevention-approved paper record of vaccination. A unique QR code and a pin code sent directly to your personal email or cellphone used at the time of vaccination is designed to ensure authorized access.  In addition to state-managed electronic records for vaccination, immunization history and prompts for booster shots, private players with access to required telecommunication infrastructure and user database have also jumped ship from their conventional care-delivery models to one that includes dynamic record-keeping.. Often funded by large venture capital firms in Silicon Beach, health tech startups like Los Angeles-based Healthvana, have partnered with local governments in providing their users access to health and immunization records using similar web-based platforms.

However, these techno solutions appear to not be living up to the hype. With information on vaccine supply chains, inoculation records, service provider information and history of immunization coming from disparate sources, the digital ecosystem is fragmented, and wrought with loopholes that leave the system vulnerable to potential misuse, including unauthorized access to patient immunization records, impersonation and possible cyber attacks compromising the validity of vaccination records. Moreover, mobile app or internet-based certification systems, relying on individuals have certain major limitations – including the ‘digital divide’ within and across communities, lack of universal smart phone access, differences in technological literacy and differences in vaccine data logging methods across states. As vaccination efforts ramp up across the country, many Americans still receive a physical vaccine certificate as their only proof of inoculation. Compounding the challenges with fragmented digital records of vaccination, handwritten, paper-based documentation can be illegible or incorrect, and easy to lose and counterfeit. 

Fortunately, technological solutions like blockchain or open-source digital ledger technologies, having seen widespread adoption in distributed finance applications, can be adapted for use in a universal, streamlined digital ledger for vaccine records. With public-private partnerships, reformed regulations on data use and integration with digital health records such as those used in California, blockchain offers a potential solution for a universal, secure vaccine verification system that can be trusted not just in California, but across the nation as states re-open and travel resumes. 

At its core, the process is simple: using a decentralized and cryptographically secure ‘trust protocol’ between multiple parties – authorities, organizations and individuals – blockchain allows immutable, transparent and tamper-proof sharing of electronic records that is optimized for intensive privacy protection using peer-reviewed consensus algorithms. All a health-care provider would need to do is create an electronic record of an individual’s vaccination using a mobile device such as a clinical smartphone or tablet, and transmit the data to a decentralized vaccine verification repository, which consists of a distributed network of computers with synchronized and validated replicas of the information documented in a digital ledger consisting of “blocks of transaction”. Using a time-stamped digital QR code (or a physical tamper-proof label on their government-issued IDs), users can then present their information at verification checkpoints in much the same way as identity verification at airports. Blockchain uses cryptographic encryption to ensure that the information provided cannot be altered or deleted and is verified, without the need of a central authority for data storage, access and dissemination. Moreover, entries can be publicly audited, individual anonymity is protected (with access only allowed with private key) and the data stored is interoperable for multiple, authorized use cases across jurisdictional boundaries.

Digital ledger technologies today hardly account as ‘emerging’. The use of blockchain, which originated from financial technology and has seen use cases across industries such as healthcare, insurance, and real estate, is already being piloted as part of ‘digital health passports’ in countries like South Korea, building on important lessons learnt from early contact tracing and smart lockdowns. Others are catching up fast: VitalPass is the first digital passport created to track Covid-19 vaccination through advanced blockchain technology guaranteeing security, traceability, and transparency during the vaccination process across Latin America.

Blockchain implementation in vaccine information verification does come with its challenges. Being a relatively new technology, it brings with it regulatory and legal challenges. Blockchain does not neatly sit into any current legal framework, particularly because of its decentralized architecture and varying policies on vaccination by State. Second, the extent and use of information and communications technologies (ICT) infrastructure varies widely across states. This poses a major challenge to create an official global, connected network of blockchain users, including pharmacies, airlines, insurance providers and public health agencies. Lack of standards on use, scale and management of blockchain technology and ownership of underlying physical assets adds another layer of regulatory complexity. In spite of these challenges, as the world recovers from the pandemic and lawmakers scramble to find solutions to challenges around vaccine passports, blockchain and the use of privacy-preserving digital ledger technologies may offer unique ways to circumvent issues of privacy, equity, verifiability and trust that have surfaced from web-only platforms like California’s Digital COVID-19 Vaccine record.

The writer is a Phd Fellow at the Pardee RAND Graduate School and an Assistant Policy Researcher at the RAND Corporation. Opinions expressed are his own.