World Health Organization International Certificate Of Vaccination And Prophylaxis
Berk Boyraz
One of the key tools used by many Member States in reopening economies during the COVID-19 pandemic has been digital COVID-19 test and vaccine certificates. As the directing and coordinating authority on international health work, at the onset of the pandemic, WHO engaged with all WHO Regions to define overall guidance for such certificates and published the Digital Documentation of COVID-19 Certificates: Vaccination status and Test results in 2021 and 2022, respectively.
Learning from the COVID-19 pandemic response, there is a recognition of an existing gap and continued need for a global mechanism that can support bilateral verification of the provenance of health documents for pandemic preparedness and continuity of care. The GDHCN can be used as an infrastructural building block to support additional use cases, which may include, for example, the digitisation of the International Certificate of Vaccination or Prophylaxis, verification of prescriptions across borders, the International Patient Summary, verification of vaccination certificates within and across borders, and certification of public health professionals (through WHO Academy). Expanding such digital solutions will be essential to deliver better health for people across the globe.
To meet this need, in line with the Global strategy on digital health priority actions, WHO has established the Global Digital Health Certification Network (GDHCN). The GDHCN is builds upon the experience of regional networks for COVID-19 Certificates and takes up the infrastructure and experiences with the digital European Union Digital COVID Certificate (EU DCC) system, which has seen adoption across all Member States of the EU as well as 51 non-EU countries and territories. The GDHCN has been designed to be interoperable with other existing regional networks (e.g., ICAO VSD-NC, DIVOC, LACPass, SMART Health Cards) specifications.
As the trust anchor, WHO is implementing an onboarding process to establish technical and governance procedures for digital trust between WHO and each Member State, and thus, between Member States participating in the trust network. WHO will not hold or otherwise have access to any individual data. Participating Member States voluntarily submit public keys into a directory managed by WHO, so they are shared in a trusted manner with other Member states. These public keys then can be used to verify that digitally signed health credentials (e.g. Immunization cards, health records) were issued by a recognized authority in the GDHCN.
Regional and global trust networks are widely used today for when the provenance of information must be certified and verified such as a passport or a website. The GDHCN is designed to leverage existing investments by jurisdictions that were made under the COVID-19 response and provide the digital health infrastructure needed for resiliency in future epidemic and pandemic responses and to deliver better health to all by enabling the use of digital personal health records for continuity of care.
The International Certificate of Vaccination or Prophylaxis (ICVP), also known as the Carte Jaune or Yellow Card, is an official vaccination report created by the World Health Organization (WHO).[1] As a travel document, it is a kind of medical passport that is recognised internationally and may be required for entry to certain countries where there are increased health risks for travellers.[1]
The ICVP is not an immunity passport; the primary difference is that vaccination certificates such as the ICVP incentivise individuals to obtain vaccination against a disease, while immunity passports incentivise individuals to get infected with and recover from a disease.[2]
The ICVP's nickname Yellow Card or its French equivalent Carte Jaune derives from the yellow colour of the document. The fact that yellow fever is a commonly required vaccination for travel has contributed to the document's association with the colour yellow, even though the ICVP can cover a wide range of vaccinations and booster shots, not just yellow fever.[1]
The International Certificate of Inoculation and Vaccination was established by the International Sanitary Convention for Aerial Navigation (1933) in The Hague, which came into force on 1 August 1935 and was amended in 1944.[3] After the 1944 amendment, in addition to Personal, Aircraft and Maritime Declarations of Health, the Convention covered five certificates:[4][5]
The World Health Organization (WHO) was formed by its constitution on 22 July 1946, effective on 7 April 1948. The WHO Constitution included stipulations to stimulate and advance work to eradicate epidemic, endemic and other diseases (Article 2.g) and that the World Health Assembly would have authority to adopt regulations concerning sanitary and quarantine requirements and other procedures designed to prevent the international spread of disease (Article 21.a).[6]The Fourth World Health Assembly adopted the International Sanitary Regulations (alias WHO Regulations No. 2) on 25 May 1951, replacing and completing the earlier International Sanitary Conventions. It confirmed the validity and use of international certificates of vaccination (Article 115), and updated the old model with a new version (Appendices 2, 3, 4).[7] The certificates mentioned were used for proof of vaccination against diseases such as cholera, yellow fever and smallpox; the term inoculation was no longer used.[7][8] The old International Certificates of Inoculation and Vaccination remained valid until they expired, after which they were replaced by the new ICV.[8] On 23 May 1956, the Ninth World Health Assembly amended the form of the International Certificate of Vaccination or Revaccination against Smallpox per 1 October 1956.[9]
The WHO's World Health Assembly adopted the International Health Regulations (IHR) in 1969, succeeding the previous International Sanitary Conventions/Regulations.[10] IHR Article 79 introduced a model International Certificate of Vaccination, and Appendix 2 and Annex VI stipulated a number of conditions that had to be fulfilled in order for it to be considered valid, such as being printed and filled out in English and French (a third language, relevant to the territory in which it is issued, could be added).[10] The 1969 IHR focused on four diseases: cholera, plague, smallpox, and yellow fever; however, Article 51 specified that vaccination against plague would not be required as a condition of admission of any person to a territory.[10] The World Health Assembly determined in 1973 that vaccination against cholera was unable to prevent the introduction of cholera from one country to another,[11] and removed this requirement from the 1973 revision of the IHR;[10][11] it was also removed from the ICV.[11]
The ICV was most successful in the case of smallpox. The mandatory possession of vaccination certificates significantly increased the number of travellers who were vaccinated, and thus contributed to preventing the spread of smallpox, especially when the rapid expansion of air travel in the 1960s and 1970s reduced the travelling time from endemic countries to all other countries to just a few hours.[12] After smallpox was successfully eradicated in 1980, the International Certificate of Vaccination against Smallpox was cancelled in 1981, and the new 1983 form lacked any provision for smallpox vaccination.[10][12] Thus, only yellow fever remained as vaccination requirement for international travel for which the ICV was used.[citation needed]
The main portion of the ICVP is a form for physicians to fill out when administering a vaccine. This section is mandated by the WHO's 2005 International Health Regulations, in which they provide a model of the document. It includes places for the traveller's name, date of birth, sex, nationality, national identification document, and signature. Below that is a row for each vaccine administered, in which the physician must include the prophylaxis or vaccine administered, date, signature, manufacturer and batch number, dates valid, and an official stamp from the administering centre.[15][13][16]
Below this, the document outlines requirements for validity. The ICVP is only valid for vaccines approved by the WHO.[citation needed] The form must be fully completed in English or French by a medical practitioner or authorized health worker and must include the official stamp of the administering centre. The certificate is valid for as long as the vaccines included are valid.[15][13]
The notes section includes information about yellow fever, since it is the only disease included in the International Health Regulations. It also specifies that the same certificate can be used if any future regulations require vaccination for another disease.[15]
The information for travellers section recommends that travellers consult their physicians to determine appropriate vaccinations before international travel and inform their physician of international travel if they fall ill after their trip.[15]
Malaria is a serious disease with no vaccine available. The ICVP recommends that travellers protect against mosquitos through mosquito nets or repellent, as mosquitos can transmit malaria. Travellers can also consult their physician for antimalarial medication, which must be taken regularly for the full duration of the prescription.[15]
The ICVP gives instructions for filling out the certificate. It also gives physicians guidelines for documenting contraindications in cases where a traveller has a medical reason that prevents them from getting a particular vaccine. This section also reminds physicians to consider travel-associated illnesses when treating a patient who has fallen ill after traveling.[15]
Yellow fever is the most common vaccine required for international travel. Many countries require the vaccine for all travellers or only for travellers coming from countries with risk of yellow fever transmission.[19] Exceptions are typically made for newborns until 9 months or one year of age, depending on the country.[20] The ICVP form is valid for yellow fever starting 10 days after vaccination. As of 2016, the vaccine is valid for the life of the traveller. No changes need to be made for those who received their vaccine or ICVP prior to 2016.[21]
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