When Integrity Mchechesi visited a bus terminal in Zimbabwe's capital city, Harare, people were calling out, asking if anyone needed a negative COVID-19 test certificate.
Such falisified COVID-19 test certificates can be bought for as little as $10 (€8.20), roughly $50 less than an actual COVID test, in Harare, said Mchechesi, a doctor and co-founder of Vaxiglobal, a health-tech start-up focused on immunization verification in Zimbabwe.
When the vaccine is rolled out in Zimbabwe, Mchechesi worries counterfeit vaccination certificates will also appear on the market.
Zimbabwe is one of a number of countries working on digital solutions to verify who has been vaccinated. Countries like Denmark, Spain and Greece have supported the idea of COVID-19 vaccination passports, and the WHO is working on an international digital vaccination card that will provide a framework with standards for countries to adhere to.
At the bus terminals in Harare, Mchechesi was researching falsified vaccination certificates. In a survey of yellow fever vaccination certificates, Vaxiglobal found that more than 80% of those used at some bus terminals in Harare were falsified.
"We thought that [was] really concerning," said Mchechesi. "It's not like there is any policing that's done, it's actually sold freely."
Focus turns to COVID-19
Now Vaxiglobal has shifted its attention to verifying COVID-19 test certificates. The organization is working with the Zimbabwean health ministry to digitize COVID-19 test results to combat the sale of counterfeit certificates.
Healthcare workers enter the results of people's COVID-19 PCR tests into a decentralized database on Vaxiglobal's platform. When they upload the results, a unique QR code is generated for each result and is attached to a certificate that can be printed or stored in Vaxiglobal's app. Border authorities can then instantly verify the certificate.
"You can imagine, someone can actually be COVID-19 positive and they don't get their test, they just bought that COVID-19 certificate and the border officials assume that the person is COVID negative — that's how cases are being transmitted internationally," said Mchechesi.
The number of fake COVID-19 test certificates hasn't been that high because there is some regulation and citizens are concerned for their health, but the fake certificates are still readily available, said Mchechesi. "You can imagine people are obviously tempted to go for that because it's cheaper."
Mchechesi said a COVID-19 PCR test costs between $45 and $60 in Zimbabwe, a country where 34% of the population lived under the extreme poverty line of $1.90 a day in 2019, according to the World Bank.
Zimbabwe has not started rolling out COVID-19 vaccines. When it does, Vaxiglobal plans to apply the same technology to verify vaccination certificates.
Setting a standard for vaccination documentation
Currently, yellow fever is the only disease specified in the World Health Organization's (WHO) International Health Regulations (IHR), which require proof of vaccination for entry to some countries. The yellow fever vaccination certificate is also the only proof of vaccination certified under the IHR.
But, "It is a paper card, easy to falsify, anybody can produce that card with a stamp [and] say 'I got a vaccine,'" Bernardo Mariano, WHO's director of digital health innovation, told DW. "We know that every time there is some sort of rule or regulation put in place, some people will try to break it, create false information — or a vaccination certificates."
The IHR provide a legal framework that defines countries' rights and obligations when handling public health crises and emergencies that have the potential to cross borders.
Vaccination against COVID-19 is not part of the IHR yet, but a country can make a unilateral decision. Some countries already require a negative COVID-19 test to enter, and the next evolution of that will be requiring proof of vaccination, said Mariano.
WHO open to cooperation with private innovators
For a COVID-19 vaccination certificate to become compulsory for travel the world over, it would have to be part of the IHR, and that process would take a long time, Mariano said. But there are other avenues.
One such initiative is the CommonPass, a digital framework for verifying COVID-19 tests and vaccination certificates. Some airlines have already been rolling out the app to passengers on select flights.
A number of organizations approached the WHO with their own individual solutions, and the WHO's role is to set the standard for certificates, Mariano told DW.
"We believe that the discussion is going on now, and there are a number of companies developing and innovating in this space," he said. "And we want to be in the discussion to set standards early on."
He likened the WHO's vision to the use of bank cards with the Visa logo on them. The cards belong to different banks but they operate using Visa's payment system.
"You have this trusted ecosystem where hundreds of thousands of banks and millions of merchants in [different] countries can transact in a trusted system," said Mariano. "Basically, [WHO] is a trusted entity that is able to validate that certificate, but then we want to ensure that we don't get into the business of producing apps and software."
That way, the companies developing digital solutions can continue their work and sell to governments.
If all goes to plan, the WHO will have developed and defined the vaccination certificate standards and addressed data privacy issues by the end of March, with the standards ready to go by the beginning of April.
Debate over requiring vaccination for travel
In a letter to the European Commission on January 12, Greek Prime Minister Kyriakos Mitsotakis suggested setting up a common European certificate for people vaccinated for COVID-19.
Vaccination would not be compulsory or a prerequisite for travel, but people who have been vaccinated should be free to travel, Mitsotakis wrote. "It is urgent to adopt a common understanding on how a vaccination certificate should be structured so as to be accepted in all member states."
On January 15, the WHO's Emergency Committee recommended that countries do not require proof of vaccination from incoming travelers based on the still unknown impact of the vaccines on reducing transmission and the limited number of vaccines available.
A country could decide to make vaccination a requirement for entry, but it would be difficult to verify without an internationally recognized standard.
"The challenge is, if there's no entity that sets the standards of what that vaccine means, I can come with any piece of paper and say: 'I have the vaccine,'" Mariano said.
The World Travel and Tourism Council (WTTC), which opposes vaccination requirements for travel, said requiring certificates would delay the revival of an already struggling travel and tourism sector that many rely on for income.
Gloria Guevara, president and CEO of the WTTC, told DW that because it will take a significant amount of time to vaccinate the global population, some people who might want to get vaccinated but hadn't had the chance yet would be discriminated against, "particularly those in less developed countries, or those in less vulnerable age groups."
The WTTC instead supports testing on departure and arrival.