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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me

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For many of us, the coming holiday season is a welcome milestone signaling not only memories of better days, but also the end of a dystopian year. This year just keeps on giving, and there has been something weighing on my mind as I watch the various events play out in our society. The pandemic has certainly created a unique panoramic view of multiple issues, and it seems that yet another facet will soon play out as we consider the coming vaccine. 

Most of us probably remember carrying around our immunization cards. Mom seemed to be able to find the paper record every couple of years as needed, and your pediatrician would dutifully fill it out, checking boxes and listing dates for things like DTaP, HepB, RV, Hib, IPV, MMR, VAR, and PCV13. As we got older, we would be handed that immunization card again as middle school approached (for renewals and boosters), and just before heading off to college (meningitis) the worn, old card made a final appearance before vanishing into some dusty box in the attic. If you were fortunate enough to travel, you might have called your mom to see if she could find those forgotten records so you could add some travel vaccines to the mix (yellow fever, dengue, hepatitis, cholera, etc.). And, chances are, you always wondered why accessing this important, personal information wasn’t easier. 

Well, my prediction is you are going to need much more than your immunization card in the future. 

Given the rapid advance of PCR and related technologies, as well as new efficiencies in genomic sequencing, you will no longer need to show Proof of Vaccination—rather, you will need to demonstrate the much higher standard of Proof of Immunity. While there is no existing standard for this yet, it is a very natural extension and logical conclusion of where our world needs to move—and it has several implications:

  1. Proof of Immunity: There will need to be antibody titer tests that are affordable, reliable, and available to the masses. They will need to be easy to administer (single prick for blood), simple to process (self contained LFA), and easy to read (like a pregnancy test). This is all coming. For now, these can be done at a lab collection site. 
  1. Authentication of Proof by a Third Party: This will become a new and emerging role for healthcare providers and health organizations to develop a level of trust and confidence that they can serve as arbitrators of truth. It will also be an interesting opportunity for blockchain technology which can create “trustless” exchanges without counterparty risk that can be openly verifiable. 
  1. Acceptable Proof Medium: Given the prevalence of mobile phones and associated apps, it seems logical that an approved healthcare provider would authenticate using this medium with the ability for confirmation. This is yet another opportunity for technologically savvy medical groups to step forward and develop simple tools that individuals can use to not only readily pull their health histories, but conveniently display their immunity passports as well. 

Crossover Health’s commitment to delivering an exceptional experience to our members has been a primary driver for the development of our own member engagement technology. The intent of this has always been to ensure our members are connected to their care teams, and the care teams are connected to each other. During the first months of the pandemic, we were hard at work evolving technology solutions to address the Proof of Immunity concept with a novel product we call Crossover Passport. Rapidly prototyped and built by our partner MyLabs, the Crossover Passport provides an easy to use Daily Checkup (health questionnaire and temperature tracker), which produces a daily “Passport” that can include both diagnostic, as well as immunity test results. These results are then displayed in a simple way at key entry points on campus, at a facility, or before entry into any premise. Given that both the Daily Checkup and the Passport are refreshed daily, we can literally monitor the health status of every single one of our members as well as provide them a simple means to display their health status as necessary. 

Crossover Passport is simple for employees to use on a daily basis, provides proactive health monitoring, enables test ordering for both in-person and remote employees, and is directly connected to the care teams for further consultation as needed. The implications of this are huge, and will only grow in the coming months as people grow ever more restless with the lockdowns, more strained with the isolation and restrictions, and more stressed by the growing disruptions in their lives. In this setting would a Proof of Immunity be considered dystopian or a source of deliverance?

In healthcare settings, the concept of Proof of Immunity is both accepted and expected:

“We have seen a progression from a requirement to simply validate the immunization dates of individuals who will be entering the healthcare field to now requiring serologic tests to confirm immunity, interpretation of the resulting data about therapeutic immunity responses, and follow-up with these individuals. Immunity titers must reflect a therapeutic response to qualify the individual as immune.” 

However, for a broader perspective on the concept, see  Nicholas A. Christakis’s interesting book Apollo’s Arrow. In it, he equivocates whether or not this is a new dystopian nightmare or a novel means of deliverance for those with immunity:

“But it occurred to me that we could have a kind of dystopian scenario where employers bid up wages for those who could prove they were immune. Indeed, first in Europe and later in the United States, people considered the idea of testing for immunity and issuing some sort of certification to this effect. Holders of such immunity passports could then return to nonessential (not just essential) jobs and could participate in large gatherings with their similarly immune brethren…the privileges afforded by such a certificate would be much broader, like the freedom to travel, return to school, go to places of worship, resume employment, or make use of online dating services.” 

His original thread on the implications of immunity was written on March 30, 2020. It’s a fascinating read as well!

There will be much more scientific debate and rigorous standardization to determine some of the difficult clinical and thorny ethical implications of Proof of Immunity. Moreover, whatever their conclusions, the general concerns or even fear of surveillance at a time when there has been a loss of trust in authorities and in governance will render adoption a challenge. I have written before about the need to build, and build on, the trust people (should) have with their health providers to effect meaningful change in healthcare and health. Guiding perceptions of the Immunity Passport away from dystopian surveillance towards a future where this level of health monitoring is both accepted and desired is a timely example of how this trust can be leveraged. But, trust  doesn’t come automatically, however. We have to continue to build new services, add enhanced capabilities, and rapidly evolve to address the emerging needs of our members to maintain our position as a secure, trusted, non-conflicted Primary Health organization, one whose recommendations regarding the Immunity Passport will be uniquely compelling. 2020 has been an inflection point for us all.

We feel a deep responsibility at Crossover to help ensure that the “new normal” we may continue to face will be one that we can also embrace. 

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