Vaccine Requirements Predate the COVID-19 Pandemic by More than a Century

The COVID-19 pandemic has created significant challenges for international travel resulting in government-issued vaccine mandates to reduce the global spread of COVID. The authors review the history of vaccine mandates and the linkages between border control and infectious disease management.  “Vaccine certification has been an internationally recommended approach to manage the spread of infectious diseases.”  “Vaccine passports” can include “paper cards, smartphone apps, and historically even physical scars.”  The British Empire’s experiences during the 1800s with implementing early vaccine requirements for smallpox are discussed. Initially bodily scars (whether from previous smallpox infection or vaccination) were used as evidence for immunity and determined whether travelers could leave or enter different countries.  Paper vaccine certificates, which include an individual’s vaccine history, were increasingly adopted in the 1900s, and their use expanded to additional communicable diseases including polio, yellow fever, cholera, and meningococcal meningitis. Inconsistencies existed, however, in the vaccine certification system with a “mosaic of rules and regulations” for specific vaccine preventable diseases. This included variations in required timeframes for receiving a vaccination, number of required shots, and issuing authorities. Episodic outbreaks of disease also led to intermittent requirements being applied at different destinations such as airports and seaports, and to certain classes of passengers and migrant workers.  Examples of fraudulent and criminal vaccine certifications and the differential burden of proof applied to travelers of lower socioeconomic status are discussed. Two major international conferences in 1926 and 1933 led to the development of a “multilateral protocol that recommended using vaccines as a condition of cross-border movement” and the standardization of international certificates of vaccination.  These processes were further streamlined by the WHO in the 1950s resulting in the issuing of the “Carte Jaune (or Yellow Card) which became the standard vaccination certification worldwide.” The authors conclude by reminding readers that “migration and the management of infectious disease – including the certification of vaccination – have been intertwined for more than a century” and that “recent requirements for certifications around COVID-19 vaccination are anything but exceptional.” (Robert Like, MD, MS)

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