ISE28/20-21

• In the light of aspirations for returning business and daily lives to normal in the community, there have been persistent calls in Hong Kong for reactivating cross-boundary travel with fewer travel restrictions (e.g. without quarantine) for COVID-19 vaccinated travellers.^{1Legend symbol denoting GovHK (2021d and 2021e).} From an economic perspective, free movement of people is vital to global business centre and regional tourism hub. From a livelihood angle, the compulsory quarantine requirement imposed on returning residents causes frustration and stranded feeling both within and outside the territory.
• By and large, the community is more receptive to relaxing travel restrictions for vaccinated travellers due to their lower risk of infection and lesser need for intensive healthcare even if infected.^{2Legend symbol denoting Centers for Disease Control and Prevention (2021).} While it is a must now for all incoming travellers to take a series of COVID tests and prove they do not carry virus upon entering Hong Kong, there is an emerging suggestion to launch digital vaccination records (i.e. so-called "vaccine passports" for cross-boundary usage) for facilitating restriction-free flows of both local residents and incoming visitors. In the Legislative Council ("LegCo"), the subject of free movement of vaccinated travellers has been discussed on at least seven occasions during the first nine months of 2021.^{3Legend symbol denoting While at least five Legislative Council questions were raised on this subject during January to September 2021, it was also discussed in other occasions.}
• Globally, some advanced places especially those with high inoculation rates begin to open their borders to fully vaccinated travellers by reducing, or even exempting, their quarantine requirements. For the European Union ("EU"), Singapore and the United Kingdom ("UK"), they have digitalized their vaccination records for their residents and/or incoming visitors on the one hand, and embarked on mutual recognition of such records with other places on the other. This issue of Essentials highlights major features of digital vaccination records in these three places, after a brief discussion of latest international travel strategies amidst pandemic and the respective concerns in Hong Kong.

Recent developments of global policy on cross-boundary people flows

• Waning protection effect of vaccines against variants: When the COVID-19 vaccines were first rolled out in early 2021, it was generally believed that a high inoculation rate could help shield local population from infection, whereas vaccinated travellers could travel as freely as before. Yet this optimism evaporated soon after the speedy spread of more contagious mutant virus strains (e.g. Delta) around the world.^{4Legend symbol denoting Global Initiative on Sharing Avian Influenza Data (2021).} Fully vaccinated persons can still be infected by the Delta variant, though with much smaller likelihood of serious illness and deaths.
  
  Taking the BioNTech vaccine as an illustration, it is 92% effective against the Delta variant 14 days after taking two doses, but its effectiveness falls progressively to just 78% after 90 days.^{5Legend symbol denoting Nature (2021).} Israel is another example. Even though 78% of its adult population has already received two doses by early September, its daily new caseload as a percentage of local population still surged to 0.02% in the first week of September (reportedly amongst the highest in the world in the same period).^{6Legend symbol denoting The Times of Israel (2021).} The earlier belief of herd immunity once inoculation rate reaches a critical level of 70% turns out to be largely "mythical".^{7Legend symbol denoting The Guardian (2021).}
• Stringent travel restrictions under the "zero infection strategy": Globally, cross-boundary travel strategies vary within a wide spectrum between two extreme camps. For more cautious places at the one end (e.g. the Mainland and New Zealand), they impose more stringent travel restrictions out of the concern that a single imported case can trigger a mass outbreak in the local community (as evidenced in the four waves of infection in Hong Kong over the past year). While this approach accords public safety the top priority, boundary lockdown could result in huge economic loss. A global study suggests that about 29% of places belong to this camp by early July 2021.^{8Legend symbol denoting World Tourism Organization (2021).}
• More relaxed policy under an emerging "living-with-the-virus strategy": At the other end, some advanced places has begun to open their borders gradually since July 2021, mainly those with very high inoculation rates. Assuming that they mass injection can hugely mitigate the risks of outbreak in the community, they can afford a more tolerant risk-based approach in cross-boundary travel (e.g. the UK and Singapore).^{9Legend symbol denoting Government of Singapore (2021).}
  
  Taking the UK as an illustration, it resumed quarantine-free entry for fully-vaccinated visitors from the United States and Europe after 70% of its population had already received two doses of vaccines on 30 July 2021.^{10Legend symbol denoting GOV.UK (2021b).} While the weekly infection caseload rebounded from 185 700 in early August to 256 100 in early September due to Delta variant, both the hospitalization rate and death rate stayed at very low levels, with apparently minimal pressure to the healthcare system.^{11Legend symbol denoting World Health Organization (2021).} The UK government then announces to relax the travel restrictions further, allowing vaccinated travellers from 177 places to enter the UK without quarantine starting from 4 October. For vaccinated travellers from 54 high-risk places on the "red list", they are still subject to the quarantine requirement.^{12Legend symbol denoting GOV.UK (2021a).}
• Common pre-conditions of quarantine-free travel: For both "zero infection" and "living-with-the-virus" camps, reactivation of cross-boundary travel seems to hinge on several common pre-conditions. First of all, travellers usually need to undergo a couple of COVID tests to prove that they are not virus carriers before and upon arrival. Secondly, the infection caseload of the originating travel place should be generally comparable to, if not lower than, the destination. Thirdly, travellers with COVID-19 vaccination proofs usually are exempted from certain restrictions upon arrival. This is a sort of balancing benefits of freer travel against potential risks to local healthcare system. Fourthly, vaccination records should be as easily verifiable as possible in both embarkation and destination. This in turn requires bilateral or even multi-lateral agreements amongst governments, as manifested in the recent agreements reached between Hong Kong and the Philippines/Indonesia regarding recognition of vaccination records of foreign domestic helpers from these two places in late August 2021.^{13Legend symbol denoting GovHK (2021a).}

Recent discussion of easing travel restrictions in Hong Kong

• Lacklustre progress in local vaccination: The pandemic situation in Hong Kong is recently under control, with just four local infections recorded from May to mid-September 2021.^{14Legend symbol denoting Centre for Health Protection (2021).} However, the progress of vaccination is lacklustre, with only 4.4 million people (65% of local population) having received the first dose of vaccine by mid-September.^{15Legend symbol denoting The numbers of fully vaccinated population (i.e. received two doses) were even lower, at 3.9 million and 58% only. See GovHK (2021c).} As local healthcare experts advise that this is far from the elevated rate required for achieving herd immunity in face of the Delta variant (estimated at 97%-143%), the Government is still highly vigilant in the fight against pandemic.^{16Legend symbol denoting 龍振邦等(2021).}
• Stringent travel restriction: As such, the Government adopts a "vaccine bubble" approach and attempts to maintain zero local infection. Put it simply, unvaccinated travellers are subject to as many as 21 days of compulsory quarantine upon arrival, allegedly amongst the most stringent in the world.^{17Legend symbol denoting As at mid-September 2021, the Government has listed 25 high risk places (e.g. Brazil, India, UK and US) and 1 low risk place (i.e. New Zealand). Other unspecified places are medium-risk places. See GovHK (2021b).} However, for vaccinated travellers from certain low-risk places (e.g. the Mainland and New Zealand), the number of such quarantine is substantially trimmed to seven days only.
• Verification of vaccination records: At present, the Government accepts both hard and digital copies of vaccination records presented by inbound travellers, provided that these copies are issued by recognized institutions containing information of (a) travellers' names as shown in travel documents; and (b) dates and types of vaccine taken.^{18Legend symbol denoting GovHK (2021b).} For local residents, their digital vaccination records are uploaded to the "LeaveHomeSafe" app so they are subject to less social distancing restrictions at certain premises within Hong Kong. The respective electronic verification mechanism on vaccination records appears to be not yet developed for cross-boundary travel, however.
  
  In the earlier months, the Government once mentioned that it was studying the suggestion of converting local vaccination records into the respective health codes in Guangdong and Macao.^{19Legend symbol denoting GovHK (2021d).} Yet there is limited public information on the progress, probably due to technical challenges and the need for bilateral negotiation.
• Issues of concerns: At present, both airline staffs and local law enforcement officers largely rely on their own judgements in manual verification of the authenticity of the hard or digital copies of vaccination records. Conceivably, manual checking is rather time-consuming, especially when there is a large volume of travellers. Moreover, reliability of this verification process is another concern. In an attempt to expedite resumption of more cross-boundary travel, there are thus calls to develop a mechanism for mutual recognition of digital vaccination records with counterpart authorities in other places.^{20Legend symbol denoting GovHK (2021d and 2021e).}

Recent global practice in verifying vaccination records of travellers

• At this juncture, some 120 places have introduced vaccine passports for cross-boundary travel, though with variations in implementation details.^{21Legend symbol denoting MoveHub (2021).} While many still resort to manual checking at immigration clearance, others have rolled out easier verification mechanism of digital records (e.g. EU, Singapore and UK). Salient feature of the verification mechanism in these places are summarised below one by one, along with a table (Figure 1).
  
  

  Figure 1 - Digital vaccination records in selected places

  

  Note: (1)

  Only applicable to returning UK residents with National Health Service COVID Pass.

  
  
• For EU, the 27 member states initiated discussion of a common verification system on vaccination record in November 2020, followed by a set of guidelines on interoperability of such records promulgated by the European Commission ("EC") in January 2021 and a proposed legislative framework in March. Once the law came into effect in June, EC formally introduced the Digital COVID Certificate ("DCC") in July, even though the bloc achieved an inoculation rate of only 43% by end-June.^{22Legend symbol denoting European Centre for Disease Prevention and Control (2021).}
• Under DCC, fully vaccinated residents can freely travel across 27 member states of EU without restrictions. In addition, 16 more places outside EU established similar electronic verification system and joined the DCC scheme upon bilateral discussion with EU. As such, DCC serves as a digital vaccine passport in altogether 43 places across Europe by mid-September 2021.^{23Legend symbol denoting These 16 places are Albania, Andorra, Faroes Islands, Iceland, Israel, Liechtenstein, Monaco, Morocco, North Macedonia, Norway, Panama, San Marino, Switzerland, Turkey, Ukraine and Vatican City State. See European Commission (2021a).}
• On verification mechanism, a specialized gateway is created to connect databases of 43 participating places for scanning QR code of DCC and for verifying digital signatures. As verification is done offline, nobody can access the personal records through the gateway for privacy protection.^{24Legend symbol denoting At the moment, vaccination records of incoming visitors from other places are checked manually.} Indicative of its wide usage, a total of 270 million DCC have been generated by end-July, equivalent to three-fifths of EU population.^{25Legend symbol denoting European Commission (2021b).} While DCC is acclaimed to be an "excellent model", its success is largely attributable to the unique institutions of EU on the back of a strong agency (i.e. EC) to iron out many thorny bilateral issues in implementation.^{26Legend symbol denoting International Air Transport Association (2021).}
• In Singapore, the government announced to "live with the virus" when its inoculation rate approached 77% in mid-August 2021.^{27Legend symbol denoting Singapore COVID-19 Vaccination Info (2021).} In cross-boundary travel strategy, it grants more flexibility to inbound travellers (including both residents and visitors) based on the perceived risks of the originating places, but not so in outbound travel. For instance, visitors from four places with very low-risk (i.e. the Mainland, Hong Kong, Macao and Taiwan on the "Category 1" list) are exempted from quarantine, even if they are not vaccinated. But for visitors from the riskiest places in the "Category 4" list, even those vaccinated have to undergo 14 days of quarantine.^{28Legend symbol denoting Ministry of Health (2021).}
• On verification mechanism, Vaccinated Travel Lane ("VTL") is launched for both vaccinated visitors and Singaporean residents returning from abroad as from September 2021.^{29Legend symbol denoting Singaporean government accepts all eight World Health Organisation Emergency Use Listing ("WHO EUL") vaccines. See Immigration and Checkpoints Authority (2021).} In short, fully vaccinated visitors from two low-risk places in "Category 2" list (i.e. Brunei and Germany) can apply for Vaccinated Travel Pass ("VTP") before entry to Singapore, by uploading the QR codes of their vaccination records for verification in advance. Visitors with VTP can then be waived from the 7-day quarantine requirement if they are tested negative in COVID test on arrival. For Singaporean residents returning from these two places, they already have Singaporean vaccinated records, and hence, need not apply for VTP in advance. As VTL was launched less than one month, it is too early to assess its effectiveness. Whether the Singapore government can strike more VTP arrangements with other places is one of the areas that merits close monitoring.^{30Legend symbol denoting 聯合早報(2021).}
• In the UK, the government decided to implement much more relaxed travel arrangement upon a 70% national inoculation rate on 30 July 2021. In May 2021, the National Health Service ("NHS") introduced the COVID Pass to facilitate checking the vaccination status of UK residents in both inbound and outbound travel.^{31Legend symbol denoting National Health Service (2021b).} Vaccinated residents can apply for digital COVID Passes from NHS, consisting of two-dimensional ("2D") barcodes on the vaccine types and the number of doses taken back in the UK. While these barcodes will expire after 30 days, the validity period can be automatically extended whenever users login the NHS mobile application again.^{32Legend symbol denoting In contrast, the paper version of COVID Pass does not have an expiry date.}
• On verification mechanism, UK residents with COVID Passes returning home from 177 places on the "non-red list" could be waived from quarantine requirement.^{33Legend symbol denoting GOV.UK (2021a).} Also, the UK government made bilateral agreements with some 30 places in the world, allowing UK residents going outbound to these places to be exempted from the travel restrictions in the destinations either in full or in part. Reflecting intensive usage of the Pass, the cumulative number of NHS mobile application users has surged by 150% in just three months to 10 million by end-July 2021, equivalent to 15% of the UK population.^{34Legend symbol denoting National Health Service (2021a).}
• Regarding inbound overseas visitors, the UK government announces to exempt quarantine requirements for vaccinated visitors from aforementioned 177 places as from 4 October 2021, if they have completed vaccination in specified places.^{35Legend symbol denoting Only vaccination in specified places (e.g. US, Japan and Singapore) are recognized. See GOV.UK (2021a).} Yet given they do not have access to NHS COVID Pass, the verification process is done through manual checking.

Concluding remarks

• As vaccination can significantly mitigate the risks of mass infection of COVID-19, some advanced places have rolled out digital vaccination records recently. With varying implementation mechanisms, they have reactivated flows of cross-boundary travellers in a risk-controlled manner.

Prepared by Sunny LAM
Research Office
Information Services Division
Legislative Council Secretariat
21 September 2021