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Marston, H.R1,2, Morgan, D.J2,1, Wilson, G3, & Gates, J3

1Health and Wellbeing Strategic Research Area, Faculty of Wellbeing, Education, Languages, The Open University, Milton Keynes, Buckinghamshire, UK, MK7 6AA. Hannah.Marston@open.ac.uk / https://orcid.org/0000-0002-8018-4166

2Centre for Innovative Ageing, Swansea University, Singleton Park, West Glamorgan, SA2 8PP, UK.

d.j.morgan@swansea.ac.uk / https://orcid.org/0000-0002-3107-3945

3Nursing, Midwifery & Health, Northumbria University, Newcastle, UK gemma.wilson@nortumbria.ac.uk / https://orcid.org/0000-0001-7362-7048/  J.r.gates@northumbria.ac.uk / https://orcid.org/0000-0002-8934-025X

As Covid-19 started to rip through the world, disabling businesses, educational institutes, travel, many citizens were mandated to adhere to the respective legislations of their regions or Countries’ Government; whereby in some instances citizens were required to carry documentation stating why they were outdoors, and/or one person was only allowed out of the house at any one time. The UK on the other hand did not enforce such legislation and were instead informing all citizens who had underlying health issues to isolate indoors.

Approximately one year ago citizens in the UK were excited at the prospect of seeing and meeting up with friends, family members and loved ones, in addition to booking holidays or having a quiet pint down at their local pub. Many citizens thought the pandemic was over, unfortunately, it was only the start of things to come. Furthermore, we have heard through many media channels, personal experiences or other that for many citizens who were categorised as vulnerable, they received a letter informing them that they had to shield because they had been categorised as vulnerable, and includes individuals who were recruited for this research project ‘COVID-19: VULNERABLE YOUNG PEOPLE LIVING WITH LIFE-LIMITING/LIFE-THREATENING CONDITIONS AND THEIR FAMILIES’ led by Dr S. Earle (The Open University). For many citizens with underlying health issues and categorised as vulnerable, the 2020 pandemic has demonstrated how dangerous Covid-19 is with a total of 128,000 deaths in the UK (UK Government, 2021a), 3,445,222 million deaths worldwide (Statista, 2021). The impact of Covid-19 however, does not only extend to issues of health, and can be felt on a socio-economic level. Indeed, on the 15th of January 2021 the chairman of Pimlico Plumbers stated that all employees would need to be vaccinated to continue working for the company (Espiner, 2021). For those respective employees that were/are not vaccinated would be reviewed on a case-by-case issue (Espiner, 2021).

While over the last 12-months we as a society both nationally and globally have had our lives turned upside down ranging from education, disruption to plans such as holidays, time spent with family and friends resulting in loneliness,  social isolation, and annual holidays such as Christmas (Marston, & Morgan, 2021; 2020a; 2020b; Marston, et al., 2020a) for many. The pandemic has provided a raft of research whether nationally funded (UKRI, 2020) or in some instances research projects have/are being conducted which has not received any external funding (Earle, et al., 2020; Marston, et al., 2020; Marston, et al., 2020d). While lives have been significantly disrupted, technology has and continues to play an integral role in the daily lives of many. This may include formal activities such as working from home, or leisure activities such as weekly quiz nights conducted over Zoom. It is clear that technology has played a big role in maintaining relationships over the pandemic and has become necessary to achieve even the more mundane of tasks, such as ordering groceries online.

However, as we reflect on the last six months of life in the UK, we have seen the national vaccination programme rolled out. Citizens who were categorised as the most vulnerable (UK Government, 2021b) were vaccinated at the beginning of December 2020, and as of the 25th May a total of 60, 965,594 citizens have received their first and second doses of either the AstraZeneca or Pfizer vaccine (UK Government, 2021c). Over the last few months there has been mooting’s about digital passports, and if/how they would be implemented into our lives as a way of continuing with our new lives (BBC News, 2021; Rawlinson & Geddes, 2021; Proctor and Devlin, 2021; Henley, 2021; Lawrie, 2021)

It is looking more likely that the UK will go down the route of vaccine passports and this evidence can be accessed via the NHS App (PA Media, 2021)– available for download from respective App stores. For anyone in England who has downloaded this App and gone through the login and verification processes they will have been able to view their electronic health record. Additional details include when and type of vaccine, repeat prescriptions, seek advice, and view any messages (Figures 1 and 2). However, for people in Wales they are unable to access their eHealth records).

While it is easy for some to throw around the pros and cons in a post-pandemic society, members of the Royal Society, SET-C (Science in Emergencies Tasking: COVID-19) group have published 12 challenges surrounding vaccine passports (2021):

  1. Meet benchmarks for COVID-19 immunity.
  2. Accommodate differences between vaccines in their efficacy, and changes in vaccine efficacy against emerging variants.
  3. Be internationally standardised.
  4. Have verifiable credentials.
  5. Have defined uses.
  6. Be based on a platform of interoperable technologies.
  7. Be secure for personal data.
  8. Be portable.
  9. Be affordable to individuals and governments.
  10. Meet legal standards.
  11. Meet ethical standards.
  12. Have conditions of use that are understood and accepted by the passport holders.
Figures 1 illustrate the interface of the NHS App. Permission granted by Marston (25.05.21)

Figures 2 illustrate the interface of the NHS App. Permission granted by Marston (25.05.21)

For many of us the NHS is something that we have grown up knowing and is revered on a global scale. Yet, for over two years there has been an app (Push Doctor) which enables citizens to access a doctor from the comfort of their home, for a price. The thought of using the ‘Push Doctor’ app as a means of accessing a registered GP and receiving a prescription is abhorrent, because it could be perceived as queue jumping, and/or a back door to privatisation of the NHS. Indeed, in recent years there has been some concerns relating to prescriptions, quality and safety, and advertising (NHS for sale, n.d). Some people would say it is the beginning of privatisation, especially when there is a financial payment of £45 which includes access to a doctor via your digital device, same day prescription, sick notes and medical records are synced (Push Doctor, n.d). This App excludes many citizens in society because of the cost of an online App appointment, or who do not feel digitally confident to use an App to speak with a health professional (e.g., GP), or for some people they do not have access to an appropriate digital device or Internet connection to facilitate this service. This in turn lends itself to creating a two tier system. Furthermore, from the 12-challenges outlined above, Points 6 and 8 also imply if such a passport was to be rolled out, then it will likely be on a smart phone, rather than a piece of paper. This too excludes many citizens who do not own a smartphone, nor may they have internet access and/or the digital skills and knowledge to download and understand what it is that they have to do. While Point 9 of the 12 challenges ‘be affordable to individuals and governments’ this in our perspective is very much a loaded point.

Moreover, we have heard over the last 12-months how for many people in our society who reside in and are categorised as areas with high deprivation the respective people can and do struggled to feed their families, keep a roof over their heads, they’ve experienced difficulty in accessing learning materials online because of the lack of digital devices in their home, receiving health appointments, or even ordering groceries online because they do not have the necessary technology devices and/or digital skills. For many people they may only use a mobile phone (not a smartphone) for making telephone calls and sending text messages; while for some citizens who do own a smartphone, they may not have access to Broadband in their homes, because they cannot afford it. What does ‘be affordable’ mean? What is affordable for one person or family, is not for another.

Additionally, and equally important to affordability is having the digital skills to conduct the necessary actions to ensure one receives the services/products. Having the digital skills is are imperative for all citizens in our society and as many services have moved online since the pandemic, some people struggle to access these online services because they do not have the basic mental models (White, Marston, Shore & Turner, 2020) to use technology.

The immediate future

As many more people become fully vaccinated or are still to receive their 1st and 2nd doses of the vaccine, the debate of vaccine passports will continue to rumble on with many experts contributing various arguments such as ethics, privacy, data protection and overall discrimination towards vulnerable and marginalized citizens (Trian, 2021).

What we have learned from the last 12-months is how narrative and discourse can change quickly and for many people downloading the NHS App onto their smartphones, scanning the QR codes in different outlets has provided and enabled citizens, providing Public Health authorities the opportunity to provide real time information to citizens relating to self-isolation. The track and trace App started its life rather bumpy. However, it seems we are now going to be responsible for our own ‘digital passport’ should we choose to go abroad in the future and for any other activities and events (e.g., live music, or sporting events) to prove that we have been vaccinated. Additionally, there has been no discussion surrounding those members of society (e.g., older adults) who do not have access or own a smartphone to install the respective Apps. How would track and trace work for them and should there be alternative provision(s) afforded by individual organisations, councils and/or Government?

However, all interested parties and actors have a responsibility to all citizens to ensure data privacy is upheld coupled with ensuring citizens from lower SES communities are not left behind. The digital divide/poverty and digital by default debate has been ongoing for over 20 years and has been brought to the forefront since the pandemic.

What is pivotal is, whether it is an older adult or younger person is that they have the opportunity to learn and build on their digital skills and knowledge, not just for the possibility of a vaccine/digital passport, but to gain access to health and local services. Greater work and collaborations are needed to ensure all citizens young and old have these opportunities, not just those who are privileged.

One such collaboration, is the research project  ‘Adapt Tech, Accessible Technology’(ATAT). This project has been conducted to explore 2 aims and objectives:

  1. To understand from a new user perspective what basic adjustments need to be made to existing, affordable technology to support digital confidence and literacy among people aged 50+ years, and
  2. To identify what technological innovations and prototype applications enable new users to confidently access digital platforms.

The ATAT project is a collaboration between colleagues at Swansea University, The Open University, and Northumbria University, led by Dr Deborah Morgan; in conjunction with computer scientists, and Digital VOICE for communities in Newcastle and Digital Communities Wales, the ATAT project has taken a co-creation/participatory approach to learning and understanding the challenges, and barriers experienced by older adults in the regions of Wales and the North East of England. More importantly the research team have been able to understand the exact needs and preferences of the end-users, which is critical in understanding the role and impact(s) that technology plays in the day-to-day lives of end-users who have limited or no digital skills. The pandemic enabled the research team to organise and conduct online workshops with end-users who were located in their respective regions. In a pre-pandemic society, it would have been likely that the research team would have physically travelled to the communities/regions. However, conducting online workshops enables everyone involved in the project to come together in one place, providing a rich and lively discussions.

There are thousands of Apps available for download onto smartphones, one key take home message is, while over the years, products, and services have been designed and developed without the direct input of the end-user which has in turn led to designers and developers who do have advanced digital skills thinking they know best. This is not the case and has led to failure. The ATAT project did not take approach, at the heart of the research project was the end-user – and what their experiences are.

As for society returning to some sort of a new post-pandemic society, none of us really know what the future holds, we can only pontificate, imagine and dream. Would the integration of vaccine/digital passport be so bad? As noted earlier on in this piece for some citizens in society – quite possibly and this has the potential to bring a 2-tier society, the haves and the have nots. One thing is for sure is technology is not going to disappear any time, and therefore we have the responsibility to ensure that all citizens are equipped with the skills, knowledge, and access to enjoy their respective lives in a post-pandemic society.

References

Adapt Tech, Accessible Technology (ATAT). 2020-present. Research project website https://healthwellbeing.kmi.open.ac.uk/related-projects/adjust-tech-accessible-technology-atat/. Accessed 25th May 2021.

BBC News. (2021). Covid-19: PM promises review on issues of vaccine passports. 24th February 2021, retrieved from https://www.bbc.co.uk/news/uk-56169616. Accessed 25th February 2021.

Earle, S. et al. (2020). COVID-19: Vulnerable Young People Living with Life-Limiting/Life Threatening Conditions and their Families. Research Project website. Available at https://healthwellbeing.kmi.open.ac.uk/covid-19/vulnerable-young-people-living-with-life-limiting-life-threatening-conditions-and-their-families/. Accessed 25th May 2021.

Espiner, T. (2021). Pimlico Plumbers to make workers get vaccinations. BBC News, 15th January 2021. Retrieved from https://www.bbc.co.uk/news/business-55654229. Accessed 25th February 2021.

Henley, J. (2021). Covid: EU unveils ‘digital green certificate’ to allow citizens to travel. The Guardian, 17.03.21. Available at https://www.theguardian.com/world/2021/mar/17/covid-eu-unveils-digital-green-certificate-to-allow-citizens-to-travel. Accessed 25th May 2021.

Lawrie, E. (2021). ‘Vaccine passports’: Will I need one for going out, work and travel? BBC News, 24th February 2021. Retrieved from https://www.bbc.co.uk/news/explainers-55718553. Accessed 25th February 2021.

Marston, H.R., & Morgan, D.J. (2020a). Technology & Social Media during COVID-19 Pandemic. Special Issue: COVID-19 & Geriatric Mental Health Worldwide. IPA Bulletin; 37(2). Available from https://www.ipa-online.org/publications/ipa-bulletin/featured-articles/covid-19-bulletin-articles/technology-social-media-during-covid19. Accessed 25th May 2021.

Marston, H.R., & Morgan, D.J. (2020b). Lockdown 2.0: Gunpowder Plot, Digital Christmas, Sex and Relationships. Ageing Issues Blog, 2nd November 2020. Available at https://ageingissues.wordpress.com/2020/11/02/lockdown-2-0-gunpowder-plot-digital-christmas-sex-and-relationships/. Accessed 25th May 2021.

Marston, H.R., & Morgan, D.J. (2021). Happy New Year, 3rd Wave, Lockdown 3.0 & Easter. Ageing Issues Blog, 22nd January 2021

Marston, H.R., et al. (2020). COVID-19: Dating Apps, Social Connections, Loneliness, & Mental Health in Pandemic. Research project website. Available at https://healthwellbeing.kmi.open.ac.uk/covid-19/sex-social-connection-on-a-monday/. Accessed 25th May 2021.

Marston, H.R., Ivan, L., Fernández-Ardèvol, M., Rosales Climent, A., Gómez-León, M., Blanche, D., Earle, S., Ko, P.C., Colas, S., Bilir, B., Öztürk Çalıkoğl., Arslan, H., Kanozia, R., Kriebernegg, U., Großschädl, F., Reer, F., Quandt, T., Buttigieg, S.C., Alexandra Silva, P., Gallistl, V., & Rohner, R. (2020d). COVID-19: Technology, Social Connections, Loneliness & Leisure Activities: An International Study Protocol. Front. Sociol. doi:10.3389/fsoc.2020.574811

Marston, H.R., Musselwhite, C., & Hadley, R.A. (2020a). COVID-19 vs Social Isolation: the Impact Technology can have on Communities, Social Connections and Citizens. Ageing Issues, 18th March, 2020. The British Society of Gerontology. Available at https://ageingissues.wordpress.com/2020/03/18/covid-19-vs-social-isolation-the-impact-technology-can-have-on-communities-social-connections-and-citizens/?fbclid=IwAR1sUsffKNd_G5u6d_oc0Z56u4Es7HyoCJYKr0qSnqFxX68pD3PY5JaSl7g. Accessed 25th May 2021.

NHS for sale. (n.d.). Push Doctor. Available at https://www.nhsforsale.info/private-providers/push-doctor-2/. Accessed 25th May 2021.

PA Media. (2021). Hancock praises NHS app after 1.3m people register since vaccine status added. The Daily Mail, 23.05.21. Available at https://www.dailymail.co.uk/wires/pa/article-9609557/Hancock-praises-NHS-app-1-3m-people-register-vaccine-status-added.html. Accessed 25th May 2021.

Proctor, K., & Devlin, H. (2021). Coronavirus UK: health passport ‘possible in month’. The Guardian, 04.05.20. Available at https://www.theguardian.com/politics/2020/may/03/coronavirus-health-passports-for-uk-possible-in-months. Accessed 25th May 2021.

Push Doctor. (n.d.). Push Doctor paid service. Available at https://www.pushdoctor.co.uk/paid-service. Accessed 25th May 2021.

Rawlinson, K., Geddes, L. (2021). NHS app will be used as Covid ‘vaccine passport’ for foreign travel. The Guardian, 28.04.21. Available at https://www.theguardian.com/world/2021/apr/28/covid-nhs-app-will-be-used-as-vaccine-passport-for-foreign-travel. Accessed 25th May 2021.

Royal Society, The. (2021). Twelve criteria for the development and use of COVID-19 vaccine passports. 14th February 2021. Retrieved from https://royalsociety.org/-/media/policy/projects/set-c/set-c-vaccine-passports.pdf?la=en-GB&hash=A3319C914245F73795AB163AD15E9021. Accessed 25th February 2021.

Statista. (2021) Number of novel coronavirus (COVID-19) deaths worldwide as of May 21, 2021, by country. Retrieved from https://www.statista.com/statistics/1093256/novel-coronavirus-2019ncov-deaths-worldwide-by-country/. Accessed 25th May 2021.

Trian, N. (2021). As more government mull vaccine passports, critics raise discrimination fears. France 24. 23rd February 2021, retrieved from https://www.france24.com/en/europe/20210223-as-more-governments-mull-vaccine-passports-critics-raise-discrimination-fears. Accessed 25th February 2021.

UK Government. (2021a). Coronavirus (COVID-19) in the UK. Last updated 24th May 2021. Retrieved from https://coronavirus.data.gov.uk/details/deaths. Accessed 25th May 2021.

UK Government. (2021b). COVID-19 vaccination first phase priority groups. Updated 23rd February 2021, retrieved from https://www.gov.uk/government/publications/covid-19-vaccination-care-home-and-healthcare-settings-posters/covid-19-vaccination-first-phase-priority-groups. Accessed 25th February 2021.

UK Government. (2021c). Coronavirus (COVID-19) in the UK – vaccinations in the UK. Last updated 24th May 2021. Retrieved from https://coronavirus.data.gov.uk/details/vaccinations. Accessed 25th May 2021

White, P.J., Marston, H.R., Shore, L., & Turner, R. (2020). Learning from COVID-19: Design, Age-friendly Technology, Hacking and Mental Models. [version 1; peer review: 1 approved]. Emerald Open Res, 2:21 (https://doi.org/10.35241/emeraldopenres.13599.1)