In the age of digitization and international mobility, legacy handwritten vaccination cards may seem a bit outdated and inefficient. Yet, there was no commonly agreed international digital format until very recently. The European Union Digital COVID Certificate (DCC) has paved the way for such a digital vaccination card, both technically and in daily usages.
However, it is important to remain conscious of the difference between a vaccination card and a vaccination certificate.
Like a vaccination certificate, a vaccination card is a portable document, gathering reliable information about vaccine administrations, and it remains in the custody of the person who has been vaccinated. Yet its purpose is not to demonstrate compliance to some legal or administrative rule, but to carry the necessary information to guarantee the continuity of care, including for people crossing borders and changing healthcare jurisdiction.
Even for a digital vaccination card, the previous definition applies. To respect the control and portability by the vaccinated individual, it does not consist of a record held in an Electronic Health Record (EHR), a public health Immunization Information System (IIS), or even the on-demand retrieval of foreign patient summaries promoted within the eHealth Digital Service Infrastructure (eHDSI). Such systems may be consumers or producers of digital vaccination cards, but the card itself is the piece of information carried by the person.
This piece of information can be dematerialised into some local or online repository, such as a mobile phone wallet, or materialised with a printed format. The same methods that were used for the DCC can be reused to store within a QR Code up to 100 vaccine administration events, which is more than enough to follow vaccination throughout a person’s lifetime.
Wanted: a common lexicon
The only remaining difficulty is to agree on a common language to identify the administered vaccines. Contrary to any other medication, vaccines have an effect that last for decades, and vaccines that were administered sixty years ago, or vaccines that have never been authorized in Europe, are relevant and must be recorded.
Paper trails may use local brand names (active or inactive vaccines to record historical records), language dependent codes for antigen content (such as TdaP in English, which is dTca in French), including unknown formulations or target diseases; electronic records mostly use the national codes for pharmaceutical distribution; encompassing global terminologies, such as SNOMED-CT or ATC, are far too imprecise.
Yet, a focused effort on the representations of vaccines is absolutely feasible. The total number of representations would not exceed one thousand terms, and most of them are already present in the NUVA (Nomenclature Unifiée des Vaccins) database supporting the MesVaccins.net platform, complemented with a structured description of function and composition, alternative names and spellings, and correspondence with the encodings used in existing IIS and EHRs.
The MesVaccins team is ready and willing to contribute to the creation of a European terminology server for vaccine designations, as a common good under the control of ECDC.
From October 1st, a demonstration platform will be live at https://vaccination.cards, allowing any visitor to test the encoding and delivery of a printed vaccination card, and whenever necessary to submit for the creation of a new entry in the nomenclature. In advance, thanks to every contributor.
François Kaag is Compliance Manager at SYADEM (MesVaccins.net) and Jean-Louis Koeck is founder of MesVaccins.net
October 24th, 2022
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