Interview with Henrique Martins, from ISCTE-IUL, Lisbon where he teaches management and digital health. He was the past president of SPMS, Portugal’s Digital Health Agency, where he led eHealth efforts for about 7 years.
How do you evaluate the EU Digital COVID Certificate and its overall infrastructure?
Henrique Martins: The EU Digital COVID Certificate is a pan-European system: it needs to be operational from Portugal to Poland and from Ireland to Cyprus. It is an interoperable system, crossing language barriers and borders. But its main strength is also its main weakness; the problem with EU healthcare is that the treaties significantly limit what can be regulated at EU level, therefore it is almost impossible to harmonise legal instruments for health. And if we can’t gather vaccination data, we can’t produce the certificates.
It’s easy for Portugal, for example, because our national vaccination software is on one single digital health platform. We started building this platform in 2012, and then improved it in 2015 along with many other digital services, namely one for vaccination. This gives us easy access to online data on vaccination availability per region and per healthcare centre. Citizens and healthcare workers can go online to check the progress of the population’s vaccination, because all of the nurses are registered on the same platform, regardless of whether the hospital is public or private, who the primary care physician is, etc. Once the data is on the platform, people will have access to it via an app on their phone – this data will then become their EU Digital COVID Certificate. Since Portugal already has this national platform, rolling out the certificates should be fairly simple. It’s just a matter of tweaking the national platform to include the EU’s infrastructure and records. However, Member States that don’t already have a similar platform from before the COVID-19 pandemic will have a hard time rolling out the certificate by 1 July. For this reason, I don’t see how we can expect all Member States to adopt the EU Digital COVID Certificate in unison. Nevertheless, I don’t think that the start date needs to be changed.
From a practitioner’s perspective, I think the certificate is well thought through. If successful, people may see the value in building an EU-wide standard for digital health: it would allow the scaling up of cross-border exchanges such as medical images, laboratory results or digital care, and would make the case for an EU healthcare system by building a single market for health. But in order to get there, we need to invest in the same way we did in the digital single market. The certificate is a first promising step in that direction, but to really harmonise patient-centred healthcare across the EU, more political and legal efforts are needed.
How do you evaluate the Digital COVID Certificate and its infrastructure in the light of the recent EU eHealth initiatives?
Henrique Martins: While I think it is a good idea as it can be used to propel interoperability in e-health in the EU, the system as a whole is not yet ready to produce an EU Digital COVID Certificate for everyone from a technical, legal and even professional standpoint, at least in the first few months. Some people travel and some don’t – the question is whether the EU can set up a system that works for both profiles. The EU Digital COVID Certificate is a part of two ecosystems: the ecosystem of data from the local vaccination registry, and the ecosystem of interoperable data at EU level.
COVID-19 has also raised the issue of proof of vaccination. From a healthcare perspective, it will always be important to know what vaccines people have had. I think that the EU should make the certificates the uniform standard for proof of vaccination once the pandemic is over. EU citizens would be able to get their certificate on a voluntary basis, either in physical or digital format, with the option to delete it if they so wish. The EU would issue a certificate that follows a technical and an interoperable specification, a ‘European standard’ that would enable mutual recognition and the sharing of public health resources across the EU.