# Why does the US have such a low tech and easily forged vaccine card

**URL:** <https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045>\
**Category:** The Quarantine Zone\
**Tags:** covid-quarantine\
**Created:** [May 27, 2021, 4:36pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045 "2021-05-27T16:36:38Z")\
**Posts on this page:** 20\
**Page:** 4

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**Author:** ![Little\_Nemo](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/little_nemo/32/3120_2.png) [@Little\_Nemo](https://boards.straightdope.com/u/Little_Nemo)\
**Post date:** [May 28, 2021, 3:36pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/61 "2021-05-28T15:36:19Z")

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What kind of idiot would pay for a fake copy of something they will give you a real copy of for free?

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**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\
**Post date:** [May 28, 2021, 3:40pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/62 "2021-05-28T15:40:34Z")

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> [@SanVito](#):
>
> Biometric passports carry your personal data on a microchip - it’s more than a digital photo.

Um, no, [it’s not.](https://www.dhs.gov/e-passports) I have a US passport. The US government does not have my fingerprints or my iris/retina scan. They have the photograph I submitted with my last passport renewal, and the mathematical information they can glean therefrom.

> [@SanVito](#):
>
> Isn’t this what national governments are for? They manage to issue passports, I can’t image issuing some kind of renewable vaccine card (in all likelihood, digital these days) is beyond the wit of civil servants.

Vaccines are not administered by civil servants. They are administered by doctors, nurses, pharmacists, and a whole slew of other health professionals in a range of settings. How do you get the information securely from a pop-up clinic at the shopping mall to the national government? How does the civil servant know who the pharmacist vaccinated, unless the pharmacy staff is keeping biometric data?

> [@SanVito](#):
>
> As for undocumented people, well, that’s very definition of being undocumented, isn’t it? I can’t imagine they’ll be too troubled about getting a vaccine passport for their annual trip to Cancun.

No, but are they going to get a vaccine if the process for getting the shot requires disclosure of their presence, facial contours, fingerprints, or whatever other biometrics are in place? If the CVS pharmacy or the vaccine clinic requires biometrics to know who got the shot, that is going to increase vaccine hesitancy in a vulnerable population; what are the public health implications thereof? Right now, most public health departments are vaccinating everybody, regardless of citizenship status ([example](https://www.11alive.com/article/news/health/coronavirus/covid-vaccine-undocumented-immigrants-georgia/85-727fc85b-aa07-462d-af16-430f6462ba68)) or presence/absence of identification documents, and they’re just handing out paper cards. How do you hand out “secure” proof of vaccination in such circumstances, or do you just give up and leave a reservoir of unvaccinated workers, many in essential occupations?

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**Author:** ![SCAdian](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/scadian/32/3292_2.png) [@SCAdian](https://boards.straightdope.com/u/SCAdian)\
**Post date:** [May 28, 2021, 3:53pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/63 "2021-05-28T15:53:58Z")

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> [@Broomstick](#):
>
> Probably the only vaccination I can prove that I have ever had is the smallpox vaccine… because it leaves a distinctive scar which I still have 55+ years later.

Only 38 years for me, and there’s no sign of the scar.

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**Author:** ![Treppenwitz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/treppenwitz/32/3445_2.png) [@Treppenwitz](https://boards.straightdope.com/u/Treppenwitz)\
**Post date:** [May 28, 2021, 3:56pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/64 "2021-05-28T15:56:12Z")

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FWIW, here’s something I posted in another thread a couple of days ago:

> [@The Vaccine Passport - news and views](https://boards.straightdope.com/t/the-vaccine-passport-news-and-views/933668/66):
>
> I now have a Vaccine Passport. I thought it might be of interest to describe setting it up and how it works. The Vaccine Passport – it says that it is intended to support travel abroad – is a smartphone application which has been available since the 17th May, but I gave it a week just in case. If there had been major problems with it, I was happy to let someone else find that out.
> 
> There’s an app for everything these days. There’s a [NHS (National Health Service) app](https://www.nhs.uk/nhs-services/online-services/nhs-app/about-the-nhs-app/), which allows you to schedule doctor’s appointments, re-order prescriptions and so forth; and the passport has been added to that. So, having downloaded the NHS app, you have to set the vaccine passport up. You enter personal data – name, DOB, NHS number, address, email address and so on. The personal information allows the app to find your medical records on the NHS IT system. You can limit cookies to essential only. The app then uses your phone camera three times. (1) – it takes a picture of your face; (2) – you have to take a photo of an item of photo ID – passport, driving licence etc (there are workarounds if you have no photo ID); (3) it does some weird facial recognition thing to confirm that your face matches the photo ID. If it’s all in order, you’re set up and good to go.
> 
> To use the passport (“Share Your COVID-19 Status - View and share proof of your COVID-19 status for travel”) you enter email and password (you can do fingerprint or facial recognition instead). It pings you a 6 digit code; you enter the code; and the passport consists of a screen showing your details, vaccination history and a _big_ matrix code (which says that it expires 20th June).
> 
> And there I run out of information. Mrs T got her phone and tried to read the code – it isn’t readable. I guess you have to have the right software installed to read it. I presume the code takes you to the photo taken when the app was setting up, to verify whose status – and indeed passport – this is.
> 
> All in all, does what it says on the tin.

Useful background, I hope.

j

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**Author:** ![Treppenwitz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/treppenwitz/32/3445_2.png) [@Treppenwitz](https://boards.straightdope.com/u/Treppenwitz)\
**Post date:** [May 28, 2021, 4:07pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/65 "2021-05-28T16:07:27Z")

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As an addendum to the above, you can get the passport to mail you a link to a downloadable (and printable) copy of your vaccination status. This reads (with redactions for obvious reasons):

[Big QR code]

This is a downloaded copy. Check against the bearer’s identity.  
Coronavirus (COVID-19) vaccination records  
This document is important. Keep it safe. It proves that you have been vaccinated.  
Name: [TREP]  
Date of birth: [Long ago]  
2D barcode expiration date: 20 June 2021  
Your NHS Records shows that you have received the following vaccines:

Dose 1  
Date of vaccination X February 2021  
Vaccine product Vaxzevria  
Manufacturer AstraZeneca AB  
Disease targeted COVID-19  
Vaccine SARS Cov-2 Antigen Vaccine  
Batch number AB000X  
Country of vaccination GB  
Authority NHS Digital  
Dose 2  
Date of vaccination [etc]…

j

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**Author:** ![IvoryTowerDenizen](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/ivorytowerdenizen/32/17937_2.png) [@IvoryTowerDenizen](https://boards.straightdope.com/u/IvoryTowerDenizen)\
**Post date:** [May 28, 2021, 4:12pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/66 "2021-05-28T16:12:34Z")

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Because they don’t want the vaccine, but they want the privileges that come with being vaccinated.

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**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\
**Post date:** [May 28, 2021, 4:14pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/67 "2021-05-28T16:14:34Z")

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That works in the UK because, as I understand it, the NHS is responsible for vaccine distribution AND has pretty much everybody’s medical records anyway.

In the US, vaccines are being distributed primarily through the state health departments, and then through whatever subnetworks they have established (local public health agencies, hospital systems, etc.). However, most people are not receiving the vaccine through their regular medical provider (assuming they _have_ a regular provider in the first place), and there is no real analog to the NHS central repository of medical records.

In my case, for example, I was vaccinated via a clinic established at my employer; they billed my insurance company, and somebody (insurance? local public health dept? ?) notified my doctor’s office, which acknowledges receiving the notification. However, because I didn’t get it through the doctor’s office, the field in their system for the COVID vaccine remains blank; I can’t look up my vaccine status in MyChart (their electronic medical records system).

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**Author:** ![Treppenwitz](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/treppenwitz/32/3445_2.png) [@Treppenwitz](https://boards.straightdope.com/u/Treppenwitz)\
**Post date:** [May 28, 2021, 4:20pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/68 "2021-05-28T16:20:06Z")

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Yeah, I was really only posting for background information - for those who want to hear how the UK system works. I have no real understanding of the practicalities of the US healthcare system(s), but I had picked up that organising a US vaccine passport would be a much greater administrative challenge.

Still, there is a passport, I have one, at least some countries have health systems which permit its fairly straightforward introduction. It seems to work. If I ever get to cross a border again, I’ll find out for real. 😉

j

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**Author:** ![SanVito](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/sanvito/32/2805_2.png) [@SanVito](https://boards.straightdope.com/u/SanVito)\
**Post date:** [May 28, 2021, 4:21pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/69 "2021-05-28T16:21:32Z")

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> [@slash2k](#):
>
> Um, no, [it’s not.](https://www.dhs.gov/e-passports) I have a US passport. The US government does not have my fingerprints or my iris/retina scan. They have the photograph I submitted with my last passport renewal, and the mathematical information they can glean therefrom.

No one is talking about personal data including retinal scans and finger prints except you. Personal data means the information which is already printed in your passport - read your own link.

> [@slash2k](#):
>
> Vaccines are not administered by civil servants. They are administered by doctors, nurses, pharmacists, and a whole slew of other health professionals in a range of settings. How do you get the information securely from a pop-up clinic at the shopping mall to the national government? How does the civil servant know who the pharmacist vaccinated, unless the pharmacy staff is keeping biometric data?

Are you telling me vaccine centres don’t keep electronic records of who they’ve vaccinated? What kind of operation are you lot running over there?

> [@slash2k](#):
>
> No, but are they going to get a vaccine if the process for getting the shot requires disclosure of their presence, facial contours, fingerprints, or whatever other biometrics are in place?

Who the hell is talking about this stuff, except you? All a vaccine passport needs is a record of who you are and what and when was the vaccine you got. Facial contours WTF. And presumably, if you don’t want to reveal your identity, then you don’t and you also don’t get a vaccine passport. That’s the deal with ID, you kinda have to say who your are.

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**Author:** ![hajario](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/hajario/32/171_2.png) [@hajario](https://boards.straightdope.com/u/hajario)\
**Post date:** [May 28, 2021, 4:24pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/70 "2021-05-28T16:24:52Z")

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> [@Little\_Nemo](#):
>
> What kind of idiot would pay for a fake copy of something they will give you a real copy of for free?

Someone who doesn’t want an actual vaccination.

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**Author:** ![shh1313](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/shh1313/32/8020_2.png) [@shh1313](https://boards.straightdope.com/u/shh1313)\
**Post date:** [May 28, 2021, 4:30pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/71 "2021-05-28T16:30:50Z")

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\*SNIP San Vito & 'Everyone else per CDC

With specific exceptions, several Presidential proclamations suspend and limit entry into the United States, as immigrants or nonimmigrants, of noncitizens who were physically present within the following countries during the 14-day period preceding their entry or attempted entry into the United States. For a full list of exceptions, please refer to the relevant proclamations in the links below.’

- [**China** external icon](https://trumpwhitehouse.archives.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-persons-pose-risk-transmitting-2019-novel-coronavirus/)
- **[Iranexternal icon](https://trumpwhitehouse.archives.gov/presidential-actions/proclamation-suspension-entry-immigrants-nonimmigrants-certain-additional-persons-pose-risk-transmitting-coronavirus/)**
- [**European Schengen area** external icon](https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/25/proclamation-on-the-suspension-of-entry-as-immigrants-and-non-immigrants-of-certain-additional-persons-who-pose-a-risk-of-transmitting-coronavirus-disease/) (Austria, Belgium, Czech Republic, Denmark, Estonia, Finland, France, Germany, Greece, Hungary, Iceland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Slovakia, Slovenia, Spain, Sweden, Switzerland, Monaco, San Marino, Vatican City)
- [**United Kingdom** external icon](https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/25/proclamation-on-the-suspension-of-entry-as-immigrants-and-non-immigrants-of-certain-additional-persons-who-pose-a-risk-of-transmitting-coronavirus-disease/) (England, Scotland, Wales, Northern Ireland)
- [**Republic of Ireland** external icon](https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/25/proclamation-on-the-suspension-of-entry-as-immigrants-and-non-immigrants-of-certain-additional-persons-who-pose-a-risk-of-transmitting-coronavirus-disease/)
- [**Brazil** external icon](https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/25/proclamation-on-the-suspension-of-entry-as-immigrants-and-non-immigrants-of-certain-additional-persons-who-pose-a-risk-of-transmitting-coronavirus-disease/)
- **[South Africaexternal icon](https://www.whitehouse.gov/briefing-room/presidential-actions/2021/01/25/proclamation-on-the-suspension-of-entry-as-immigrants-and-non-immigrants-of-certain-additional-persons-who-pose-a-risk-of-transmitting-coronavirus-disease/)**
- **[Indiaexternal icon](https://www.whitehouse.gov/briefing-room/presidential-actions/2021/04/30/a-proclamation-on-the-suspension-of-entry-as-nonimmigrants-of-certain-additional-persons-who-pose-a-risk-of-transmitting-coronavirus-disease-2019/)**

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<div class="post-metadata">

**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\
**Post date:** [May 28, 2021, 5:09pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/72 "2021-05-28T17:09:02Z")

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> [@SanVito](#):
>
> No one is talking about personal data including retinal scans and finger prints except you. Personal data means the information which is already printed in your passport - read your own link.

A vaccine passport, to be secure and easily matched to the person bearing it, needs to contain some sort of biometric data. That can be a photograph digitized to meet facial recognition standards, such as the current US e-passport, or it can be some other sort of technology such as fingerprints. No matter what sort of biometrics it contains, however, the technology has to be available at the point where the vaccines are administered. That means every pharmacy and pop-up clinic needs facial recognition technology, for example, or fingerprint scanners or whatever other mechanism is chosen. Currently, fingerprint scanners are cheaper and easier to implement than facial recognition, but somebody somewhere has to make the decision and come up with the money to implement some sort of biometrics. Personal data, by itself, is NOT a solution, since the insecure and easily-forged vaccine card contains that.

> [@SanVito](#):
>
> Are you telling me vaccine centres don’t keep electronic records of who they’ve vaccinated? What kind of operation are you lot running over there?

Every vaccination center is keeping records, and probably most are doing so electronically. However, there is not a single national standard for what that electronic record needs to look like, which means exchanging records can be problematic. It is a legacy of the decentralized US health care system.

> [@SanVito](#):
>
> Who the hell is talking about this stuff, except you? All a vaccine passport needs is a record of who you are and what and when was the vaccine you got.

A vaccine passport that is merely a record of who I am and the what and when of the vaccine I received is a piece of paper (or cardstock). This entire thread is about how to make that record secure, which requires a little bit more. How do you propose to document definitively who I am, for example? The UK version mentioned by @Treppenwitz above, for example, “does some weird facial recognition thing to confirm that your face matches the photo ID”; that’s facial contours and measurements.

> [@SanVito](#):
>
> And presumably, if you don’t want to reveal your identity, then you don’t and you also don’t get a vaccine passport. That’s the deal with ID, you kinda have to say who your are.

Ok. So you are proposing vaccination sites must have available the capacity to provide TWO kinds of documentation, to different standards, and also publicize that they are making that distinction and not accidentally (or accidentally on purpose) getting too much information about people who don’t want to reveal their identity. Is that correct?

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**Author:** ![suranyi](https://avatars.discourse-cdn.com/v4/letter/s/e36b37/32.png) [@suranyi](https://boards.straightdope.com/u/suranyi)\
**Post date:** [May 28, 2021, 5:25pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/73 "2021-05-28T17:25:46Z")

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In California they have been emphatic that you do not need ID to get vaccinated.

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**Author:** ![eschrodinger](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschrodinger/32/122_2.png) [@eschrodinger](https://boards.straightdope.com/u/eschrodinger)\
**Post date:** [May 28, 2021, 6:30pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/74 "2021-05-28T18:30:24Z")

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I’ve brought this up before in similar threads:

The issue that people are concerned about, and that will cause problems, is not someone having their vaccine information on a fake card. It’s someone having **fake vaccine information** in a form that is likely to be accepted. One way to address that is to make a format that would be hard to recreate be the standard, so that fake information is unlikely to be in a form that is likely to be accepted.

Another way to address the issue would be to make submitting fake vaccination information carry a heavy penalty. It’s fraud. Make it an aggravated level of fraud because it puts people at risk. Make it so that, if you do this, and someone gets Covid from you, that’s also a separate crime. And you’d have civil liability. Then, whenever people are submitting this kind of information, do spot checks or post checks to keep an eye on what the level of dishonest reporting is. Throw the book at people who are caught.

I think we should make the norm be that society needs to be able to rely on honest reporting of vaccination status. Therefore, it’s a breach of the social contract, and should be a crime, to be dishonest about it.

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**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\
**Post date:** [May 28, 2021, 6:48pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/75 "2021-05-28T18:48:47Z")

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> [@eschrodinger](#):
>
> Make it so that, if you do this, and someone gets Covid from you, that’s also a separate crime.

How would one prove, beyond a reasonable doubt (criminal standard of proof), who got COVID from whom? With such a large percentage of asymptomatic cases, for example, this modern Typhoid Mary may display no more evidence than the original.

(I do agree with your point that society needs to be able to rely on honest reporting of vaccination status, however.)

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**Author:** ![eschrodinger](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/eschrodinger/32/122_2.png) [@eschrodinger](https://boards.straightdope.com/u/eschrodinger)\
**Post date:** [May 28, 2021, 6:55pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/76 "2021-05-28T18:55:29Z")

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It may not always be possible, but contact tracing, plus, if it’s a big enough outbreak to warrant it, probably analysis of the particular virus to prove it’s the same one, could be enough. It will obviously depend on lots of circumstances. But if someone comes down with Covid and their recent contacts are tested, and fake-vaccination-card-guy is the only one that’s positive, and covid-victim is otherwise pretty risk-free, you’d have a good case, I think.

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**Author:** ![slash2k](https://avatars.discourse-cdn.com/v4/letter/s/439d5e/32.png) [@slash2k](https://boards.straightdope.com/u/slash2k)\
**Post date:** [May 28, 2021, 7:10pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/77 "2021-05-28T19:10:58Z")

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> [@eschrodinger](#):
>
> But if someone comes down with Covid and their recent contacts are tested, and fake-vaccination-card-guy is the only one that’s positive, and covid-victim is otherwise pretty risk-free, you’d have a good case, I think.

You’d still have the burden of proving that covid-victim didn’t pick it up from some random person at the grocery store or the soccer game and then transmitted it _to_ fake-vaccination-card-guy. Sure, it may be unlikely, but it would probably be enough to create reasonable doubt, and since the end of stay-at-home orders and venue closures and widespread social distancing, contact tracing is a lot harder than it was in spring 2020 (even assuming fake-vaccination-card-guy is in fact the only known contact who is positive, or that you can find contacts to check°).

°"In some regions of the United States, more than half of people who test positive provide no details of contacts when asked."–[Why many countries failed at COVID contact-tracing — but some got it right](https://www.nature.com/articles/d41586-020-03518-4)

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**Author:** ![Yllaria](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/yllaria/32/3452_2.png) [@Yllaria](https://boards.straightdope.com/u/Yllaria)\
**Post date:** [May 29, 2021, 8:02pm UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/83 "2021-05-29T20:02:59Z")

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> [@suranyi](#):
>
> In California they have been emphatic that you do not need ID to get vaccinated.

Although back before everyone could get it, there were often clinic reservations made through your physician and your ID would be checked to prevent line-jumpers. Those records may have been kept, but may be difficult to access.

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**Author:** ![bump](https://avatars.discourse-cdn.com/v4/letter/b/7c8e57/32.png) [@bump](https://boards.straightdope.com/u/bump)\
**Post date:** [May 30, 2021, 3:15am UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/84 "2021-05-30T03:15:50Z")

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Even at that, it’s kept at your pediatrician’s office, and they can just print you out that record. Ther’e’s no formal vaccination record for children that I’m aware of.

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**Author:** ![doreen](https://avatars.discourse-cdn.com/v4/letter/d/858c86/32.png) [@doreen](https://boards.straightdope.com/u/doreen)\
**Post date:** [June 1, 2021, 12:54am UTC](https://boards.straightdope.com/t/why-does-the-us-have-such-a-low-tech-and-easily-forged-vaccine-card/943045/85 "2021-06-01T00:54:42Z")

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Depends on the location - NYC and NYC have immunization registries ,although they were established only 15 or 20 years ago

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