You knew it was coming, and now it is official. COVID-19 vaccinations could begin distribution in the next three weeks, according to WSAV in Savannah, Georgia. With the glorious two-step vaccine that is likely to make you feel ill for a few days with each dose, you will get a COVID vaccination card:

The Department of Defense on Wednesday released the first images of a COVID-19 vaccination record card and vaccination kits.

“Everyone will be issued a written card that they can put in their wallet that will tell them what they had and when their next dose is due,” Dr. Kelly Moore, associate director of the Immunization Action Coalition, said in a CNN report.

There is a rationale for providing the patient with a record. According to the CDC:

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“For most COVID-19 vaccine products, two doses of vaccine, separated by 21 or 28 days, will be needed. Because different COVID-19 vaccine products will not be interchangeable, a vaccine recipient’s second dose must be from the same manufacturer as their first dose.”

Of course, the information on the type and date you received the vaccine could be given on a piece of paper or something less formal than a card. It is not hard to figure out how this record is likely to be used, so if you get the vaccine, laminate it. They were nice enough to make them wallet-sized.

This will allow a whole range of businesses and services to require you to show the card in order to shop, get a haircut, or use other services. Hotels and airlines may decide to require proof of vaccination to travel. This is despite no significant outbreaks on planes or associated with hotels.

This is insane for several reasons. First, the news regarding immunity in recovered patients is very positive. Studies of those who have had COVID-19 demonstrate that while antibodies provide the initial response, a long-term response from T & B memory cells in the immune system is durable and provides protection from reinfection. If COVID-19 is similar to SARS, studies have shown this long-term immune response is still active after 17 years. The good news is that the two viruses have a structure that is 80% similar, and they utilize the same method to enter cells.

Why would someone with active immunity need to receive a vaccine? The short answer is they don’t. The CDC and the testing companies should be working on an accurate test for commercial use to detect this response. If the experts assert that this virus will act wildly different from its close cousins, they will need an extraordinary explanation.

Next, some percentage of the population has the same-long term immune response based on exposure to other coronaviruses. The same commercially available test for recovered patients could be administered before vaccination to see if it is necessary. This is not to encourage anti-vax sentiment, but if natural immunity exists, it seems the decision to take one should be between a patient and his or her doctor.

Finally, there is some rather disappointing rhetoric coming out of Pfizer’s chairman. With all we have understood about how vaccines function for decades, the statement also stretches credibility. Albert Bourla told Dateline NBC  that the pharmaceutical company was “not certain” if the vaccine prevented the coronavirus from being transmitted, adding, “This is something that needs to be examined.”

This makes one wonder what 90% effective means. It appears it means it is effective in causing a vaccinated person to develop antibodies against COVID-19. It is hard to understand why this would not be sufficient to stop transmission if it effectively stops illness. According to the CDC, people who don’t become ill with COVID-19 are not primary drivers of infection, and a recent study in China found 300 asymptomatic cases with no transmission to their nearly 2,000 close contacts.

It also seems like this is something that could have been tested during the trials. The COVID-19 vaccine does use new technology, but how the immune system works once it is triggered is not. If the virus can be transmitted from a vaccinated person, these companies have developed a therapeutic, not a vaccine by any traditional definition. Vaccines provide immunity, and vaccinated persons act as a brake on transmission. If this is not the case, it would require another extraordinary explanation.

It will be tough to sell a vaccine that changes absolutely nothing about the public policies governing the way many Americans live. Masks, distancing, and shutdowns will still be possible. Figuring out the answer to the possible transmission after vaccination is now job #1 for Pfizer.