Scientists have favorable opinions on immunity certificates but raise concerns regarding fairness and inequality

Assessing the impact of COVID-19 passes and mandates on disease transmission, vaccination intention, and uptake: a scoping review

PURPOSE

Policymakers have struggled to maintain SARS-CoV-2 transmission at levels that are manageable to contain the COVID-19 disease burden while enabling a maximum of societal and economic activities. One of the tools that have been used to facilitate this is the so-called "COVID-19 pass". We aimed to document current evidence on the effectiveness of COVID-19 passes, distinguishing their indirect effects by improving vaccination intention and uptake from their direct effects on COVID-19 transmission measured by the incidence of cases, hospitalizations, and deaths.

METHODS

We performed a scoping review on the scientific literature of the proposed topic covering the period January 2021 to September 2022, in accordance with the PRISMA-ScR guidelines for scoping reviews.

RESULTS

Out of a yield of 4,693 publications, 45 studies from multiple countries were retained for full-text review. The results suggest that implementing COVID-19 passes tends to reduce the incidence of cases, hospitalizations, and deaths due to COVID-19. The use of COVID-19 passes was also shown to improve overall vaccination uptake and intention, but not in people who hold strong anti-COVID-19 vaccine beliefs.

CONCLUSION

The evidence from the literature we reviewed tends to indicate positive direct and indirect effects from the use of COVID-19 passes. A major limitation to establishing this firmly is the entanglement of individual effects of multiple measures being implemented simultaneously.

Individual factors influencing public's perceptions about the importance of COVID-19 immunity certificates: a cross-sectional online questionnaire survey in the UK

BACKGROUND

Understanding how perceptions around immunity certificates are influenced by individual characteristics is important to inform evidence-based policy making and implementation strategies for services around immunity and vaccine certification.

OBJECTIVE

To assess what were the main individual factors (including health beliefs about COVID-19, vaccination views, socio-demographic and lifestyle factors) influencing people's perception of the importance of using COVID-19 immunity certificates.

METHODS

Cross-sectional online survey with a nationally representative sample in the UK, conducted on the 3rd of August 2021. Responses were collected and analysed from 534 participants, aged 18 and older, residents of the UK. The primary outcome measure (dependent variable) was the participants' perceived importance of using immunity certificates, computed as an index of six items. The following individual drivers were used as the independent variables: a) personal beliefs about COVID-19 (using constructs adapted from the Health Belief Model), b) personal views on vaccination, c) willingness to share immunity status with service providers, and d) variables related to respondents' lifestyle and socio-demographic characteristics.

RESULTS

Perceived importance of immunity certificates was higher among respondents who felt that contracting COVID-19 would have a severe negative impact on their health (β=0.2564, P<.001=0.0000) and felt safer if vaccinated (β =0.1552, P<.001=0.0000). The prospect of future economic recovery positively influenced perceived importance of immunity certificates. Respondents who were employed or self-employed (β=-0.2412, P=.0010), or experienced an increase in income after the COVID-19 pandemic (β=-0.1287, P=.0020) perceived less important the use of immunity certificates compared to those who were unemployed or had retired or those who had experienced reduction in their income during the pandemic.

CONCLUSIONS

The findings of our survey suggest that more vulnerable members in our society (unemployed or retired and those believing that COVID-19 would have a severe impact on their health) and people who experienced a reduction in income during the pandemic perceived the severity of not using immunity certificates in their daily life as higher.

CLINICALTRIAL

Public views on the Covid-19 immunity certificate: A scoping review

INTRODUCTION

Already in its first implementation, the introduction of the Covid-19 immunity certificate has generated some debate among the public. This debate might be a hindrance to the effective realization of this policy. This study aimed to systematically review published research evaluating public feeling of the Covid-19 immunity certificate policy measure and to find which factors might influence its acceptance.

METHODS

We followed the scoping review methods manual by the Joanna Briggs Institute. We included studies with no time limits that presented novel data, and no exclusions have been made based on study design. We excluded articles that presented just expert opinions.

RESULTS

We found and reviewed 17 articles. The included studies were conducted in two main countries (the United Kingdom and Switzerland), with the rest from Israel, Italy, Spain, Germany, Australia, Taiwan and China. Both qualitative and quantitative studies were included, and nonrepresentative samples were mostly used to explore the public feeling about the Covid-19 immunity certification. The included studies showed that public views on immunity certification are quite contradictory and influenced by age, gender, ethnicity, political orientation and attitudes towards Covid-19 vaccination. The topic more often addressed by the included studies was the public's views on the positive and negative implications of the Covid-19 immunity certificate in terms of ethical, legal and behavioural consequences of this measure.

CONCLUSION

The varying acceptance rates are notable and may partly be linked to differences in demographics, Covid-19 concerns and ideological beliefs, as seen in other health-related tracking policies. Moreover, dominant factors behind the (un)success of this policy are complex and entangled with the cultural and political dimensions rather than being just technical. For this reason, it is important to expand psychosocial research to better understand the concerns behind health certifications and allow planning of culturally based and ethically sound suitable strategies. This would be very relevant to increasing public approval and compliance with this public health measure.

PATIENT OR PUBLIC CONTRIBUTION

This does not apply to our work as it was a review paper.

Public Perceptions of Harms and Benefit of COVID-19 Immunity Certificate: A Cross-Sectional Study in the Italian Setting

A cross-sectional survey between 29 January 2022 and 3 February 2022 was conducted to understand the public rationale for accepting or rejecting the use of COVID-19 immunity certificates and to identify the psychosocial factors that mostly predict the positive/negative individuals' perceptions of this measure. One thousand twenty-two Italian adults were recruited by a professional panel provider by employing a stratified sampling strategy controlled for gender, age, geographical area of residence, size of the urban centre of residence, employment, and wage. Eight Welch's ANOVAs were then carried out to compare the perception of benefits and the perception of harms among different population groups. Multiple linear regression was carried out to measure the explained variance of benefits perception and harms perception by age, trust in institutions, and concern for health emergencies. The results shows that age, trust in institution, and concern for the COVID-19 emergency explain more variance of perceived benefits than of perceived harms of COVID-19 immunity certificates but the opposite regarding political orientation which explains perceived harms better than perceived benefits. The need for policy improvements is pressing because a large share of the world's population remains unvaccinated. Moreover, our results can serve as vital information for similar health crises that may occur in the future. In addition, our results are expected to offer useful insights into public feelings around the use of digital health information tools.

Why 'one size fits all' is not enough when designing COVID-19 immunity certificates for domestic use: a UK-wide cross-sectional online survey

OBJECTIVES

The present study explored public's willingness to use COVID-19 immunity certificates across six different domestic scenarios.

DESIGN

Cross-sectional online survey.

SETTING

UK representative survey conducted on 3 August 2021.

PARTICIPANTS

534 UK residents over 18 years old.

INTERVENTIONS

Participants replied to the same set of questions.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome measure was willingness to use immunity certificates across three different domestic settings: (1) visiting the general practitioner (GP) for a non-urgent health issue; (2) dining in a restaurant and (3) attending a performance in a theatre. For each setting two options, one prioritising convenience (option A) and the other privacy (option B), were offered. Our secondary outcome measures were computed indices from items adapted from the Health Belief Model; attitudes towards sharing immunity status with service providers; prior to COVID-19 lifestyle. In addition, we recorded data about respondents' sociodemographic characteristics.

RESULTS

Respondents were more willing to use immunity certificates that prioritised convenience (92%), rather than privacy (76%), when visiting their GP . However, privacy was more favourable in the other two settings (dining in a restaurant (84%) and going to a theatre (83%)) compared with convenience (38% and 39% respectively). Personal beliefs about COVID-19 and immunity certificates were associated with variations in willingness to use these across all scenarios. No variations were observed across sociodemographics and lifestyle.

CONCLUSIONS

The findings of this survey suggest that there is not one-size-fits-all solution for designing immunity certificates. Immunity certificates are complex sociotechnical systems, any attempt to implement these for domestic use should be tailored to different settings and user needs. The design of certification services requires a more evidence-based approach and further research is needed to understand how different settings, design elements (like convenience or privacy) and personal beliefs about the pandemic should inform their design.

Trust in Science, Perceived Media Exaggeration About COVID-19, and Social Distancing Behavior

For many individuals, the media function as a primary source of information about preventative measures to combat COVID-19. However, a considerable number of citizens believe that the media coverage about pandemics is exaggerated. Although the perception of media exaggeration may be highly consequential for individual health behaviors, we lack research on the drivers and consequences of this perception. In a two-wave panel study, we examined associations between trust in science, perceptions of media exaggeration about COVID-19, and social distancing behavior during the lockdown in Austria (NT2 = 416). Results showed that trust in science at T1 led to less perceptions of media exaggeration about COVID-19 at T2. Furthermore, consistent with the theory of psychological reactance, perceptions of media exaggeration about COVID-19 at T1 caused less social distancing behavior at T2. Thus, findings suggest that trust in science may positively affect individuals' social distancing behavior by decreasing perceived media exaggeration about COVID-19 over time. Implications for research on media effects in times of COVID-19 and conclusions for journalists are discussed.

Easing Restrictions During Vaccine Scarcity. How Mitigation Measures Help Tackling Associated Moral and Behavioral Challenges

Background: When vaccines became first available during the Covid-19 pandemic, their demand significantly exceeded their supply. In consequence, the access to vaccines, initially, was distributed unequally. At the same time, governments started easing pandemic restrictions for vaccinated and recovered persons and restoring their freedoms since their risk of transmitting the virus is significantly reduced. Evidence: We show that restoring freedoms for vaccinated and recovered persons - while upholding restrictions for the rest of the population - is morally unfair during vaccine scarcity. Further, it may yield unintended side-effects, including perverse incentives, growing rifts in society, and the expansion of marginalization. Policy Options & Recommendations: We recommend accompanying easing for vaccinated and recovered individuals by mitigation measures for those who are neither vaccinated nor recovered. We propose, first, to temporarily lift the same restrictions for negative-tested individuals, as for vaccinated or recovered people. Second, the state must ensure broad and easy access to testing for everyone - free of charge. Conclusion: If done right, these mitigation measures create (at least temporarily) equal access to freedom for everybody - solving the moral problem of unfair access to freedoms and counteracting possible negative consequences.

Does the EU COVID Digital Certificate Strike a Reasonable Balance between Mobility Needs and Public Health?

The need to fight a highly aggressive virus such as SARS-CoV-2 has compelled governments to put in place measures, which, in the name of health protection, have constrained many freedoms we all enjoy, including freedom of movement, both nationally and within the European Union. In order to encourage and facilitate the return to free movement, the European Parliament has launched a "COVID-19 digital certificate". A spirited debate centered around the use of this certificate is still ongoing among scholars, many of whom have pointed out the uncertainties relative to COVID-19 immunity, privacy issues and the risk of discriminatory effects. The authors, while highlighting some critical aspects, argue that the COVID digital certificate in its current approved version can effectively help prevent the spread of the infection and promote free movement, while upholding the right to health as much as possible. However, they also stress the need for a thorough information campaign to illustrate the advantages and limitations of this document in order to avoid creating a false sense of security in the public opinion, who may wrongly assume that the emergency has been overcome for good.

Passport to a Mighty Nation: Exploring Sociocultural Foundation of Chinese Public's Attitude to COVID-19 Vaccine Certificates

Vaccination against COVID-19 is essential against the pandemic. There are broad discussions on adopting certificates for vaccination and the immunity obtained after infection. Based on a national sample of over 2000 participants administered in April 2021, the current study examines the Chinese public's attitudes to the so-called COVID-19 vaccination passport and factors contributing to their viewpoints. Generally, the Chinese people had favorable opinions on the passport. Among possible contributing factors, income, personal benefit perception, the subjective norm of COVID-19 vaccination, and nationalism were significantly associated with the public's positive attitude. At the same time, general vaccine knowledge and scientific literacy had an inconstant effect. Echoing recent studies, these findings reveal a collectivism-oriented attitude of the Chinese public towards the proposal to certify vaccination publicly. Theoretical and practical implications of the results were discussed.

Acceptability of COVID-19 Certificates: A Qualitative Study in Geneva, Switzerland, in 2020

Immunity certificates related to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) have been under discussion since the beginning of the pandemic with conflicting opinions. In order to identify arguments in favor of and against the possible implementation of documents certifying immunity of an individual based on serological testing, we developed a qualitative study in Geneva, Switzerland. The study took place between two lockdowns with a sense of semi-normalcy during summer 2020 in Switzerland but at a time when no vaccine was available and seroprevalence was below 21%. Eleven focus groups with members of the public and 14 semi-structured interviews with stakeholders were conducted between July and November 2020, with a total of 68 participants with an age range between 24 and 77 years. Interviews and focus groups transcripts were coded with the ATLAS.ti CAQDAS. Few participants considered immunity certificates based on serological testing as an acceptable public health measure. Major concerns included the reliability of scientific data related to COVID-19 immunity and serological testing potential re-infection as well as the possibility that the use of certificates could result in deleterious outcomes. Discrimination, counterfeiting, incitement for self-infection, invasion of the private sphere, violation of personal integrity, and violation of medical secrecy were perceived as the major risks. Benefits of immunity certificates were more perceived when in relation to vaccination, and included gains in medical knowledge and protection in certain contexts involving leisure or work-related activities. The consequences of implementing immunity certificates are numerous, and the acceptability by the general population has to be considered when engaging in such policy. Even if the results provide a snapshot of arguments discussed around immunity certificates based on serological testing before the implementation of the COVID-19 vaccine, most of the issues discussed are central in the current debates about vaccination certificates.