A scoping review of global vaccine certificate solutions for COVID-19

[Opportunities and challenges in vaccination implementation against COVID-19: A systematic review]

OBJECTIVE

To analyze the experiences regarding the implementation of COVID-19 vaccination strategies, emphasizing the opportunities and challenges identified during its implementation.

DESIGN

A systematic review of the literature published between 2020 and 2022.

DATA SOURCES

The study was conducted across four databases: PubMed, ScienceDirect, Scielo, and Lilacs.

SELECTION OF STUDIES

Publications selection followed the PRISMA methodology (Preferred Reporting Items for Systematic Review and Meta-Analysis).

DATA EXTRACTION

A database was created where key elements of the selected study were identified and recorded, such as results, discussion, and conclusions. In addition, analysis categories were created such as: stages of the implementation plan, challenges identified and opportunity areas.

RESULTS AND CONCLUSIONS

292 publications were found, of which 25 were selected for analysis. Of these, 64% came from high-income countries and 32% from upper-middle-income countries. According to the stages of the implementation plan, 20% of the studies focused on regulations, planning and coordination; 28% in prioritization of the population to be vaccinated; 16% in acceptance, demand, and risk communication; and 16% in administration and information systems. Reflection on the response to the pandemic invites us to consider various aspects, such as the organization and function of health systems, the importance of collaborative work, efforts to achieve equity, communication strategies, as well as ethical dilemmas when seeking preserve health.

The barriers, facilitators and association of vaccine certificates on COVID-19 vaccine uptake: a scoping review

BACKGROUND

Globally, COVID-19 vaccines have proven to be instrumental for promoting population health by reducing illness from SARS-CoV-2. Vaccine certificates emerged as a potentially promising solution for encouraging vaccination and facilitating the safe reopening of society, however, they were controversial due to criticisms of infringing upon individual rights. While there is extensive literature describing the ethical, legal, and public health implications of vaccine certificates, there is currently a gap in knowledge about the association of vaccine certificates on vaccine uptake during the COVID-19 pandemic and barriers and facilitators to their use.

OBJECTIVES

The objectives of this scoping review are to (i) describe the existing literature on the association of vaccine certificates on the rates of COVID-19 vaccine uptake across several countries and (ii) describe the intrinsic and extrinsic barriers or facilitators that moderate this relationship.

METHODS

We conducted a scoping review based on PRISMA Extension for Scoping Reviews (PRSIMA-ScR) guidelines. We searched three bibliographic databases (APA PsychInfo, Embase Classic + Embase, OVID-Medline) and preprint severs during the first week of July 2023. Three reviewers independently screened the studies based on pre-specified eligibility criteria and performed quality assessments of the primary literature and data extraction.

RESULTS

Sixteen studies met the inclusion criteria. 14 or these were surveys and 2 were modelling studies. The majority documented that vaccine certificates were significantly associated with increased rates of COVID-19 vaccine uptake (n = 12), motivated by factors such as travel/employer requirements, influence from the government/peers, and trust in the safety, efficacy, and science behind COVID-19 vaccines. Three studies had non-significant or mixed findings. Only one study found a significant decrease in COVID-19 vaccine uptake, motivated by pervasive distrust in the QR code-based system of digital vaccine certificates in Russia. Quality of survey studies was generally high.

CONCLUSION

Our findings provide insights into the existing literature on vaccine certificates association with vaccine uptake in several different jurisdictions and barriers and facilitators to their uptake. This information can be used to guide future examinations of the implementation of vaccine certificates and more effective implementations.

Detection of live SARS-CoV-2 virus and its variants by specially designed SERS-active substrates and spectroscopic analyses

A method using label-free surface enhanced Raman spectroscopy (SERS) based on substrate design is provided for an early detection and differentiation of spike glycoprotein mutation sites in live SARS-CoV-2 variants. Two SERS-active substrates, Au nanocavities (Au NCs) and Au NPs on porous ZrO₂ (Au NPs/pZrO₂), were used to identify specific peaks of A.3, Alpha, and Delta variants at different concentrations and demonstrated the ability to provide their SERS spectra with detection limits of 0.1–1.0% (or 10⁴⁻⁵ copies/mL). Variant identification can be achieved by cross-examining reference spectra and analyzing the substrate-analyte relationship between the suitability of the analyte upon the hotspot(s) formed at high concentrations and the effective detection distance at low concentrations. Mutation sites on the S1 chain of the spike glycoprotein for each variant may be related and distinguishable. This method does not require sample preprocessing and therefore allows for fast screening, which is of high value for more comprehensive and specific studies to distinguish upcoming variants.

Proof-of-vaccination credentials for COVID-19 and considerations for future use of digital proof-of-immunization technologies: Results of an expert consultation

Objective

As part of COVID-19 pandemic control efforts, digital proof-of-vaccination credentials were launched in Canada in 2021-2022 following widespread vaccine availability. Given the controversy over proof-of-vaccination credentials-often colloquially called vaccine or immunization "passports"-it is imperative to document successes, shortcomings, and recommendations for any future uses.

Methods

This expert consultation applied inductive qualitative content analysis to online video interviews with key informants whose expertise ranged from ethics to public health to computer science to identify what we can learn from this experience with proof-of-vaccination credentials, and what decision-makers must keep in mind for possible future use of such technologies.

Results

There remains a lack of consensus regarding appropriate language and scope for digital proof-of-vaccination technologies, the respective roles of the technology sector versus government in design and implementation, and parameters for future use. However, experts agree on many recommendations, including the importance of clear communication, evidence-based rationale for the use of proof-of-vaccination credentials, multidisciplinary consultation including academic experts and the public, and the importance of pan-Canadian standards for accessibility and interoperability. Identified risks of use that emerged, and should be minimized in the future, include risks of coercion and backlash; threats to access, equity and privacy; and impacts such as costs of the technology and workload burden of enforcement and fraud detection.

Conclusions

There is much to learn from this first major use of digital proof-of-vaccination credentials. A full scientific review of the impacts on health and equity should be combined with expert recommendations to create pan-Canadian guidelines for the future use of digital proof-of-vaccination solutions.

The influencing factors of digital health passport adoption and acceptance during COVID-19 in Saudi Arabia

Background

The COVID-19 outbreak has left a destructive trail around the world in terms of deaths, travel restrictions, trade deficits, and an economy that is collapsing, including job losses, real estate, health benefit loss, and a decrease in the quality of access to care and services in almost all sectors, as well as generally in the overall quality of life. The successful development of COVID-19 vaccines may hasten the acceleration of global post-pandemic recovery by vaccinating residents, with a particular focus on important groups, in order to decrease secondary transmission. This will facilitate the easing of enforced restrictions on global and local travel, the tourism industry, education sectors, and other aspects of social life. Vaccinating residents may also help reduce the risk of secondary transmission. The efforts that Saudi Arabia made to control the epidemic were outstanding on all fronts and in all spheres, including the health, education, commerce, and tourism industries, among others.

Objective

The purpose of this research was to investigate the elements that influence a traveler's decision to acquire and use a digital health passport (DHP), which was introduced by the Tawakkalna application in Saudi Arabia at the COVID-19 conference.

Methods

The technology acceptance model (TAM) and the information system success model (ISSM) were the primary theoretical frameworks that guided this investigation. The terms "perceived ease of use" (PEOU), "perceived usefulness" (PU), "information quality" (IQ), "service quality" (SQ), and "net benefit" (NB) were applied in order to investigate the user's acceptance and use of the DHP, as well as how it contributes to the facilitation of traveling and public perception toward using the DHP.

Results

In order to assess the validity of the proposed model and its four assumptions, a survey was sent through social media platforms to get responses from nationals and residents of Saudi Arabia. The SPSS program was used to evaluate a total of 103 replies that were considered valid. Following the completion of the study, the findings revealed that PEOU, PU, IQ, SQ, and NB all had favorable impacts on the use of DHP.

Conclusion

PEOU, PU, IQ, and SQ have a significant relationship with NB that affects the public's acceptance and use of DHP. This study has established validity and reliability while testing the relationship between the variables suggested in the research model.

Proposal of a Novel Framework in Korea for a Total Safe-Care Fitness Solution in the COVID-19 Era

Physical activity is a crucial factor for maintaining not only physical health status, but vast amounts of research have shown its link with better mental health. Supporting the use of gyms for the safety of its practitioners is vital in the new norm and living with COVID-19. Therefore, in this study we show research supporting the development of a framework for a Total Safe-Care Fitness Solution based on a multimodal COVID-19 tracking system integrating computer vision and data from wearable sensors. We propose a framework with three areas that need to be integrated: a COVID-19 vaccine and health status recognition system (QR code scan prior to entry to the gym, and physiological signals monitored by a smart-band and a health questionnaire filled in prior to entry to the gym); an accident detection system (video and smart-band based); and a gym-user digital tracking system (CCTV and smart-band based). We show the proposed architecture for the integration of these systems and provide practical tips on how to implement it in testbeds for feasibility testing. To the best of our knowledge, this is the first proposed COVID-19 tracking system of use in gyms that includes a predictive model for accident detection for safer exercise participation through health monitoring.

Accelerated Digitalization of the Epidemiological Measures: Overcoming the Technological and Process Complexities of Establishing the EU Digital COVID Certificate in Slovenia

OBJECTIVE

In order to facilitate free movement of EU citizens during the COVID-19 pandemic, in early 2021 the European Commission proposed the establishment of an EU Digital COVID Certificate. By 1 July 2021, all EU Member States have successfully implemented the EU Digital COVID Certificate. The technological and procedural complexities encountered while establishing the EU Digital COVID Certificate in Slovenia are reviewed in this article.

METHODS

This research employs a case study methodology. Controlled focus group sessions comprising eighteen eminent experts (not including medical and other expert groups involved in the epidemiological measures) in charge of the EU Digital COVID Certificate and other national eHealth services in Slovenia were used as the primary data collection technique. Focus group discussions were preceded by an all-encompassing review of the literature and the examination of numerous materials covering the EU Digital COVID Certificate-related content.

RESULTS

The study findings reveal that the technological and process complexities are associated with the fragmented data sources and complicated and abundant business rules used for the generation and verification of the EU Digital COVID Certificate. However, despite the technological, process and other impediments that arose during the establishment of the EU Digital COVID Certificate in Slovenia, it can be argued that the approach used and stakeholder commitment, especially in critical pandemic conditions, offered the much-desired harmonisation and application of this digital service at the EU level.

CONCLUSIONS

The study highlights the importance of a sound and coherent model for the impending establishment of cross-border eHealth services and suggests that the ad hoc implementation of such challenging and delicate digital solutions in the future will only be feasible with the prior construction of robust and interoperable digital health infrastructures across the EU Member States.

The distribution of fake Australian vaccine digital certificates on an alt-tech platform

This paper provides the first exploration of the online distribution of fake Australian COVID-19 vaccine certificates. Drawing on a collection of 2589 posts between five distributors and their community members on the alt-tech platform Gab, this study gathers key insights into the mechanics of illicit vaccine certificate distribution. The qualitative findings in this research demonstrate the various motivations and binding ideologies that underpinned this illicit distribution (e.g. anti-vaccine and anti-surveillance motivations); the unique cybercultural aspects of this online illicit network (e.g. 'crowdsourcing' the creation of fake vaccine passes); and how the online community was used to share information on the risks of engaging in this illicit service, setting the appropriate contexts of using fake vaccine passes, and the evasion of guardians in offline settings. Implications for future research in cybercrime, illicit networks, and organised crime in digital spaces are discussed.

Blockchain for Electronic Vaccine Certificates: More Cons Than Pros?

Electronic vaccine certificates (EVC) for COVID-19 vaccination are likely to become widespread. Blockchain (BC) is an electronic immutable distributed ledger and is one of the more common proposed EVC platform options. However, the principles of blockchain are not widely understood by public health and medical professionals. We attempt to describe, in an accessible style, how BC works and the potential benefits and drawbacks in its use for EVCs. Our assessment is BC technology is not well suited to be used for EVCs. Overall, blockchain technology is based on two key principles: the use of cryptography, and a distributed immutable ledger in the format of blockchains. While the use of cryptography can provide ease of sharing vaccination records while maintaining privacy, EVCs require some amount of contribution from a centralized authority to confirm vaccine status; this is partly because these authorities are responsible for the distribution and often the administration of the vaccine. Having the data distributed makes the role of a centralized authority less effective. We concluded there are alternative ways to use cryptography outside of a BC that allow a centralized authority to better participate, which seems necessary for an EVC platform to be of practical use.

Vaccine Passport and Traveler Behaviors in the New Market of the Domestic and International Tourism Industry Facing the With-Corona Era

To ensure a smooth and rapid recovery of tourism, countries around the world are stepping up vaccinations against COVID-19. China, in particular has a very high vaccination rate due to its own vaccine production. Following this trend, many countries have started introducing vaccine passports as an alternative solution to verify valid and vaccinated travelers. This study attempted to understand the fundamental perceptions of travelers' intentions using vaccine passports. A total of 601 samples were investigated and analyzed. As a result, four factors were identified: perceived usefulness, destination trust, risk perception, and perception of incentives. Also, this study performed means comparisons analysis with the major demographic characteristics of respondents. Based on this study, it is expected that the results will contribute to the revival of the travel industry in the future and provide valuable implications for marketing plans to help the travel industry suffer from COVID-19.

Persistence of Vaccine Hesitancy and Acceptance of the EU Covid Certificate Among French Students

Covid-19 vaccine hesitancy among young adults is a current public health issue that needs to be addressed considering the seasonally driven waves of disease and the administration of vaccine boosters. As a prevention measure, the EU Covid certificate had been implemented to increase vaccine uptake, but its application was controversial. Our study investigated students’ opinions and attitudes towards Covid-19 vaccination and the EU Covid certificate through a mixed-methods design. An 18-item questionnaire was administered to 200 students during a vaccination campaign in September 2021 at the University of Bordeaux, France. Simultaneously, 30 students attended a semi-structured interview. Collected data were analyzed separately then discussed together through a parallel and convergent approach. Results showed that vaccine hesitancy was high among students, mostly from fear of short-term side effects. However, respondents decided to get vaccinated to obtain the EU Covid certificate, even if they considered it as a violation of their freedom. Straightforward communication about Covid-19 vaccination did not reach students, although this was a strong expectation from governmental and health institutions. Findings suggest that key health personnel should provide evidence-based information about vaccines in efforts of building trust with young people.

NovidChain: Blockchain-based privacy-preserving platform for COVID-19 test/vaccine certificates

The COVID-19 pandemic has emerged as a highly transmissible disease which has caused a disastrous impact worldwide by adversely affecting the global economy, health, and human lives. This sudden explosion and uncontrolled worldwide spread of COVID-19 has revealed the limitations of existing healthcare systems regarding handling public health emergencies. As governments seek to effectively re-establish their economies, open workplaces, ensure safe travels and progressively return to normal life, there is an urgent need for technologies that may alleviate the severity of the losses. This article explores a promising solution for secure Digital Health Certificate, called NovidChain, a Blockchain-based privacy-preserving platform for COVID-19 test/vaccine certificates issuing and verifying. More precisely, NovidChain incorporates several emergent concepts: (i) Blockchain technology to ensure data integrity and immutability, (ii) self-sovereign identity to allow users to have complete control over their data, (iii) encryption of Personally Identifiable Information to enhance privacy, (iv) W3C verifiable credentials standard to facilitate instant verification of COVID-19 proof, and (v) selective disclosure concept to permit user to share selected pieces of information with trusted parties. Therefore, NovidChain is designed to meet a high level of protection of personal data, in compliant with the GDPR and KYC requirements, and guarantees the user's self-sovereignty, while ensuring both the safety of populations and the user's right to privacy. To prove the security and efficiency of the proposed NovidChain platform, this article also provides a detailed technical description, a proof-of-concept implementation, different experiments, and a comparative evaluation. The evaluation shows that NovidChain provides better financial cost and scalability results compared to other solutions. More precisely, we note a high difference in time between operations (i.e., between 46% and 56%). Furthermore, the evaluation confirms that NovidChain ensures security properties, particularly data integrity, forge, binding, uniqueness, peer-indistinguishability, and revocation.