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Papers please: Factors affecting national and international COVID-19 immunity and vaccination passport uptake as determined by representative national surveys

BACKGROUND

In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision makers must know whether these passports will be widely accepted by the public, and under what conditions? This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program, however, our general findings also extend to vaccination passports.

OBJECTIVE

We aimed to assess attitudes towards the introduction of immunity passports in six countries, and determine what social, personal and contextual factors predicted their support.

METHODS

We collected 13,678 participants through online representative sampling across six countries - Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom - during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports.

RESULTS

Immunity passport support was moderate-to-low, being highest in Germany (51%; 775 of 1507 participants) and the United Kingdom (51%; 759 of 1484), followed by Taiwan (47%; 2841 of 5989), Australia (46%; 963 of 2086) and Spain (46%; 693 of 1491), and lowest in Japan (22%; 241 of 1081). Bayesian generalized linear mixed-effects modelling assessed predictive factors for immunity passport support across countries. International results showed neoliberal world views (odds ratio, OR = 1.17, CI[1.13:1.22]), personal concern (OR = 1.07, CI[1:1.16]) and perceived virus severity (OR = 1.07, CI[1.01:1.14]), the fairness of immunity passports (OR = 2.51, CI[2.36:2.66]), liking immunity passports (OR = 2.77, CI[2.61:2.94]), and a willingness to become infected to gain an immunity passport (OR = 1.6, CI[1.51:1.68]), were all predictive factors of immunity passport support. By contrast, gender (woman; OR = 0.9, CI[0.82:0.98]), immunity passport concern (OR = 0.61, CI[0.57:0.65]), and risk of harm to society (OR = 0.71, CI[0.67:0.76]) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modelled separately to provide national accounts of these data.

CONCLUSIONS

Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policy-makers to introduce effective COVID-19 passport policies in these six countries and around the world.

CLINICALTRIAL