Behavioural responses to Covid-19 health certification: a rapid review

Abstract

Background Covid-status certification – certificates for those who test negative for the SARS-CoV-2 virus, test positive for antibodies, or who have been vaccinated against SARS-CoV-2 – has been proposed to enable safer access to a range of activities. Realising these benefits will depend in part upon the behavioural and social impacts of certification. The aim of this rapid review was to describe public attitudes towards certification, and its possible impact on uptake of testing and vaccination, protective behaviours, and crime. Method A search was undertaken in peer-reviewed databases, pre-print databases, and the grey literature, from 2000 to December 2020. Studies were included if they measured attitudes towards or behavioural consequences of health certificates based on one of three indices of Covid-19 status: test-negative result for current infectiousness, test-positive for antibodies conferring natural immunity, or vaccination(s) conferring immunity. Results Thirty-three papers met the inclusion criteria, only three of which were rated as low risk of bias. Public attitudes were generally favourable towards the use of immunity certificates for international travel, but unfavourable towards their use for access to work and other activities. A significant minority was strongly opposed to the use of certificates of immunity for any purpose. The limited evidence suggested that intention to get vaccinated varied with the activity enabled by certification or vaccination (e.g., international travel). Where vaccination is seen as compulsory this could lead to unwillingness to accept a subsequent vaccination. There was some evidence that restricting access to settings and activities to those with antibody test certificates may lead to deliberate exposure to infection in a minority. Behaviours that reduce transmission may decrease upon health certificates based on any of the three indices of Covid-19 status, including physical distancing and handwashing. Conclusions The limited evidence suggests that health certification in relation to COVID-19 – outside of the context of international travel – has the potential for harm as well as benefit. Realising the benefits while minimising the harms will require real-time evaluations allowing modifications to maximise the potential contribution of certification to enable safer access to a range of activities.

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

“…The findings partially confirm previous research on the public attitude to immunity certificates in the US, UK, and Japan [ 9 , 13 ]. For example, income and personal benefit perception were constantly correlated with attitude to VP, but as a whole, demographic variables that were significantly associated with attitude to VP in the UK, Germany, and Japan, such as gender, age, and education [ 9 ], were not significant predictors of such attitude in the Chinese context.…”

“…For VP, existing studies found a moderate to high public support across countries, with people in the UK and the United States having the most favorite attitude, particularly for international travel [ 10 , 13 , 14 ]. Although varying across contexts, men and older populations generally support the passport [ 9 , 15 ], so do more educated and wealthy people [ 8 ].…”

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

“…Furthermore, the psychological element should not be overlooked. Since it is not possible to completely eliminate the risk of contagion, the mere possession of the COVID Digital Certificate could generate a false sense of security, leading to reckless behaviors that could endanger the health of the individual and of those with whom he or she comes into contact [50]. Another risk worth considering is the abrupt failure of computer systems, either as a result of a virus or cybercrimes.…”

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

“…Regarding societal support for the idea of easing restrictions for the immunized population, the empirical evidence is still limited [ 9 ]. However, public and scientific opinion seems to be far from a consensus [ 8 , 18 ].…”

“…During this transitional phase and due to the perceived safety of vaccination many governments are considering to or are already easing the restrictions for vaccinated as well as for recovered individuals [ 8 , 9 ] – often introducing immunity certificates for this purpose [ 10 ]. Justifications for facilitating vaccinated and recovered individuals are often based on the principle of proportionality of policy measures [ 11 , 12 ].…”