The potential impact of vaccine passports on inclination to accept COVID-19 vaccinations in the United Kingdom: evidence from a large cross-sectional survey and modelling study

Abstract

Background: Four vaccines against the novel coronavirus 2019 disease (COVID-19) caused by the severe acute respiratory coronavirus 2 (SARS-CoV-2) have currently been approved for use in the United Kingdom. As of 30 April 2021, over 34 million adults have received at least one dose of a COVID-19 vaccine. The UK Government is considering the introduction of vaccine passports for domestic use and to facilitate international travel for UK residents. Although vaccine incentivisation has been cited as a motivating factor for vaccine passports, it is currently unclear whether vaccine passports are likely to increase inclination to accept a COVID-19 vaccine. Methods: We conducted a large-scale national survey in the UK of 17,611 adults between 9 and 27 April 2021. Bayesian multilevel regression and poststratification is used to provide unbiased national-level estimates of the impact of the introduction of vaccine passports on inclination to accept COVID-19 vaccines among all respondents who have not yet had two vaccination doses. Multilevel regressions identify the differential impact of the likely impact of vaccine passports on uptake intent between socio-demographic groups. Gibbs sampling was used for Bayesian model inference, with 95% highest posterior density intervals used to capture uncertainty in all parameter estimates. Findings: We find that the introduction of vaccine passports will likely lower inclination to accept a COVID-19 vaccine once baseline vaccination intent has been adjusted for. Notably, this decrease is larger if passports were required for domestic use rather than for facilitating international travel. The impact of passports while controlling for baseline vaccination intent differentially impacts individuals by socio-demographic status, with being male (OR 0.87, 0.76 to 0.99) and having degree qualifications (OR 0.84, 0.72 to 0.94) associated with a decreased inclination to vaccinate if passports were required for domestic use, while Christians (OR 1.23, 1.08 to 1.41) have an increased inclination over atheists or agnostics. There is a strong association between change in vaccination inclination if passports were introduced and baseline vaccination intent: stated change in vaccination inclination is thus lower among Black or Black British respondents (compared to Whites), younger age groups, and non-English speakers. We find notable sub-national trends, for example, that passports could increase inclination among students and Jewish respondents in London compared to those in full-time education or atheists or agnostics, respectively. Interpretation: To our knowledge, this is the first quantitative assessment of the potential impact of the introduction of vaccine passports on COVID-19 vaccine intention. Our findings should be interpreted in light of sub-national trends in current uptake rates across the UK, as our results suggest that vaccine passports may induce a lower vaccination inclination in socio-demographic groups that cluster geographically in large urban areas. Caution should therefore be exercised in introducing passports as they may result in less positive health-seeking behaviours for the COVID-19 vaccine (as well as other existing or future vaccinations) and may contribute to concentrated areas of low vaccinate uptake, which is an epidemic risk. We call for further evidence on the impact of vaccine certification on confidence in COVID-19 vaccines and in routine immunisations in wider global settings and, in particular, in countries with low overall trust in vaccinations or in authorities that administer or recommend vaccines.

Exploring vaccine hesitancy in care home employees in North West England: a qualitative study

“…This is in line with previous research that shows the majority of vaccine-hesitant individuals do not approve a mandatory policy for the COVID-19 vaccine 35. Additionally, mandating vaccines can increase anger and negative attitudes among vaccine-hesitant individuals, leading to reduced vaccination intentions and uptake,36–39 and potential stigmatisation of those who refuse to have the vaccine 40. However, despite some participants stating they would leave their job rather than get the vaccine, we do not know how this intention may or may not translate to actual behaviour.…”

Forecasting sub-national trends in COVID-19 vaccine uptake in the UK before vaccine rollout

“…This study found that socio-demographic background is strongly associated with intent to accept the vaccine, with females, younger age groups, Muslims and 'other' religions, and Black and 'other' ethnicities, and non-English speakers less likely to state an intent to vaccinate than their respective baseline groups. While many of these associations had been found at the time of this analysis for both existing immunisation programmes [34][35][36][37] and a COVID-19 vaccine 19,38,39 , recent evidence has suggested that COVID-19 vaccine passports may drive lower vaccination sentiment in the UK 40,41 . In particular, lower sentiment is evidenced in groups with low COVID-19 vaccine confidence, which includes young adults, males, those with Black/Black British ethnicity (a result also found in US populations 42 ), as well as highly educated groups 40 : this is a plausible explanation for London's MRP forecasts lagging observed uptake, opposing broader national trends.…”

“…In particular, lower sentiment is evidenced in groups with low COVID-19 vaccine confidence, which includes young adults, males, those with Black/Black British ethnicity (a result also found in US populations 42 ), as well as highly educated groups 40 : this is a plausible explanation for London's MRP forecasts lagging observed uptake, opposing broader national trends. Vaccine passport policies have typically been found to be polarising, increasing uptake intentions in some groups but reducing them in others 40,42 : of particular concern in ongoing and future vaccination campaigns is whether these one-size-fits-all policies have enhanced resistance in areas with low vaccine confidence, which may pose challenges for achieving local and national herd immunity targets 22 .…”

“…A key limitation of this present study is that the precise drivers of COVID-19 vaccine acceptance beyond socio-demographic determinants have not been considered. In the recent published literature in the UK and beyond, there are a wide-range of possible reasons for non-vaccination that includes trust in the COVID-19 vaccines themselves or in those recommending the vaccine 27 , the impact of misinformation 10 , or the impact COVID-19 vaccination policies on intent-to-vaccinate behaviours 40,41 . Extending the set of putative determinants may have yielded more robust forecasts of COVID-19 vaccine acceptance.…”

Digital Migration in the South African Public Sector: Realising its Potential or Hamstrung by Incumbents? Sabelo Dlamini PhD in Technology and Innovation Management

“…Governments such as UK Government are already considering the introduction of vaccine passports for domestic use and to facilitate international travel for UK residents (de Figueiredo, Larson and Reicher, 2021). While this may only be focusing on the UK, it means other countries that may need their citizens to travel to the UK may be required to produce such vaccine passports.…”