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Table 1 Study characteristics

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

Author (Date)
Country of Study
Study Design Participants Data collection period Disease Intervention Findings
Adepoju, P. (2019)
Nigeria
Narrative N/A N/A Yellow fever Vaccination certificate • Yellow fever is the only disease specified by WHO for which countries can require proof of vaccination from travellers.
• The shortage of vaccines in Nigeria, combined with yellow fever epidemics, has led to the creation of a black market for counterfeit vaccination cards.
Behavioural Insights Team (2020)
UK
Experiment 4765 13/11/2020–16/11/2020 Covid-19 Covid Test • A negative personal test result for COVID-19 decreases stated intention to comply with government guidance by 2 percentage points. Accompanying negative results with a certificate decreases stated intention to comply by a further 5 percentage points.
• A negative test result decreases the proportion of participants saying they would not meet friends by 7 percentage points. Accompanying negative results with a certificate further decreases this by 6 percentage points.
Betsch, C., et al. (2020a)
Germany
Experiment 993 23/06/2020–24/06/2020 Covid-19 Mandatory vaccination • A hypothetical compulsory vaccination against Covid-19 had a negative effect on the willingness to undertake a voluntary vaccination against influenza.
• Compulsory vaccination against Covid-19 (compared to voluntary vaccination) led to greater irritation, especially a) amongst participants who had an attitude that vaccinations should be voluntary and b) if the importance of high vaccination rates were not communicated.
• Irritation then had a negative effect on willingness to accept the flu vaccination.
Betsch, C., et al. (2020b)
Germany
Survey 1007 05/05/2020–06/05/2020 Covid-19 Immunity certificate • 48.6% of respondents disagreed with the introduction of an “immunity card”, with around 25.6% agreeing.
• 67% felt that those with immunity cards should have no privileges; 13% thought they should have freedom of movement; 8% fewer restrictions; 6% removal of the mask requirement.
• Further analyses showed that the respondents would not intentionally get infected in order to receive an immunity pass (no data shown to confirm this).
Betsch, C., et al. (2020c)
Germany
Survey 1014 12/05/2020–13/05/2020 Covid-19 Immunity certificate • 45.1% of respondents disagreed with the introduction of an “immunity card”, with 26.2% agreeing.
Betsch, C., et al. (2020d)
Germany
Survey 972 19/05/2020–20/05/2020 Covid-19 Immunity certificate • 45.2% of respondents disagreed with the introduction of an “immunity card”.
Betsch, C., et al. (2020e)
Germany
Survey 925 25/05/2020–26/05/2020 Covid-19 Immunity certificate • 45.9% of respondents disagreed with the introduction of an “immunity card”.
Betsch, C. & Bohm, R. (2016)
Germany
Experiment 297 Not known Not specific Mandatory vaccination •Compulsory vaccination increased the level of anger among individuals with a negative vaccination attitude, whereas voluntary vaccination did not. This led to a decrease in vaccination uptake by 39% in the second voluntary vaccination (reactance).
•Making selected vaccinations compulsory can have detrimental effects by decreasing the uptake of voluntary vaccinations
Bricker, D (6 Nov, 2020)
Canada
Survey 1000 23/10/2020–26/10/2020 Covid-19 Mandatory vaccination •Support for mandatory vaccinations has fallen from 72% in July to 61% in October.
COSMO (2020)
Germany
Continuous surveys approx. Each fortnight Varied: around 1000 each time. 14/04/2020–15/12/2020 Covid-19 Mandatory vaccination • Vaccination intent has gone from 79% on 14/04/2020 to 49% on 15/12/2020.
• Support for mandatory vaccination has gone from 73% on 14/04/2020 to 36% on 15/12/2020.
Dennis, S. et al. (2020)
Australia
Survey 1169 15/04/2020 Covid-19 Immunity certificate • Final support for immunity passports: 10.6% not at all, 49.9% slightly to moderately, 25.1% a lot to fully.
• Likelihood of self-infection: 70.4% not at all, 21.7% slightly to moderately, 7.8% a lot to extremely.
Feleszko, W. et al. (2020)
Poland
Survey 1066 02/06/2020–09/06/2020 Covid-19 Vaccination certificate •Respondents indicating that they do not plan to vaccinate if the COVID-19 vaccine becomes available (N = 301) were confronted with a list of eight different hypothetical reasons to vaccinate. When asked if any of the reasons would sway them to be in favor of being vaccinated, the majority (51%) answered that none of the presented reasons would change their decision. The list of presented reasons included both “High penalties for not vaccinating myself or my child (e.g. 5000 PLN equivalent ca. 1000€)” and “It is not possible to enter some countries without a vaccination certificate”.
Garret, P. et al. (2020)
Australia
Survey 449 07/05/2020 Covid-19 Immunity certificate • Final support for immunity passports: 10.6% not at all, 49.9% slightly to moderately, 25.1% a lot to fully.
• Likelihood of self-infection: 69.7% not at all, 22.6% slightly to moderately, 7.8% a lot to extremely.
Graeber, D., et al. (2020)
Germany
Survey 851 08/06/2020–04/07/2020 Covid-19 Mandatory vaccination • 70% of respondents would voluntarily be vaccinated against Covid-19.
• 51% of interviewees are against and 49% in favour of mandatory vaccination.
• The approval rate for mandatory vaccination is significantly higher among those who would get vaccinated voluntarily (59%) than those who would not be (27%).
• Willingness to voluntarily be vaccinated is positively correlated with men, age, education, household income.
• Mandatory vaccination is rejected with higher probability by women, but favoured by older people. Approval is negatively associated with neuroticism, and positively associated with subjective probability of contracting life-threatening Covid-19.
Haney, C. & Laughlin, G. (2020)
US
Survey 1020 Jun-20 Covid-19 Immunity certificate •22% of respondents would “probably” or “definitely” seek infection if earning immunity gave access to various opportunities: 14% to go to gatherings greater than 25 people, 13% to visit eldercare facilities, 12% to visit foreign countries, 10% to visit hospital patients, 11% to maintain or access employment at an eldercare facility.
•Younger age was significantly positively associated with willingness to seek infection.
•29% of gig workers reported they would seek self-infection to maintain or access employment in eldercare.•51% of respondents “strongly” or “somewhat” agree that eldercare facilities should be allowed to require immunity certificate from employees.
Hearn, A. & Bull, T. (27 Nov, 2020)
UK
Survey 2000 Not known Covid-19 Mandatory vaccination •45% of respondents think the Covid-19 vaccine should be compulsory, with 35% disagreeing entirely.
•Of those who did not want to be vaccinated, 19% would do so if they could go to the pub, 35% if they could go on holiday abroad, 28% if they could go to sporting, music or other events.
•71% of people think people arriving in the UK for holiday or business should have a certificate confirming vaccination, 70% think UK residents leaving the country should have a certificate saying they’ve been vaccinated.
IATA
(August, 2020)
11 countries
Survey 4700 recent air travellers Aug-20 Covid-19 Covid test •88% were willing to undergo a COVID test as part of the travel process, 84% thought it should be required of all travelers.
IPSOS Essentials (2020)
15 countries
Survey 14,500 27/08/2020–30/08/2020 Covid-19 Mandatory vaccination • 39% of respondents in the UK “strongly support” mandatory vaccination; 31% “somewhat support” them.
• Support for mandatory vaccinations is generally strongest in countries with the greatest health impact (Brazil, Mexico, India).
IRES - Romanian Institute for Evaluation and Strategy (2020)
Romania
Survey (Computer Assisted Telephone Interviewing) 1027 13/05/2020–14/05/2020 Covid-19 Immunity certificate • Over 4 out of 10 Romanians would be willing to be vaccinated against COVID - 19 once there was an approved vaccine, but 33% say they would not be vaccinated in any form.
• 6 out of 10 Romanians would be willing to be tested in exchange for receiving an “immunity passport”.
Largent, E.A. et al. (2020)
USA
Survey 2730 14/09/2020–27/09/2020 Covid-19 Mandatory vaccination • 40.9% of respondents found state mandates for adults acceptable, and 44.9% unacceptable.
• Slightly more respondents found employer-enforced employee mandates acceptable (47.7% acceptable to 38.1% unacceptable)
• Individuals likely to get a COVID-19 vaccine accepted mandates at higher rates than those unlikely to do so (65% vs 17.3% for state-mandated, 72.5% for 22.9% for employer-mandated).
• Acceptance of mandate was also positively associated with non-Black respondents and those with a bachelor’s degree. No gender differences observed.
Lazarus et al. (2020)
19 countries
Survey 13,426 (768 UK) 16/06/2020–20/06/2020 Covid-19 Mandatory vaccination • There is a discrepancy between reported acceptance of a COVID-19 vaccine and acceptance if vaccination was mandated by one’s employer: all respondents, regardless of nationality, reported that they would be less likely to accept a COVID-19 vaccine if it were mandated by employers.
Lewandowsky, S. (2020)
Spain
Survey 1500 27/04/2020–02/05/2020 Covid-19 Immunity certificate • Final support for immunity passports: 17.3% not at all, 60.7% slightly to moderately, 22.1% a lot to fully.
• Likelihood of self-infection: 65.6% not at all, 27.3% slightly to moderately, 2.9% a lot to extremely.
Lewandowsky, S., et al. (2020)
UK
Survey 1500 16/04/2020 Covid-19 Immunity certificate • The majority of respondents did not object to the idea of immunity passports, with over 60% of respondents supporting the idea to varying extents.
• Over 60% of respondents wanted an immunity passport for themselves.
• Around 20% of respondents considered immunity passports to be unfair and opposed them completely.
• 79% of respondents would not consider at all deliberate self-infection to obtain an immunity passport, around 21% considered doing so to varying degrees.
• Increased age, greater perceived risk of the disease, greater trust in government were positively associated with acceptance of immunity passports whereas gender had no effect.
Lorenz-Spreen, P. et al. (2020)
Germany
Survey 1109 17/04/2020–22/04/2020 Covid-19 Immunity certificate Attitudes towards Immunity passports in Germany: Awaiting precise data
Available from: https://ai_society.mpib.dev/tracking-app/wave2.html#Immunity_Passports
Nehme, M., et al. (2020).
Switzerland
Survey 1425 27/05/2020–27/06/2020 Covid-19 Immunity certificate • 60% of participants reported that immunity certificates should be offered to the general population.
• The contexts where certificates would be perceived as most useful were taking a plane (73%) and entering a country (72%); fewer participants agreed with them being useful for participating in large gatherings (55%) or the right to work (32%).
• 55% of participants thought a vaccination should be mandatory and 49% thought a vaccination certificate should be mandatory.
• 68% felt there was a potential risk of discrimination.
• 28.6% felt there was a risk of deliberate infection to acquire immunity.
Qualtrics (Sept 2020)
USA
Survey 1074 21/09/2020–24/09/2020 Covid-19 Mandatory vaccination • Requirements that would make respondents “a little more likely” or “a lot more likely” to vaccinate:
• To visit a hospital or nursing home: 70%
• Travel to another state without quarantining: 70%
• Flying: 68%
• Going into office to work: 60%
• Large gatherings: 59%
• Large religious gatherings: 55%
• Attend school in person: 51%
Redfield & Wilton Strategies (2020)
UK
Survey 1500 16/05/2020 Covid-19 Immunity certificate •69% of respondents would support a policy of immunity certificates, with 16% against.
•30% of respondents believe an immunity certification policy would implicitly reward those who did not follow social-distancing measures.
•19% of respondents would consider deliberately catching coronavirus in response to a policy of immune certification, whilst 71% would not; 9% were unsure.
Savanta:Comres (2020)
UK
Survey 2090 20/11/2020–22/11/2020 Covid-19 Mandatory vaccination • Where it is voluntary to receive the vaccine 67% are likely to get it and 23% unlikely. When it is mandatory without legal penalty, less are actually likely to get it (65 to 24%). A legal penalty does not make much difference (65 to 25%).
Waller, J., et al. (2020).
UK
Survey 1204 28/04/2020–01/05/2020 Covid-19 Immunity certificate • Participants did not perceive any difference in risk between the terms Passport, Certificate, or Test for an antibody test.
• When using the term Immunity, 19.1% of participants perceived no risk of catching coronavirus compared to 9.8% for the term Antibody.
• Perceiving no risk of infection was associated with an intention to wash hands less frequently, but there was no significant associated with intended avoidance of physical contact.
YouGov (2 Dec, 2020)
UK
Survey 5351 02/12/2020 Covid-19 Mandatory vaccination •37% of respondents supported government making it legally compulsory for all people in Britain to be vaccinated against Covid-19, with 44% opposing.
YouGov (24 Nov, 2020)
UK
Survey 4311 24/11/2020 Covid-19 Vaccination certificate •72% of people support all airlines instituting a policy of only allowing passengers who can provide proof that they have been vaccinated (42% strongly support, 30% somewhat support). 18% of people disagree and 11% don’t know.
• Support appears to be correlated with age. No relationship with social grade.
YouGov (8 Dec, 2020)
UK
Survey 5396 08/12/2020 Covid-19 Vaccination certificate •Those who should have been vaccination should not be subject to any more coronavirus restrictions: 22%
•Everyone should be subject to the same coronavirus restrictions until most people have been vaccinated: 66%
YouGov/Sky (2 Dec, 2020)
UK
Survey 1706 02/12/2020–03/12/2020 Covid-19 Vaccination certificate •50% of respondents would continue to follow coronavirus rules and restrictions just as strictly after having a vaccination; 29% less strictly, 11% not at all.
•Opinions of whether it would be “acceptable” to only allow people who have had vaccination to:
•Travel by plane: 54% acceptable, 29% not acceptable, 17% unsure•Go to the cinema: 44% acceptable, 37 not acceptable, 20% unsure
•Go to a restaurant: 39% acceptable, 43% not acceptable, 19% unsure
•Travel on public transport: 36% acceptable, 46% not acceptable, 18% unsure