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

Drury, John and Mao, Guanlan and John, Ann and Kamal, Atiya and Rubin, G. James and Stott, Clifford and Vandrevala, Tushna and Marteau, Theresa M. (2021) Behavioural responses to Covid-19 health certification: a rapid review. BMC Public Health, 21 (1). p. 1205. ISSN 1471-2458

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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.

Item Type: Article
Additional Information: ** From Springer Nature via Jisc Publications Router ** History: received 07-04-2021; accepted 27-05-2021; registration 28-05-2021; pub-electronic 24-06-2021; online 24-06-2021; collection 12-2021. ** Licence for this article:
Identification Number:
27 May 2021Accepted
24 June 2021Published
Uncontrolled Keywords: Research, Covid-19, SARS-CoV-2, Covid-status certification, Health certification, Vaccine passport, Mandatory vaccination, Vaccination certificate, Immunity certificate, Immunity passport, Health passport
Subjects: CAH04 - psychology > CAH04-01 - psychology > CAH04-01-01 - psychology (non-specific)
Divisions: Faculty of Business, Law and Social Sciences > School of Social Sciences > Dept. Psychology
SWORD Depositor: JISC PubRouter
Depositing User: JISC PubRouter
Date Deposited: 28 Jun 2021 09:28
Last Modified: 12 Jan 2022 11:38

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