Coronavirus (COVID-19) vaccine certification: evidence paper update

4. The existing vaccination certification scheme

Monitoring the scheme involves addressing a range of questions, including the implementation and use of the new systems; the impact against the stated aims of the scheme;^[14] and the other immediate and longer term effects of the policy.

A range of information and data are relevant to these questions, including information about public knowledge and support for the scheme, confidence in the potential effectiveness, the changes in numbers of COVID cases, vaccination rates and health system impacts, and the impacts on human rights and equalities for people and groups.

The scheme was announced on 1 September 2021, and whilst there is emerging data on some of these effects, there is as yet incomplete information about the longer term effects on the pandemic, wider society, and the economy.

Given the fast changing nature of the pandemic and the multi-faceted response to COVID-19 it is challenging to isolate the effects of any one intervention, but data can provide insight into some of the monitoring questions.

4.1 System use

System use data shows large scale use of the app, and requests for paper and PDF copies.

As of midnight 13 November 2021 the NHS Covid Status App has been downloaded 1,571,575 times. It is important to note a single user may choose to download the app on multiple devices, so this figure does not represent unique individuals.

Between 3 September 2021 (introduction of QR codes) and midnight 13 November 2021:

• 478,014 paper copies of COVID-19 Status have been requested. This may not represent unique users if an individual requests a second copy (for example if they have lost their paper copy).
• 1,205,549* PDF versions of COVID-19 Status have been downloaded. This provides a measure of the total number of times a new QR code has been generated via PDF. An individual can generate more than one successful QR code so the figure does not represent unique users.

*1st, 2nd, 3rd October data for PDFs is missing due to a technical error, we can reasonably estimate that there were 35,000 – 45,000 PDFs successfully generated PDFs in total for those three days.

4.2 Vaccination uptake

The certification scheme was announced at a point when there was a relatively high overall uptake of first and second doses.

A regular survey of public attitudes to COVID-19 has tracked attitudes to vaccination since September 2020^[15]. A large majority of respondents said they were likely to be vaccinated and this is consistent with vaccination uptake data as the vaccination programme has rolled out.

In recent waves of the survey from September to November, high proportions of the very small percentage of the population who have not yet received a vaccination said they were unlikely to do so, and scored themselves 0-2 on a scale of 0-10. In November, just under three quarters (74%) of people who were yet to be vaccinated said they were very unlikely to be vaccinated.

This suggests that increasing first and second dose uptake is more challenging as the vaccination uptake rate increases.

Between the introduction of the scheme on 1 September and 16 November there has been a relatively small increase in the uptake of first doses, and a slightly higher uptake of second doses for those aged 18+. The increase was higher in younger age groups, whose scheduled vaccinations came later in the rollout schedule.

The proportion of those aged 12+ with a first dose rose from 86.0% to 90.5% (4.5 percentage points). The proportion of those aged 12+ with a second dose rose from 77.6% to 82.2% (4.6 percentage points).

Evidence from comparison with other UK nations suggests that there has been a relatively slight impact on uptake of vaccination since the scheme was introduced in Scotland on 1 September. The rate of overall increase in first and second doses, has been similar across 4 UK nations. All four nations were however starting from an already high level of vaccination uptake and coverage.

Between the announcement of the scheme and the present, first dose coverage has risen by 4.6 percentage points in Scotland, the highest rise of the four nations, and slightly higher than England, Wales and Northern Ireland.

For second doses, the biggest increase in uptake was in Northern Ireland (5.4 percentage points) and England (5.4 percentage points) and Scotland had a similar level of increase (4.9 percentage points).

Table 1: Vaccination dose 1 and dose 2 coverage % and percentage point change, since the announcement of the certification scheme in Scotland on 1 September 2021 and 15 November 2021 ^[17].

	1st dose coverage % 1 September	1st dose coverage % 15 November	Percentage point change
England	83.5	87.8	4.3
Northern Ireland	80.6	84.3	3.7
Scotland	86	90.6	4.6
Wales	85.6	89.4	3.8
	2nd dose coverage % 1 September	2nd dose coverage % 15 November	Percentage point change
England	74.4	79.8	5.4
Northern Ireland	72.9	78.6	5.7
Scotland	77.3	82.2	4.9
Wales	79.4	81.9	2.5

This is also shown in the data for younger age groups. The lowest level of vaccination coverage for first and second doses in adults has been in 18-29 year olds. At the point when the scheme was announced the uptake of vaccine was decreasing, and these trends have continued in the period since then.

The rate of vaccination uptake for 18-29 year olds in Scotland between 1 September and 16 November 2021 is similar to the rate in England, where no certification scheme has been in place. Scotland was starting this time period from a higher baseline, so this represents important progress as the vaccination coverage reaches an upper plateau.

In Scotland the first dose coverage rose by 4.0 percentage points, (from 74.6% on 1 September 2021, to 78.6% on 16 November). The second dose rose by 16.2 percentage points, (from 52.8% on 1 September 2021, to 68.9% on 16 November 2021).

In England (where no certification scheme was in place) the first dose uptake rose by 3.0 percentage points (from 72.2% on 1 September to 75.2% on 16 November). The second dose uptake rose by 16.5 percentage points (from 49.7% on 1 September to 66.2% on 16 November).

Research into public attitudes carried out by YouGov for the Scottish Government, on 2/3 November 2021, (n=1002 people in Scotland) highlighted attitudes towards vaccination. The proportion of people surveyed who said they have been vaccinated for COVID-19 is high. 91% of all respondents have already received at least their first vaccine dose. Of those not vaccinated (and small base must be noted), 6% report they are likely to be vaccinated when a vaccine becomes available to them^[19].

On 19/20 October^[20], 87% of those who have had their first and second dose stated they are likely to have a booster vaccine when it is offered.

UK-wide research suggests that, while general willingness to get vaccinated is high, vaccine hesitancy (the "reluctance or refusal to vaccinate despite the availability of vaccines") is inversely related to age, as 16–24 year olds are 1.48 more likely to be vaccine hesitant than those aged 45–54 years^[21] Scottish polling conducted in 19/20 October 2021^[22] found that, among those awaiting their first, second or booster vaccination, 75% of 18-44 year olds were 'likely' to take it, compared to 89% of those aged 50 and over.

UK-wide analysis suggests that vaccine hesitancy has decreased slightly among younger age groups. The ONS Opinions and Lifestyle Survey^[23] conducted June-July 2021, found vaccine hesitancy was:

• 11% among those aged 16 to 17 years (14% previously in the ONS survey conducted January-February 2021),
• 5% among those aged 18 to 21 years (9% previously)
• 9% among those aged 22 to 25 years (10% previously).