Coronavirus (COVID-19) domestic vaccine certification: children's rights and wellbeing impact assessment

Key Findings, including an assessment of the impact on children's rights, and how the measure will contribute to children's wellbeing

A summary of the key findings is set out below. This is followed by an assessment of children's rights and the potential impact of Covid Vaccine Certification.

• Protecting public health: this will positively impact all people, including children, and will particularly benefit disabled children and children from minority ethnic groups.
• Protecting and promoting the wellbeing of children and young people in Scotland: during engagement, stakeholders recognised that Certification could be beneficial in enabling entertainment settings, which are particularly attractive to younger people, to remain open if the state of the pandemic changes. As evidence shows, the restrictions and lockdowns had a negative impact on children's mental health, which gradually improved in line with the easing of restrictions.
• Proof of age: while children are exempt from the requirement to prove Covid Vaccine Certification, a small proportion may be asked for proof of age. Some children, particularly LGBT or migrant children, may not have proof of age or others may be challenged on the validity of their ID.
• Digital exclusion: all under-18s are exempt in the regulations from the domestic Certification scheme. However, some children may choose to access a record of their vaccination. We know that digital exclusion affects some children, particularly care experienced, young carers, migrant, and low income children, as well as children from minority ethnic groups. A paper Certificate can be requested by calling the Covid-19 Status Helpline on 0808 196 8565. This is free and open every day from 10:00-18:00.
• Vaccine hesitancy: this could be exacerbated in some communities and demographics. If so, it would compromise the policy intention to increase vaccine uptake and protect public health, which could in turn negatively impact upon children.
• Exceeding the policy intention: even though children are exempt, there is the possibility that they could be refused entrance to a regulated setting. There is also the possibility that businesses or third parties could use Certification voluntarily and deny access to children who do not have proof of vaccination. Furthermore, even though the policy does not apply to employment, private business or third parties could make Certification a requirement of employment, differentially impacting children who are less likely to be vaccinated.
• The Vaccination status of parents, guardians or relevant adults: this could potentially impact on the enjoyment of a child's rights if a child is denied access to a regulated setting as their parent, guardian or carer does not have Certification. Additionally, even though the policy does not apply to employment, private businesses or third parties could make Certification a requirement of employment. If a parent is unable to maintain or gain employment due to their Vaccination status, this could impact upon the household finances and compromise their housing status or quality of life, and in turn affect a child's enjoyment of their rights.
• Potential for Covid Vaccine Certification to be used as a tool to exert control: as Covid Vaccine Certification becomes required to access some settings, it could potentially be used as a method of coercive control. This could be done by taking a phone or paper certificate from the victim. There is the potential that Certification could be used to exert control over the relevant adult who cares for the child, which could in turn impact upon the child's wellbeing.

The Scottish Government has found that a number of children's rights may be impacted by the introduction of Covid Vaccine Certification.

Right to non-discrimination (Article 2)

While children are exempt from the requirement to prove vaccination status to access the regulated spaces, stakeholders have highlighted that some children who look 18 or older may be asked to provide proof of age to prove their exemption. While there are lots of pre-existing schemes which require proof of age for under-18s and there are schemes such as the Young Scot National Entitlement card which can act as proof of age, many children do not routinely possess or carry proof of identification (ID) and there is a risk that these children could be unfairly discriminated against.

Stakeholders have highlighted that some groups are more unlikely to have ID than others. Unpublished interim findings from a joint survey run by Stonewall and the LGBT Foundation found that nearly one in four respondents (23%) had experienced problems having ID accepted in the past; just under three quarters of respondents (73%) owned a 'usable'^[36] UK passport, and just over two thirds of respondents (68%) owned a usable driving license. The top five most common barriers or concerns cited in relation to obtaining ID were: receiving intrusive questions from other people when applying for or presenting ID (38%); obtaining ID taking more energy (37%) or time (26%) than they have available; being unable to easily print documents (32%); and being 'outed' as trans when applying for or presenting ID (31%). While this data does not distinguish between children and adults, there may be higher rates of LGBT children than non-LGBT children who do not have ID and as a result higher percentages of LGBT young people may be denied access to the regulated settings.

There are also other considerations in relation to proof of age. There is the potential that unconscious bias could cause enforcement of Certification to be administered in a discriminatory manner. This is true for children as well as adults. While the possibility is low, a child could be refused access to a space where Certification is required as the enforcer's unconscious bias could lead them to assume that the child is not using valid ID because of a protected characteristic such as race. There are also more subtle ways that unconscious bias could be enacted. For example while operating a system to check Certification, employees may spot check children based on protected characteristics such as perceived race, gender, or disability. This is a concern that stakeholders have raised in relation to racial profiling and data shows that, across the UK, Black children were over four times more likely than white children to be arrested.^[37] While children may ultimately gain access to the setting, the experience of feeling singled out could cause distress, a loss of time, distrust in the scheme, and anxiety about future use.^[38][39]

There is also the risk that Covid Vaccine Certification exceeds the policy intention and while children are exempt, they could be denied access to the regulated spaces. Disabled People's Organisations have raised this as a concern and cited face coverings as a prior example: people who are exempt and have a Scottish Government exemption card have been denied access to settings where face coverings are mandated. This has resulted in anxiety and distress for disabled people.

There is also the possibility that businesses or third parties could use Certification voluntarily and deny access to children who do not have proof of vaccination. Stakeholders explained that even as restrictions have eased, accessing community spaces for young people remains an issue, and they raised concerns that the work put into re-opening these spaces could be at risk if Certification creates a new barrier to accessing spaces and services.

Therefore, unless mitigations are put in place, Certification could potentially impact upon children's right to non-discrimination and exacerbate inequalities. Evidence suggests that those who face discrimination have poorer mental health and so if Certification was used, even in a limited way, to reinforce discrimination, then this would be contrary to the promotion of children's wellbeing.

As a mitigation, sectoral guidance has been developed to support effective implementation consistent with our policy aim. This provides more information to the sectors where Certification is mandated on the policy and regulations, and the reasonable implementation, enforcement and handling of exemptions. This guidance can be found on the Scottish Government website. We will also produce public guidance to provide information on what Certification is, the policy objectives, where it is regulated and why, and the steps to attain Certification. Our Guidance will be clear about the settings in which use of Certification is required to mitigate the risk that businesses and other entities consider using it also for activities and services which fall out of the scope under the Regulations.

More information on mitigations to prevent the potential engagement of Article 2 can be found in the mitigations section of this document.

The best interests of the child (Article 3)

The best interests of children have been central in the policy development of Covid Vaccine Certification. If the policy objectives to reduce transmission and to increase vaccine uptake are achieved then this would positively impact children, as any reduction in transmission of the virus would positively impact on the protection of public health, including the protection of children's health. As laid out in the summary of evidence, disabled children and children from minority ethnic groups are most likely to benefit from a reduction in transmission due to their poorer health outcomes if the contract the virus.

We also know that social interactions, both with friends and wider family, play a key role in optimising children's development and their wider wellbeing. In answers to the Lockdown Lowdown 2 survey of 11 – 25 year olds (carried out in September to November 2020)^[40] and in associated focus groups^[41] carried out in October and November 2020, many young people discussed the benefits to their mental wellbeing of being able to meet up with their friends again and of not being confined to their homes. Therefore if the policy objective is achieved and the risk of transmission is reduced, allowing higher risk settings to continue to operate as an alternative to closure or more restrictive measures, Certification could positively impact on children's wider development, promote their wellbeing and more generally be within their best interests.

Covid Vaccine Certification may be particularly beneficial to promoting the wellbeing of some children. Evidence suggests that girls and young women had worse wellbeing outcomes than boys and young men throughout the pandemic and gender differences were patterned by age and were generally more pronounced among the older age groups. The Lockdown Lowdown 2 survey cited above found that male respondents were substantially more likely to agree that they felt good about their mental health and wellbeing (59%) than female respondents (34%).^[40] The Teen Covid Life 2 survey of 12 – 18 year olds found that a higher percentage of female participants (56% for those aged 12 - 14, 64% for those aged 15 - 18) reported low mood compared with male participants (33% for those aged 12 – 14, 46% for those aged 15 - 18).^[42] Lastly, in the Children's Parliament survey of 8 – 14 year olds girls were less likely to feel resilient at both ages 8 to 11 (58%) and 12 to 14 (54%) than boys (76% 8 to 11; 69% 12 to 14%).^[43]

A survey by Family Fund carried out during March and April 2020 found that 94% of families said the health and wellbeing of their disabled or seriously ill children had been negatively affected.^[44] A qualitative study of the experiences of 16 families in Scotland with children that have additional support needs and disabilities found that most families mentioned the negative impact of the pandemic on the mental health and wellbeing of their children, while some mentioned challenges with maintaining their children's regular exercise.^[45]

LGBT young people have been nearly twice as likely as their non-LGBT peers (52% vs 27%) to have felt lonely and separated from the people they are closest to on a daily basis during lockdown. 68% of LGBT+ young people surveyed also reported their mental health has worsened since the pandemic began, compared with 49% of non-LGBT+ young people.^[46]

Findings from engagement with young care experienced people on the impacts of lockdown found that a large majority of participants said that their mental health had become worse during the pandemic, and that they often felt worried, anxious, depressed and lonely.^[47]

Therefore, if the policy objective to allow higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, this is likely to particularly positively impact girls, disabled children, LGBT children and young care experienced children, whose mental health and wellbeing has been negatively impacted by the pandemic.

Life, survival and development (Article 6)

The Scottish Government has been clear that Certification will only be required for customers and not staff and public guidance which is clear about the settings in which use of Certification is required to mitigate the risk that businesses and other entities consider using Certification in relation to activities and services which fall outside the regulations will be published on the Scottish Government website.

If Covid Vaccine Certification were used beyond the policy intention as a condition of employment, children's right to life, survival and development could be engaged if they are unable to gain or maintain employment due to their vaccine status. Equally, if a child's parent, guardian, carer or relevant adult's employment or financial status is impacted by their vaccination status, then this too has the potential to impact upon a child's right to life, survival and development.

More information on mitigations to prevent the potential engagement of Article 6 can be found in the mitigations section of this document.

Right to freedom of association (Article 15)

The Scottish Government recognises the right to freedom of association and the democratic right to protest and its integral role in society. Therefore, there is an exception for premises being used for certain purposes, including worship and protest.

If Covid Vaccine Certification were used beyond the policy intention to deny children access to spaces, then there is the potential that their right to freedom of association could be engaged. Public guidance, which will be clear about the settings in which use of Certification is required to mitigate the risk that businesses and other entities consider using Certification in relation to activities and services which fall outside the regulations will be published on the Scottish Government website. More information on mitigations to prevent the potential engagement of Article 15 can be found in the mitigations section of this document.

Right to privacy (Article 16)

All under-18s are exempt from the domestic Certification scheme. However, 12-17 year olds who have been vaccinated may choose to access their record of vaccination by downloading a PDF via NHS Inform or requesting a paper Certificate by calling the Covid-19 Status Helpline. If children do choose to use the paper or PDF Certificate their right to privacy could be engaged. A privacy notice is available on NHS Inform: Personal information we process, How we use your data, Your Rights. The Easy Read Version can be found online. This provides information on the collating, sharing, storage, use and destruction of data. An overview of the key issues relating to children can be found below.

Stakeholders have highlighted that data matching may be an issue for some users if they choose to request a hard copy or download a PDF certificate. Some trans children may have different names on different documents and databases. While changing personal data with a GP is straightforward, stakeholders have highlighted potential issues with systems and data interoperability; data may be correct on one system but has not been updated on another and so could result in mismatches. This could create a more burdensome process for trans people and may mean they spend more time interacting with healthcare services and the helpline to ensure their data is consistent. Moreover, trans children may not want to call the helpline and explain their medical history to a call handler.

Once a child has managed to obtain a record of their vaccination, stakeholders have highlighted the risk of discrimination and distress if a user's name is displayed on the paper or PDF certificate. For example, if someone's name on their medical records – and therefore on their certificate – is different to the name that they use with their friends, family and others, this could lead to their transgender identity being unintentionally disclosed. LGBT young people are already fearful of disclosing their identity – 'coming out' – and 77% of young people believed their sexual/gender identity was a causal factor in their rejection from home.^[48]

For some, there are real concerns regarding the right to privacy and the sharing of data. Stakeholders have informed us that migrants with secure, insecure and illegal immigration status have specific concerns that their data could be shared with the Home Office and impact their immigration status.^[49] This is founded on historic experience of NHS data being shared with the Home Office which resulted in deportations.^[50] Evidence shows that the majority of documented migrants that are recent entrants to the UK do not register with a GP, despite relatively easy access to primary healthcare.^[51]

Right of children with disabilities (Article 23)

As stated in the summary of evidence, disabled children are disproportionately impacted by Covid-19.

As of 13 September 2021 there are 1,431 under-16s on the clinically extremely vulnerable list (previously known as 'shielding'), although we do not have disaggregated data about the number of disabled children who are on it. While not all of those at highest risk are disabled, and not all disabled people are at highest risk, some disabled people are considered to be at high risk of health harms if they contract Covid-19, such as children with learning disabilities.^[52] While not all disabled children were asked to shield, and shielding ended on 1 August 2020, anecdotal evidence from stakeholders suggests that concerns about contracting the virus have remained and many individuals and families have continued to behave as if they are still shielding, which has had an adverse impact on their quality of life.

Disabled children's mental health and wellbeing has been impacted by restrictions and lockdowns. Survey data from families with disabled or seriously ill children found that 94% of respondents said that the health and wellbeing of their child had been negatively affected by restrictions and lockdowns.^[53] Other evidence found that respondents reported negative effects of lockdown restrictions, with 61% reporting a reduction in physical activity levels and over 90% reporting a negative impact on mental health (including poorer behaviour, mood, fitness and social and learning regression).^[54] The pandemic has also had an impact on the parents and carers of disabled children: survey results found that 86% of respondents had higher stress levels than expected population norms; 82% of parents felt the Covid-19 pandemic had also affected their other children; 67% of parents reported their child's sibling to be having issues with their sleep; and 59% reported feelings of anxiety. It also found that 4 in 10 parents reported that their quality of life, and that of their disabled child, was worse in the last month, with 5 in 10 parents reporting the same for their other children.^[55]

Therefore, if the policy objectives of reducing transmission and increasing vaccine uptake are achieved, this would positively impact disabled children, as any reduction of the risk of transmission would improve public health, including that of disabled children.

Certification could also promote the mental health and wellbeing of disabled children and their families and carers, as it could add a layer of reassurance and support them to feel safer and more confident participating in society. Public insights polling has found that 53% of those surveyed agreed that the high level of people with two doses of the vaccine in Scotland gives them more confidence to go out and about^[56] and 62% of respondents agreed that, it they wanted to go to a venue or event, having Covid Vaccine Certification in place would make them feel more comfortable doing this.^[57] This was particularly true of women, who were 7% more likely to agree that it would make them feel more comfortable (women 65% vs men 58%).

Lastly, if the policy objective is achieved and allows higher risk settings to continue to operate as an alternative to closure or more restrictive measures, and disabled children are still able to attend the regulated settings with family, friends and support groups and services, this too could have positive impacts on disabled children as socialisation plays a key role in promoting wellbeing.

Right to health and health services (Article 24)

If the policy objectives to reduce the risk of transmission, reduce the risk of serious illness and death thereby alleviating current and future pressure on the National Health Service and increase vaccine uptake are achieved, this would result in a higher level of community protection and would positively impact upon children's right to health and health care services.

Certification could provide reassurance to children, as those around them are vaccinated and so they are less likely to contract and spread the virus to family and friends, and could support them to feel safer and confident participating in society. Evidence has found that 45% of 11-25 year olds surveyed were concerned about catching coronavirus and 64% of respondents were concerned about transmitting coronavirus to others.^[58] There is also evidence that young carers had higher levels of concern about catching and transmitting Covid-19.^[59] Findings from Who Cares? Scotland^[60] found similar results and focus groups^[61] reported that young carers spoke about being particularly cautious going out and attending school in order to protect people they care for.

In terms of mental health and wellbeing during the pandemic, a PHE report found experiences vary by children and young people's characteristics, with those from Black, Asian and Minority Ethnic (BAME) backgrounds, those with existing mental health conditions, those with Special Educational Needs and Disabilities, and those living in low income families were more likely to have been negatively affected.^[62] A different report found that LGBT+ respondents reported lower emotional wellbeing before and during lockdown compared with heterosexual respondents.^[63] Who Cares? Scotland found that a large majority of participants said that their mental health had become worse during the pandemic, and that they often felt worried, anxious, depressed and lonely.^[64] Lastly, consistent findings across a number of surveys and most questions found that girls and young women had worse wellbeing outcomes than boys and young men overall.^[65]

Multiple surveys have found that children's mental health has gradually improved as restrictions eased. For example, in a survey of 11 – 25 year olds carried out between September and November 2020 many young people discussed the mental wellbeing benefits of being able to meet up with their friends again and not being confined to their homes^[66], and in survey a parents of 2 – 7 year olds carried out in November and December 2020, 79% of parents said that their child's mood was the same or had improved since the initial lockdown.^[67]

As such, if the policy objective of allowing higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved and children are still able to socialise and attend the regulated settings with family, friends and support groups and services, then this could positive promote their mental health and wellbeing. This could particularly positively impact girls, children from minority ethnic groups, LGBT, disabled and care experienced children whose mental health was more negatively impacted by lockdowns.

However, the policy may have unintended negative health impacts on some communities which are already less inclined to come forward for vaccination. Survey data from UK-wide research suggests that, in comparison to White British and White Irish participants, Black African and Mixed Black African health and social care workers were less likely to have been offered a vaccine and much more likely to have declined vaccination if offered. Reasons for doing so among Black African participants included distrust in Covid-19 vaccination, healthcare providers and policymakers.^[68] Uptake by the White Polish community is also comparatively much lower.^[69]

Stakeholders raised concerns that the introduction of Covid Vaccine Certification could exacerbate vaccine hesitancy in some communities, which could potentially undermine the policy objective to increase vaccine uptake. They felt that Certification is unlikely to incentivise asylum seekers, refugees or migrants to take up the vaccine as they do not often frequent the settings in scope. Stakeholders also felt that as parents and guardians are influential figures in children's lives, children may hold the same sentiments as their parents and may also become less likely to take up the vaccine.

As stated throughout this document, even though they are exempt, children could be denied access to spaces and services as they are unable to provide proof of vaccination. The experience of being denied access to a space could negatively impact on a child's wellbeing. Additionally, if there is unconscious bias while enforcing Certification, as detailed under right to non-discrimination, then this too could negatively impact on a child's mental health and wellbeing if it results in them feeling ostracised from friends, peers and society more widely.

Right to an adequate standard of living (Article 27)

The Scottish Government has been clear that Certification will only be required for customers and not staff, and public guidance will be published on the Scottish Government website, which will be clear about the settings in which use of Certification is required to mitigate the risk that businesses and other entities consider using Certification for activities and services that fall outside the Regulations.

If Covid Vaccine Certification were used beyond the policy intention as a condition of employment, children's right to an adequate standard living could be engaged if they are unable to gain or maintain employment due to their vaccine status. Equally, if a child's parent, guardian, carer or relevant adult's employment or financial status is impacted by their vaccination status then this too has the potential to impact upon a child's right to life, survival and development.

More information on mitigations to prevent the potential engagement of Article 27 can be found in the mitigations section of this document.

Right to education (Article 28)

The First Minister has been clear that the education and wellbeing of our children are paramount and should be prioritised above all else during the pandemic. As such, education is out of scope and Ministers have been clear that vaccine status should not be a condition of accessing education.

We know that education occurs outside the classroom and other more formal teaching structures and can take place at societies and other social groups which are operated by or affiliated to students unions and colleges and universities. While student unions across the UK, including Scotland,^[70] have expressed their opposition to Certification in educational spaces, individual students may choose to implement it at societies or social groups. If a student is unable to participate in societies or social activities due to their vaccination status this could potentially impact upon their right to education as well as their right to development (Article 6).

More information on mitigations to prevent the potential engagement of Article 28 can be found in the mitigations section of this document.

Right to leisure, play and culture (Article 31)

There is a strong recognition that play and social interactions, with friends and wider family plays a key role in optimising children's development and wider wellbeing. If the policy objective to allow higher risk settings to continue to operate as an alternative to closure or more restrictive measures is achieved, this could positively impact on a child's right to leisure and to access cultural events if they are still able to attend the regulated settings with family, friends and support groups and services.

As previously explained, the vaccination status of a parent, guardian or relevant adult could impact upon the child's enjoyment of their rights in a number of ways. In terms of the right to leisure, play and culture, Certification could cause negative impacts if a parent is denied access to a regulated setting and as a result the child is denied access too as they cannot enter without an adult.

As with many other rights assessed, even though they are exempt, there is the potential that private businesses and third parties could use Certification beyond the policy intention and deny access to children. Children could therefore be denied access to leisure, play and cultural spaces as they are not able to provide proof of vaccination. This could negatively impact on their enjoyment of Article 31.

Sectoral guidance has been produced on the Scottish Government website to support effective implementation consistent with our policy aim. We will also publish public guidance to provide information on what Certification is, the policy objectives, where it is regulated and why, and the steps to attain Certification.

Our Guidance will be clear about the settings in which use of Certification is required to mitigate the risk that businesses and other entities consider using Certification in relation to activities and services which fall outside the regulations.

More information on mitigations to prevent the potential engagement of Article 31 can be found in the mitigations section of this document.