Vaccine Passport Rules Might Actually Increase Vaccine Hesitancy

“Not allowing unvaccinated people into nightclubs is not the way to increase vaccination coverage," says expert.

Introducing vaccine passports at nightclubs will actually put people off having a vaccine, rather than encouraging take-up, a leading academic has warned.

Dr Pauline Paterson is co-director of the Vaccine Confidence Project and assistant professor in the Department of Infectious Disease Epidemiology, at the London School of Hygiene & Tropical Medicine.

She’s leading a team who are researching public perceptions of vaccination programmes – and says Boris Johnson’s latest announcement won’t work.

“Not allowing unvaccinated people into nightclubs and events is not the way to increase vaccination coverage,” she says. “This risks further entrenching the views of those that already having concerns about vaccination, rather than alleviating them.”

People queuing to get in to the Egg London nightclub in the early hours of July 19. 
People queuing to get in to the Egg London nightclub in the early hours of July 19. 

A survey of 17,000 adults conducted by the Vaccine Confidence Project in April found that vaccine passports would “likely lower inclination to accept a Covid-19 vaccine for those that are undecided”.

Another study, conducted as part of the Health Protection Unit in Vaccines and Immunisation (a partnership between Public Health England, the London School of Hygiene & Tropical Medicine and the University of Cambridge) found that “health and social care workers who felt pressured by their employers to vaccinate were less likely to.”

Both studies are available in pre-print and are yet to be peer reviewed, but Dr Paterson says they demonstrate how mandatory vaccines can actually increase hesitancy.

“Those that are currently hesitant are unlikely to be swayed by this new policy decision,” she says. “Vitally it is not possible to have informed consent under duress or coercion. This policy also risks increasing stigmatisation and segregation.”

“If you were offered to take a blue pill, and were told you were not allowed to go out with your friends unless you took it, would you trust it more or less?”

- Dr Pauline Paterson, Vaccine Confidence Project

Vaccine passports will be mandatory in nightclubs and other large-scale settings from the end of September. Other venues, such as restaurants, pubs and theatres, are already being “encouraged” to check vaccination and health status. Dr Paterson is concerned this will put more people off of vaccination, putting them at higher risk of infection.

“Research has shown that enforcing a vaccine policy by placing social or economic sanctions on those that choose not to vaccinate increases hesitancy and mistrust in the very vaccines the policy is intended to promote,” she says.

“If you were offered to take a blue pill, and were told you were not allowed to go out with your friends unless you took it, would you trust it more or less?”

Instead, Dr Paterson says researchers and politicians should be focussing on identifying the reasons for non-vaccination, acknowledging concerns and designing evidence-informed responses.

Only time will tell if the latest plan will alter vaccine take-up, but scientists do agree that being fully vaccinated will help reduce the spread of coronavirus – and lower the risk to individuals.

Dr Peter English, a retired consultant in communicable disease control, says ideally, nightclubs should have stayed closed until cases were lower, but as the government has decided to open them, requiring vaccination will reduce the risk.

“Many nightclubs are noisy, crowded, and in small-volume spaces, and thus particularly high-risk for transmission,” he says. “This risk is further exacerbated given that (as we prioritised highest risk people first, and have been moving down the age groups) younger people are less likely to be fully vaccinated.

“It would have been far preferable to keep indoor nightclubs closed until disease incidence (the number of new cases per day) is much lower and decreasing. Vaccination is not a foolproof way of preventing infection and transmission; but it does reduce the risk.

“Given that the government has not heeded the advice to keep nightclubs closed, requiring vaccination certificates may help reduce the risk.”

He adds that full vaccination is necessary to prevent the prevalent Delta variant and that vaccination certificates “will need to provide proof of full vaccination in a way that cannot easily be forged”.