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

5. The current situation in Europe

Cases, and subsequent hospitalisations and deaths have been increasing in Europe since late September (Figure 10). In response, governments are increasing the strictness or reintroducing NPIs, including vaccine certification. For example, the scope of vaccine certification was extended on 15 November in Wales to include cinemas, theatres and concert halls, where both a negative antigen test and vaccination status is accepted^[24]. England and Northern Ireland have vaccine certification included in their 'Plan B' contingency plans^{[25] [26]}.

Norway had previously ended their certification scheme on 7 October 2021 due to a reduction in case numbers. However, since then, cases have increased and the Government announced that vaccine passports, along with booster vaccination, will be returning to bars, restaurants, concert venues, sports stadiums, cinemas, theatres and museums^{[27] [28]}. Similarly in Denmark, after stopping their certification on 10 September 2021, they reintroduced certification on 12 November due to rising case numbers^[29].

As seen in Table 2, the majority of comparator countries accept a negative antigen test or recovery as a condition of entry, as well as vaccination. In Austria, a negative test has recently been removed as a condition of entry to encourage vaccine uptake^{[30] [31]}. In some German states, a negative test has also been removed to be able to access some venues, known as the 2G rule. In Saxony, Bayern (Bavaria) and Berlin negative tests are not included in certification for access to indoor hospitality, leisure facilities and nightclubs^{[32] [33]}. On 17 November, Baden-Württemberg entered their 'alert level', implementing the 2G rule in venues, including theatres, concert, cultural institutions, leisure facilities, nightclubs and indoor hospitality^{[34] [35]}. In Hamburg, the implementation of the 2G rule is the choice of the facility and business owner^[36].

The length of time vaccination status is able to be used to access a certificate varies between the comparator countries. Israel have already included booster doses in their vaccination status for the green pass. All passes were deactivated on 3 October 2021 with new applications using vaccine status requiring either the booster dose or to be within 6 months of their second dose^[37]. France have recently announced that, as of December 15, people over 65 who were vaccinated with Johnson & Johnson must have had their booster or their QR code will be deactivated automatically. This will be extended at the beginning of December to those aged 50 to 64^[38]. Austria have also introduced a 9 month expiry date for two dose vaccinations. Those vaccinated with Johnson & Johnson will have their certificates expire on 3 January 2022 if they have not had a booster^[39].The other compactor countries range from a year validity to not providing an expiry date^{[40] [41] [42] [43] [44] [45] [46] [47]}.

The scope included in certification is also greater in comparator countries compared to Scotland, as seen in Table 3. The majority require certification for indoor hospitality and leisure facilities in addition to events and nightclubs current certified in Scotland. In addition to the compactor countries in the table below, other EU countries which require hospitality green pass (proof of vaccination, recent test or previous infection) for access to indoor hospitality spaces and/or cultural and sport venues include Cyprus, Finland, Greece, Latvia, Luxembourg, Portugal, Romania and Slovenia^{[48] [49] [50]}.

Beyond certification, Austria implemented a lockdown for unvaccinated individuals on 15 November^[51]. In Upper Austria, bars and nightclubs have been closed and events cancelled until 5 December^[52]. The Netherlands introduced a partial lockdown beginning 13

November, with bars, restaurants and non-essential stores ordered to close early for at least three weeks^[53]. Germany's lower house have voted in favour of implementing a 2G rule on public transport and workplaces^[54]

Source: Coronavirus (COVID-19) Cases - Statistics and Research - Our World in Data Accessed: 17 November 2021

Since the publication of the previous evidence paper some further research on the impact of certification across Europe has been produced. A study used a model comparing six countries (Denmark, Israel, Italy, France, Germany, Switzerland) that introduced certification (May-August 2021), with 20 control countries. The schemes used by the six countries were not vaccine only schemes as currently implemented in Scotland, and have different scopes to the current Scottish scheme. In some countries COVID-19 certification led to increased vaccinations 20 days prior to implementation, with a lasting effect up to 40 days after. Countries with lower than average pre-intervention uptake had a more pronounced increase (France, Italy, Israel). There was no effect in countries with higher uptake (Germany) or when introduced during limited supply (Denmark). The uptake was higher for <20 years and 20-29 years. Access restrictions linked to certain settings (nightclubs, events) were associated with higher uptake <20 years. When access restrictions were extended to broader settings, uptake remained high in the youngest group and increase was also observed in 30-49 age groups^[87].