Key considerations and emerging evidence of experience across jurisdictions implementing documentation of vaccination

As SARS-COV-2 vaccine administration accelerates in many countries, governments are considering implementing the policy of documentation of vaccination (or ‘DV’) to support the re-opening of the economy and the easing of restrictive public health measures. Several jurisdictions have begun to implement DV programs, with more countries expected to follow in the coming weeks and months.

This rapid literature scan outlines a set of considerations and existing recommendations (scientific, technical, legal, ethical, and behavioural) for implementing DV programs that we believe are most relevant to the Canadian context. It also presents the experiences of jurisdictions that have considered and implemented these programs to date, where this information is available. Although this report is tailored to Canada more broadly, the Ontario Science Table’s Science Brief provides key scientific, legal, ethical, privacy, and accessibility considerations for implementing COVID‑19 vaccine certificates for provincial governments, focusing particularly on the Ontario context.

Implementing policies around vaccine documentation should consider, holistically, the scientific, the technical, the legal, the ethical, and the behavioral impacts. To date, evidence that DV would be an effective public health measure to prevent the spread of COVID-19, and lead to reduced morbidity and mortality, is insufficient to guide decision-making. Further, there are few countries with significant levels of fully vaccinated populations. As such, implementation may require a compelling health argument that DV is a good use of resources from a public heath lens. Although there have been several use cases identified, it is clear that DV will be required by many jurisdictions for international travel with the aim to prevent the spread of COVID‑19 and its variants. There are mixed views and limited evidence around domestic use of DV for participation in activities. Development of vaccine documentation across Canadian provinces and territories may cause technical challenges with respect to collection, storage, and sharing of sensitive health information.

This report has several limitations, primarily due to rapid deadlines:

• We may have missed relevant information due to rapid timelines to produce this report.

• Although we did not formally assess the quality of the evidence, the quality was generally low, and the majority of included texts were published editorials, commentaries, and media sources.
• Few considerations for implementation of vaccination documentation have been tested in practice as most global jurisdictions were found to be in the early stages of DV programs and implementation experience was limited.
• This report is largely limited to English-speaking countries as we restricted our search to English publications only.

This report synthesizes existing knowledge on documentation of vaccination and presents a set of considerations and recommendations for implementing a proof of vaccination program in Canada. The following are some key findings from this work:

1. A range of views exist regarding the documentation of vaccination, with national and international jurisdictions considering various approaches.

2. More research on existing vaccines and DV outcomes may be needed to justify the implementation of a DV program in Canada as considerable investment may be required.

3. Privacy, security, and interoperability are essential features of a successful DV program.

4. Introducing a DV program is a complex process as the program must comply with multiple levels of local, national, and international laws and guidelines.

5. Various accommodations may be needed to mitigate ethical concerns with DV programs for both local and international communities.

6. Introducing a DV program may shift social behaviours. Therefore, the government should model and plan for a range of potential responses.

7. DV programs may influence vaccine acceptance, if individuals see the activities that they can engage in if fully vaccinated.

8. The need for DV for domestic purposes may be time-limited and of less value once vaccination coverage levels are high and case rates low.

9. Lack of federal policy and standards for DV may result in a patchwork of different programs across the provinces and territories.

10. Global perceptions towards DV programs are rapidly evolving, and existing examples highlight the importance of strong partnerships and comprehensive planning in their implementation.