In 2021, from the onset of COVID-19 vaccinations, the Government of Canada created a national vaccine certificate. This initiative allowed vaccinated people freedom of movement to more than 2000 public places. These certificates, offered in physical and/or digital format, consisted of personalized QR codes. They lifted restrictions on restaurants, bars, theatres and other high contact environments. This shift was intended to protect the public’s health as hospitals were overwhelmed by the burden of COVID-19 variants such as Delta.
As vaccine distribution accelerated and the pandemic shifted, Canada started to lift these certificates starting in early 2022. A new article co-authored by EBP’s Maxwell Smith explores these and other future pandemic scenarios. It outlines what the right conditions would be to consider vaccine certificates. While the authors did not directly use their framework to address COVID-19, they asked critical questions about the public health response and outlined how to improve interventions.
Understanding Vaccine Certificates
Vaccine certificates operated as a key escape route from the pandemic, offering a way to enforce access to public spaces. Vaccinated people could show their vaccination pass. This provided them the opportunity to work in environments with greater likelihood of sustained virus exposure.
Smith noted that “by virtue of saying, ‘Going to restaurants, bars and theatres is conditioned upon you being vaccinated,’ that meant more people got vaccinated.” This new method builds trust and motivates those populations most resistant to the vaccine to receive their shots. In the end, that helps to increase vaccination rates nationwide.
The rollout of these certificates wasn’t exactly smooth sailing. These ethical issues, of prohibiting access based on vaccination status, crossed serious lines of questioning personal freedom and raised major concerns about equity. Smith was clear on the importance of assessing not just pathogen severity, but pathogen prevalence. Such assessment should be fundamental to the decision-making process regarding reintroducing any future measures.
“We then need to determine when we, collectively, think a pathogen is ‘sufficiently’ severe, prevalent, etc., to justify the use of vaccine certificates.” – Maxwell Smith
Complex Evaluation of Impact
…we find that assessing vaccine certificates’ effectiveness, to a symbolic degree, poses an exceedingly difficult evaluative task for academics and public health authorities. Smith and co-author Dr. Allison McGeer fear a deep disconnect in their analysis. In the process, they fail to properly disentangle the effects of travel bans from those of vaccine certificate requirements.
Smith stressed the need to talk to the public about their concerns when it comes to vaccine mandates. He cautioned that not addressing these concerns would risk bringing about the same protests. That would set a dangerous precedent of creating confusion during future health crises.
“If we don’t try to answer those questions and maybe try to socialize those answers with the Canadian public, we’ll be facing the exact same protests or confusion or contention with a future threat that we faced during COVID.” – Maxwell Smith
Additionally, he made it clear that he understood the ethical implications of curbing people’s personal freedoms for the benefit of all. “If we care about the most vulnerable people in society,” he stated, “we need to think about what sort of reductions of my own freedom might be necessary in order to protect other people’s freedom.”
Ethical Implications and Public Perception
That said, the ethical dimensions surrounding vaccine certificates are significant. Debates over whether the sacrifice of civil liberties is worth it are often contentious. Smith wondered how far these public health measures could be considered unreasonable encroachments on liberty.
He remarked, “I think infringing on liberty is one thing. I think the more important question is whether it was an unjust infringement on liberty.” These normative queries matter for grounding and calibrating public sentiment toward adopting pandemic-related health policies and to engendering public trust.
The influence of vaccine certificates did not stop there. It went well beyond the scope of public health science to shape social perceptions about vaccination. Smith noted that these measures created high pressure environments for people to be vaccinated. He said a failure was that they were not considered coercive in every case.
“They did put pressure on people to get vaccinated. We wanted to live our lives. It didn’t force us to do it, but it did put pressure on us to do so.” – Maxwell Smith
Dr. McGeer echoed the sentiment that in moments of crisis, decisions must be made swiftly, often prioritizing immediate needs over long-term considerations. “There’s a sense in moments of crisis you do what is the right thing now and pick up the pieces later,” she stated.
Moving Forward
As our society moves into a post-pandemic world and prepares for future health crises, conversations around healthcare vaccine certificates will continue to be relevant and important. The tension between our public health obligations and the need to respect personal liberties continues to be a sensitive issue.
