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The Impact of Federally Required Vaccination Records on COVID-19 Vaccine Uptake

In a recently published work in the nature of human behavior Journal, the researchers analyzed the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination order on vaccine uptake.

Study: COVID-19 Vaccination Requirements and Vaccine Uptake.  Credit: K_E_N/Shutterstock
Study: COVID-19 Vaccination Requirements and Vaccine Uptake. Credit: K_E_N/Shutterstock


Vaccination has proven particularly effective in reducing the transmission and severity of SARS-CoV-2 infection, with vaccinated individuals having a significantly reduced likelihood of serious outcomes. Nevertheless, vaccinations against CoV disease 2019 (COVID-19) have fallen noticeably in several countries after a sharp increase in early 2021 in the summer months. Due to the increased reproductive rate of the SARS-CoV-2 delta variant, even regions with increased vaccination rates witnessed increased virus spread or had to continue or reintroduce non-pharmaceutical measures such as indoor capacity limitations or mask-wearing in autumn 2021.

Therefore, achieving high COVID-19 immunization coverage is critical to reducing the economic and public health consequences of the epidemic. The increasing uptake of vaccines has been a concern of public health officials internationally, particularly among the reluctant or reluctant populations. In response to this problem, several local and national governments have issued vaccination certificates or mandates that allow vaccinated individuals to attend non-essential social and sporting facilities and events such as stadiums, concerts, restaurants, museums and bars. These regulations have two goals: to encourage vaccination and to minimize virus transmission in indoor or crowded high-risk environments.

About the study

In this work, researchers examined and quantified the impact of government-mandated proof of COVID-19 immunization requirements for admission to public entities and non-essential businesses on first-dose vaccine uptake against SARS-CoV-2 in 10 Canadian provinces and three European countries ( Italy, France and Germany).

Some regulations allow companies to opt out if they are following additional restrictions or considering a previous positive or recent negative SARS-CoV-2 test report as a substitute for vaccination. The mandates in Italy, France, Germany, Saskatchewan, and Alberta, among the jurisdictions analyzed by the authors, allowed for such choices during the study period. The team selected the current sites because they have comparable demographics, economics and vaccine availability. Additionally, all implemented and announced mandates had July-October 2021 (a timeframe with little commitment to vaccine supply or access restrictions) and a strong first-dose baseline vaccination frequency.

Investigators assessed how the mandates became accessible to people who remained unvaccinated for months or weeks after the SARS-CoV-2 vaccination, such as those who were vaccinated. Because the starting doses of the COVID-19 vaccine most directly reflect the vaccination decision, the team used them as the primary outcome in the statistical analysis.

They also calculated the magnitude of the increase in primary vaccinations after a mandate was announced, taking into account other possible causes. In addition, the researchers analyzed the duration of these vaccination successes and the overall impact on vaccine uptake.


The team found that the announcement of the COVID-19 vaccine mandate was associated with a rapid and significant increase in new vaccinations (an increase in weekly first doses of over 60%), with the variance in timings of these metrics across Canadian provinces was used in a difference. In-Differences (DID) strategy. Time-series analyzes of each Canadian province, as well as Italy, France and Germany supported these results.

Following the publication of the mandate, immunization uptake increased significantly in all four of Canada’s most populous provinces and three European countries, often in contrast to a significant decrease in the weeks leading up to the announcement. The day after the mandate was announced in France, daily first-dose consultations increased dramatically. On the other hand, Spain showed a steady decrease in starting doses per week over the period indicated.

As of October 31, 2021, counterfactual simulations based on current estimates imply the following cumulative increases in vaccination coverage in the eligible population, i.e. persons aged 12 and over: approximately five percentage points (pp) for the Canadian provinces, total 979,000 (range from 425,000 to 1,266. 000) first doses for Canada (five to 13 weeks after notification of provincial requirements); eight pages (from 4.3 to 11) for France (16 weeks after the announcement); 12 pages (between 5 and 15) for Italy (14 weeks after announcement); and 4.7 pp (between 4.1 and 5.1) for Germany (11 weeks after publication).


Overall, study results showed that government-assigned immunization compliance criteria or certificates in Canada, Italy, Germany and France had a drastic and statically relevant impact on COVID-19 vaccine uptake. In addition, these impacts were associated with a significant increase in first-dose immunizations in the first few weeks after the announcement of the mandate and long-term cumulative improvements compared to the pre-announcement pattern. This includes strong DID evidence based on differences in mandate release timing within the same nation, Canada. The present results were similar in size to those of other researchers using other methods and data samples.

The mandate’s estimated impact on vaccine uptake varies by province in Canada, with the timeframe for clearance and implementation and the proportion of unvaccinated individuals all playing a role. In addition, it also varied in France, Italy and Germany. The authors noted that this study could benefit from further investigation that justifies this variability and several potentially critical issues.

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