From an early stage in the pandemic, Covid Passes have provoked intense public debate. We first wrote about the concept in August 2020. Since then, they have been introduced in numerous countries worldwide, generating real-world evidence of their impact. Two years after the UK first went into lockdown, we have tried to understand how effective they have been, how this matched up to our initial expectations and how this translated into government policy in England.
We have consistently argued that a global pandemic requires unconventional but practical tools to help maintain normality as far as possible. Covid Passes are one such tool, but their use was emphatically rejected by much of the British political class, before any detailed policy research by government had taken place. This approach to thorny but surmountable policy debates is problematic. Many public service innovations come with difficult questions, and it is a concerning reflection of state capacity if innovations are passed by, or under-used, due to a failure to engage properly with the evidence and trade-offs.
What we said then and what we know now
Covid Passes were a consistent theme of our Covid-19 policy programme in 2021. At the start of last year, we took a bold stance on what were then ‘health passports’. We suggested they should be used to help reopen the economy, for global travel, to reduce restrictions for the vaccinated and as a tool of pandemic preparedness.
A year on, our analysis of the evidence suggests that on balance, they are a useful tool to mitigate public health risks from Covid. Despite their widespread usage, they remain under-studied, and too few governments have published data and research relating to the implementation of Covid passes. But while the evidence available is not exhaustive, it’s robust enough to provide an indication of where they’ve been most effective and how to use them well in future.
Covid Passes aided the pandemic response in two ways. First, they acted as a vaccine incentive (as shown by the research from the University of Oxford and Bruegel), thus reducing hospitalisations, deaths and economic instability. Second, they helped to manage direct transmission risk (see the evidence gathered through the UK’s Events Research Programme). The latter role was what we emphasised in our early analysis, but evidence shows we severely underestimated their role as a vaccine incentive.
Covid Passes proved themselves a valuable pandemic response tool for three main reasons. First, they are versatile. They were switched on and off easily and supported both strict and relaxed restrictions (i.e., once introduced, the requirement to use them could be imposed, extended to more people and settings, and revoked quickly), depending on the epidemiological needs of society. This was seen in virtually every country they were used in – most notably Israel, Germany, France and Italy. Second, they were reliable. Vaccines reduce the rate of hospitalisation, mortality and symptomatic disease and negative tests are a robust way of confirming low risk of infection or transmission, especially in high risk settings.
Third, they helped to achieve multiple policy objectives simultaneously. Covid Passes proved much more proportionate than lockdowns, and therefore allowed policymakers to target different policy objectives more specifically. Where Covid Passes increased vaccine uptake or reduced transmission, they reduced hospitalisations and boosted the economy, or they formalised rapid testing and could thus be used to enforce mandatory testing.
But while Covid Passes can be an effective risk management tool, as with all policies, they come with trade-offs. They will not totally eliminate transmission and their impact varies depending on the exact design. Covid Passes are more likely to be effective at reducing the risk of transmission when they include testing, but this is less practical on a mass scale due to the testing infrastructure required. Covid Passes can secure a consensus in democratic societies, but a vocal minority is likely to oppose them. The alternative to Covid Passes could be lengthy closures with high financial costs, but a Covid Pass could also impose costs on business that need to hire additional staff.
To better understand their impact, it’s worth considering what life without Covid Passes would have been like. There is a small but significant body of evidence to suggest that vaccination rates, hospitalisations and economic stability in France and Italy would have been much worse had Covid Passes not been implemented.
However, a major limitation of a Covid Pass was that their success as a vaccine incentive and a risk management tool was not universal. Vaccine uptake, the extent of domestic application of the Pass, enforcement of the Pass and testing infrastructure were all variables that seriously impacted their effectiveness.
The Covid Pass debate and implementation in England
The performance of the UK Government on Covid Passes was mixed. On the one hand, the actual development of the NHS App Covid Pass and the Verifier app was fast and relatively unproblematic. The Government also invested in the most extensive research programme in the world at the time on Covid Passes which has provided a wealth of data on how they could be used at large events, much of it promising.
Adding the Covid Pass to the NHS App also stimulated a remarkable increase in engagement with health technology. The NHS App had limited uptake during its first year of availability, but embedding the Covid Pass into the app prompted 18 million additional users to download the app. By the end of 2021, 39% of the population had downloaded the NHS App, versus 7% in its first year (2018). This led to greater use of the app’s other features: more than half of the 1.1 million GP appointments made via the app since its launch four years ago came in the last six months of 2021.
Yet the Covid Pass played only a small part in the UK pandemic response, and very briefly. The political debate focused on abstract questions of liberty and state coercion, tempered with some ‘bad for business’ rhetoric. The Government still rolled them out for large events for a limited time, but the nature of the public debate certainly increased the amount of political capital required to use them extensively.
This debate culminated in the most significant backbench revolt of this Parliament. 100 Conservative MPs voted against the party whip to try and prevent the very limited use of the NHS App Covid Pass for large events.
The debate ignored the role Covid Passes could play in formalising mass testing, the booster rollout and the clear decline in economic activity as the Omicron variant took hold. At which time, only 57% of adults were taking rapid lateral flow tests. Incentivising mass testing using Covid Passes to help tackle innumerous empty pubs and restaurants was severely underestimated. To further highlight the disconnect, a majority of the public were supportive of Covid Pass use domestically.
Such opposition may not be unique to the Covid Pass debate: many innovations come with difficult ethical questions, not least digital identity and new types of data sharing. The prospect of future innovations being stalled due to an obsession with dogma, minimal engagement with the evidence and a lack of understanding around trade-offs is a concerning reflection of the UK’s diminished state capacity.
Ultimately, Covid Passes proved to be helpful tools during the pandemic and many of the concerns cited by critics have not been borne out in the evidence. (One frequent concern was that, once introduced, Covid Passes would never be withdrawn, and would be extended to other communicable diseases – this has not happened.) It is also true that some of the benefits cited by supporters have not been completely borne out in evidence. But on the whole, benefits from Covid Passes were seen around the world, whereas in England, their use was accompanied – and arguably inhibited – by a polarised public discourse.
The need for them may no longer be as acute but there are lessons to be learned from this policy debate for future innovations in public services, especially when the stakes – like responding to a global pandemic - are so high.
We will be publishing detailed evidence and analysis on Covid Passes over the coming weeks.