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MONTREAL — COVID-19 vaccine passports in Quebec and Ontario did little to convince the unvaccinated to get the jab and did not significantly reduce inequalities in vaccination coverage, a new peer-reviewed study has found.

The passports, which forced people to show proof of vaccination to enter places such as bars and restaurants, were directly responsible for a rise of 0.9 per cent in the vaccination rate in Quebec and 0.7 per cent in Ontario, says Jorge Luis Flores, a research assistant at McGill University and lead author of the paper published Tuesday in the CMAJ Open journal.

Compared to wealthier parts of Quebec and Ontario, low-income neighbourhoods in both provinces tended to have higher rates of COVID-19 and lower vaccine coverage, he said in an interview. Areas in Quebec with large racialized populations also had lower vaccination rates, though the opposite was true in Ontario. 

"What we saw was that, overall, the vaccine passport had very little impact on reducing those inequalities," Flores said. 

All 10 provinces and Yukon introduced vaccine passport systems in 2021, justifying them as a tool to avoid further generalized lockdowns and increase vaccination rates, though some provinces allowed people to show a recent negative COVID-19 test instead of proof of vaccination.

The passports were discontinued across Canada by the spring of 2022.

The study looked at vaccine uptake trends in the weeks before the announcement of vaccine passports in Quebec and Ontario, using them to simulate what would have happened had those provinces not imposed the passport system.

In the 11 weeks after the provinces announced the passports, vaccination rates in both provinces rose by five percentage points. But after considering the uptake trends, researchers concluded the passports were directly responsible for a rise of less than one per cent in vaccination rates, says Mathieu Maheu-Giroux, study co-author and McGill University professor who studies public health.

"We only looked at one part of the equation — vaccine passports could have still reduced transmission," Maheu-Giroux said in an interview. "But in terms of vaccine uptake, we saw that it had a rather small effect in convincing additional people to get vaccinated." 

The study authors say the impact of vaccine passports may have been muted because of already high vaccination rates — around 82 per cent of Ontario and Quebec residents over the age of 12 were already vaccinated when the passports were announced.

Kim Lavoie, co-director of the Montreal Behavioural Medicine Centre, who was not involved in the research, says that in order to increase vaccination rates, it's important to understand why people aren't getting vaccinated.

"You can't just lump those who aren't vaccinated in the same pool, because the reasons why they're not getting the vaccine might be different," she said in a recent interview, adding that some people may not have had time to get vaccinated, while others mistrusted the medical system.

The passport strategy was based on the idea that people's desire to frequent places like restaurants was stronger than their resistance to the vaccine, she said. For the approximately eight to 10 per cent of the population that was strongly resistant to vaccination, that strategy wouldn't work, she added.

"There's no restaurant that they're going to want to go to that's going to make them override their really deeply entrenched ideas about the safety, for example, and necessity of vaccines," she said.

Lavoie said it's important for researchers to study the lessons learned during the height of the COVID-19 pandemic so they can inform governments on how to improve. 

Flores said the study shows the "need for other policies that are going to be able to reach those people who are either opposed to vaccination, or who faced structural barriers that prevented them from getting vaccinated."

The study estimates that the passports led to a larger increase in vaccination rates among young people than older people. Researchers say the passports directly led to a rise of 2.3 percentage points in Quebec and 1.3 percentage points in Ontario in the vaccination rates for people 12 to 17 — the least vaccinated group in both provinces.

Vaccine passports had the smallest effect on people 60 and over — the most vaccinated age group — increasing rates by 0.1 percentage points in both provinces, the study estimates.

In Quebec, the study estimates that vaccine passports increased vaccine coverage in the lowest-income areas by 1.1 percentage points, compared with 0.7 percentage points in the wealthiest areas.

In Ontario, the increase was comparable — between 0.7 percentage points and 0.8 percentage points — across all income groups. 

The study found similar results when it looked at the proportion of the population in each area that is racialized, finding no clear trend in Quebec and increases of between 0.7 percentage points and 0.8 percentage points in Ontario. 

This report by The Canadian Press was first published Oct. 24, 2023.

Jacob Serebrin, The Canadian Press