PT  - JOURNAL ARTICLE
AU  - Anato, Jorge Luis Flores
AU  - Ma, Huiting
AU  - Hamilton, Mackenzie A.
AU  - Xia, Yiqing
AU  - Harper, Sam
AU  - Buckeridge, David
AU  - Brisson, Marc
AU  - Hillmer, Michael P.
AU  - Malikov, Kamil
AU  - Kerem, Aidin
AU  - Beall, Reed
AU  - Wagner, Caroline E.
AU  - Racine, Étienne
AU  - Baral, Stefan
AU  - Dubé, Ève
AU  - Mishra, Sharmistha
AU  - Maheu-Giroux, Mathieu
TI  - Impact of a vaccine passport on first-dose SARS-CoV-2 vaccine coverage by age and area-level social determinants of health in the Canadian provinces of Quebec and Ontario: an interrupted time series analysis
AID  - 10.9778/cmajo.20220242
DP  - 2023 Sep 01
TA  - CMAJ Open
PG  - E995--E1005
VI  - 11
IP  - 5
4099  - http://www.cmajopen.ca/content/11/5/E995.short
4100  - http://www.cmajopen.ca/content/11/5/E995.full
SO  - CMAJ2023 Sep 01; 11
AB  - Background: In Canada, all provinces implemented vaccine passports in 2021 to reduce SARS-CoV-2 transmission in non-essential indoor spaces and increase vaccine uptake (policies active September 2021–March 2022 in Quebec and Ontario). We sought to evaluate the impact of vaccine passport policies on first-dose SARS-CoV-2 vaccination coverage by age, and area-level income and proportion of racialized residents.Methods: We performed interrupted time series analyses using data from Quebec’s and Ontario’s vaccine registries linked to census information (population of 20.5 million people aged ≥ 12 yr; unit of analysis: dissemination area). We fit negative binomial regressions to first-dose vaccinations, using natural splines adjusting for baseline vaccination coverage (start: July 2021; end: October 2021 for Quebec, November 2021 for Ontario). We obtained counterfactual vaccination rates and coverage, and estimated the absolute and relative impacts of vaccine passports.Results: In both provinces, first-dose vaccination coverage before the announcement of vaccine passports was 82% (age ≥ 12 yr). The announcement resulted in estimated increases in coverage of 0.9 percentage points (95% confidence interval [CI] 0.4–1.2) in Quebec and 0.7 percentage points (95% CI 0.5–0.8) in Ontario. This corresponds to 23% (95% CI 10%–36%) and 19% (95% CI 15%–22%) more vaccinations over 11 weeks. The impact was larger among people aged 12–39 years. Despite lower coverage in lower-income and more-racialized areas, there was little variability in the absolute impact by area-level income or proportion racialized in either province.Interpretation: In the context of high vaccine coverage across 2 provinces, the announcement of vaccine passports had a small impact on first-dose coverage, with little impact on reducing economic and racial inequities in vaccine coverage. Findings suggest that other policies are needed to improve vaccination coverage among lower-income and racialized neighbourhoods and communities.