As the Scottish Parliament prepares to vote, here is a discussion of vaccine passports.
But I am going to break the first rule of the twittersphere - my apologies - and write a nuanced thread.
Because the issues are many and the arguments complex...
The effects of vaccine passports are very dependent on levels of social trust. In countries and in groups where trust is high - where people believe the authorities are acting for their good - then passports can have a positive impact. Equally, as our own data shows...
Amongst group who are generally positive towards vaccines, the passport can give them a reason to get on with it. That's why, as in France, you see an upsurge of take-up when passports are first introduced. That's the upside. But there is another side to the story...
In countries and groups where there is low trust, the passports can be seen as a form of compulsion, making vaccination something that is done 'to us' rather than 'for us' and increasing alienation/opposition. In already divided societies, passports increase polarisation.
That is, while you might get an initial upsurge (which is important, because getting vaccinated early matters), you limit the ultimate number who you can persuade to get vaccinated. Hence you leave pockets of low vaccination and hence of high infection in some communities.
So on vaccine uptake, passports have a mixed effect - neither clearly positive nor clearly negative, different in different countries and communities as a function of trust and initial attitudes. Regarding their effect on infection transmission, the issues are also complex.
Certainly if people are fully vaccinated it reduces the probability of getting infected and passing on infections. It therefore makes venues safer and gives confidence to more vulnerable members of the community that they can attend and participate.
Both of these considerations are important. It is not enough to reopen venues, there needs to be an inclusive reopening from which all sections of society feel equally able to profit. A reopening which leaves some isolated at home is unacceptable.
But equally, vaccines do not provide total protection against infection and transmission. If the impression is given that passports are a total solution and that people are entirely safe once fully vaccinated, then it may lead to riskier behaviours...
which increase infection/transmission risk and hence undermine the benefits of the vaccines. The paradox is that if we over-state the safety provided by vaccine passports we make people less safe. So, for safety as for take-up the effects are mixed and are contingent
Overall, then, vaccine passports may - in some circumstances - contribute to a strategy of reducing infection and reopening society safely, but they are deeply problematic as the centrepiece, or (still worse) as the sole piece of such a strategy.
Rather, we need to lay more emphasis on other aspects of a comprehensive and effective strategy. In terms of roll out, we must start (as the WHO and many others have all insisted) with community engagement: going to people rather than waiting for people to come to you...
Vaccination centres in communities, in schools, in colleges. Experts available to address concerns (about fertility, pregnancy etc.). Support to overcome barriers to vaccination (e.g. loss of pay). Simple things, but proven to be effective especially in low trust communities.
In terms of safety, we need to lay much more emphasis on making environments safe. Research on large indoor events shows that they CAN be safe if there is adequate ventilation and adequate hygiene measures. Many venues are instituting these, but not all...
... and it is too important to be left to chance. We could and should make opening of venues contingent upon satisfying Covid protection standards. This would not only be good for public health but also for the economy - people will be more willing to use venues if they are safe.
What is more, a focus on the environment does not bring the downside of an emphasis on individual vaccination - the issues of civil liberties, of social division and social exclusion, or resistance and alienation...
In conclusion, what we need is an overall Covid protection strategy. We must put more emphasis on engagement and on venue safety and make sure we don't put all our eggs in the passport basket.

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More from @ReicherStephen

14 Sep
It's deja vu all over again:
a year ago to the week, on 21 Sept 2020, SAGE called for action to bring down infections.
They were ignored, infections and hospitalisations went through the roof so hard restrictions were needed - hence the awful Christmas and winter were suffered...
This week, SAGE again advises that, without action, infections and hospitalisations will again run out of control. But our learn nothing Government responds by saying they will do nothing for now but wait and watch. And as they wait our hopes for this Christmas and winter fade
The irony is that, thanks to the vaccine, the measures needed now are far less intrusive than last year: ensure that spaces are well ventilated and safe, work from home where possible, support people to self isolate, wear masks in crowded spaces...
Read 5 tweets
12 Sep
Vaccine passports ditched in England.
I think this is the right decision. They are a double edged sword.
Passports accelerate uptake in the willing but accentuate opposition in the sceptical.
They increase safety but can increase complacency.
If you don't introduce passports, the key question is what are you going to do instead to push up vaccination and push down infections.
There are two obvious steps. The first is to increase community engagement on vaccines - go to people, talk to people, respect their concerns.
This has always been the best way to maximise uptake.
The 2nd step is to make environments safe. Require that they meet Covid standards in order to be open to the public. We don't allow restaurants with dirty kitchens to trade, why should we allow venues with dirty air to open?
Read 6 tweets
6 Sep
We have let young people down in so many ways during this pandemic:
we don't keep them safe at school
we ignore their mental health problems
and we TWICE screwed up their examinations
this is so much more frustrating because it was entirely predictable…
Earlier this year, we met with the DfE to raise three issues.
First, we pointed out that, without robust checking, both within and between schools, teacher assessment can lead to enhanced inequalities of class, race and gender. That must be addressed.
Second, we argued that grades must be accompanied by a record of the context in which they were achieved: how much school had been missed, ability to study at home, illness and bereavement in the family and so on.
Read 12 tweets
2 Sep
So Scotland is going for vaccine passports for large events and England is likely to follow.
Is this the right decision?
The evidence suggests that the effects of passports very much depend on social trust... Image
In high trust countries (e.g. Denmark) and high trust communities, passports can accelerate uptake amongst those inclined to get vaccinated but who haven't yet got round to it. As vaccination goes up, so the need for the passport declines and they can be dropped Image
In lower trust countries and communities (e.g. the black community) passports can increase the sense that the state is trying to control us and increase resistance to vaccination. It alienates the very people you need to win over. Image
Read 8 tweets
1 Sep
It is important to be accurate about what our study on vaccine passports shows. Our key point is that they have different effects on different populations and overall lead to a polarisation of positions.
So, for those who are initially positive...…
passports make them even more positive and give people a good reason to do what they intended to do anyway (but might not have got around to). Since most of the population are positive to vaccines, the overall effect is to accelerate take-up...
However, for those who are initially sceptical, passports for everyday activities make them even more sceptical (increasing the sense that vaccines are about control and playing into the narratives of anti-vaxxers) and decreasing willingness to get jabbed.
Read 12 tweets
30 Aug
Yesterday I tweeted about the need about the urgent need for more psychologists: the NHS has a mere 8,000 clinical psychologists. Today we learn there are 8 MILLION people needing care. An impossible load of 1,000 people per psychologist.…
What is more, roughly a quarter of these are under 16. Children in huge distress but lacking the support they need (we have had special @IndependentSage briefings to highlight the impact of the pandemic on youth). Yet again we are letting young people down.
The only response must be a major expansion of clinical psychology trading. Where is the emergency plan to expand mental health provision? When will we end the Cinderella status of psychology in an already underfunded NHS?
Read 4 tweets

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