Pillar 8
Public Health, Health Systems and Social Policy Impacts

COVID-19 proof-of-vaccination requirements (aka vaccine passports) were mandated throughout the fall of 2021 for nonessential businesses and venues in Canada’s 10 provinces. The CoVaRR-Net Social Policy research team investigated whether these mandates had an impact on vaccine uptake and if so, what that impact was by age group.

The research team found that even the announcements of vaccine mandates were associated with a rapid and significant increase in first dose uptake, particularly in people under 50 years old. The team estimated that nationally, 290,168 additional people received their first dose in the seven weeks after provinces announced proof-of-vaccination policies. The number of vaccinations increased by 17.5% from the level that would have been expected without these policies. However, the team discovered that these behavioral changes were short-lived. Uptake returned to preannouncement levels—or lower—in all age groups within six weeks, despite mandates remaining in place for at least four months. This decline occurred earlier and was more apparent among adolescents ages 12–17.

This study provides novel age-specific evidence showing that proof-of-vaccination mandates led to an immediate, significant increase in national first dose coverage. The mandates were particularly effective for increasing vaccination coverage in younger to middle-aged adults. Proof-of-vaccination mandates may be effective short-term policy measures for increasing population vaccination coverage, but their impact may differ across age groups. We recommend that policymakers consider the differential responses of age groups when developing future vaccination mandates, and schedule mandates and allocate health system resources accordingly. For example, officials should consider designing proof-of-vaccination requirements around young and middle-aged adults who are more likely to socialize and work outside of their homes, as well as school-aged children who come into close personal contact daily. To support access to vaccination, this may mean offering vaccination appointments in school or other community-based settings and offering appointments during evenings or weekends. The research team also recommends that policymakers carefully consider the implementation dates and effective periods for such policies to maximize their impact.


The team estimated changes in first dose uptake in each of the seven weeks following the announcement of proof-of-vaccination requirements, by comparing uptake to that in previous weeks. Taking into account the fact that provinces implemented vaccine mandates at different times, researchers used publicly available provincial data on the weekly number of Canadian adults vaccinated against COVID-19 by age group for this analysis.

The Impact Of Provincial Proof-Of-Vaccination Policies On Age-Specific First-Dose Uptake Of COVID-19 Vaccines In Canada. Tiffany Fitzpatrick, Cheryl A. Camillo, Shelby Hillis, Marin Habbick, Monika Roerig, Nazeem Muhajarine, Sara Allin. Health Affairs. 42, NO. 11 (2023): 1595–1605; https://www.healthaffairs.org/doi/abs/10.1377/hlthaff.2022.01237