The impact of COVID-19 certification mandates on the number of cases of and hospitalizations with COVID-19 in the UK: A difference-in-differences analysis

Background: Mandatory COVID-19 certification, showing proof of vaccination, negative test, or recent infection to access to public venues, was introduced at different times in the four countries of the UK. We aim to study its effects on the incidence of cases and hospital admissions.

Methods: We performed Negative binomial segmented regression and ARIMA analyses for four countries (England, Northern Ireland, Scotland and Wales), and fitted Difference-in-Differences models to compare the latter three to England, as a negative control group, since it was the last country where COVID-19 certification was introduced. The main outcome was the weekly averaged incidence of COVID-19 cases and hospital admissions.

Results: COVID-19 certification led to a decrease in the incidence of cases and hospital admissions in Northern Ireland, as well as in Wales during the second half of November. The same was seen for hospital admissions in Wales and Scotland during October. In Wales the incidence rate of cases in October already had a decreasing tendency, as well as in England, hence a particular impact of COVID-19 certification was less obvious. Method assumptions for the Difference-in-Differences analysis did not hold for Scotland. Additional NBSR and ARIMA models suggest similar results, while also accounting for correlation in the latter. The assessment of the effect in England itself leads one to believe that this intervention might not be strong enough for the Omicron variant, which was prevalent at the time of introduction of COVID-19 certification in the country.

Conclusions: Mandatory COVID-19 certification reduced COVID-19 transmission and hospitalizations when Delta predominated in the UK, but lost efficacy when Omicron became the most common variant.