Covid-19 status certification - UK Parliament

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Covid-19 status certification - UK Parliament
By Bukky Balogun,
Daniel Ferguson,
Roger Tyers
                    Covid-19 status certification
28 July 2021

                    Summary
                    1  What is Covid-19 status certification?
                    2 Policy background
                    3 The NHS Covid Pass
                    4 Scientific evidence
                    5 Business and vaccine policies
                    6 Considerations for implementation and use
                    7 International Travel

                    commonslibrary.parliament.uk
Number CBP 9288            Covid-19 status certification

Image credit
Attribution: texting image 1490691 image by Dean Moriarty – terimakasih0
from Pixabay. / image cropped. Free for commercial use. No attribution
required. Wednesday 28 July 2021.
Contributing authors
Georgina Hutton, Industry response;
Joanna Dawson, Data protection and privacy

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                           2                                           Commons Library Research Briefing, 28 July 2021
Covid-19 status certification

Contents

Summary                                                                                   6

1       What is Covid-19 status certification?                                            9

2       Policy background                                                                11

2.1     Government review on certification                                              12
2.2     Public Administration and Constitutional Affairs Committee inquiry              15
2.3     Government report on certification                                               17
2.4     Certification requirements for nightclubs and large capacity venues 18
2.5     Exemptions                                                                      19
2.6     Response to proposals                                                           20

3       The NHS Covid Pass                                                              24

3.1     Using the NHS Covid Pass in England                                             24
3.2     Obtaining an NHS Covid Pass in England                                          25
3.3     Obtaining proof of Covid-19 status for clinical trial participants              26
3.4     Obtaining proof of Covid-19 status in devolved nations                          27

4       Scientific evidence                                                             28

4.1     Immunity                                                                        29
4.2     Vaccine effectiveness                                                           32
4.3     Accuracy and availability of Covid-19 testing                                   37
4.4     Variants of concern                                                             39

5       Business and vaccine policies                                                   41

5.1     Overview of the legal framework                                                 41
5.2     Employment law                                                                  43
5.3     Equality law                                                                    45
5.4     Data and privacy concerns                                                       47
5.5     Human rights law                                                                49

6       Considerations for implementation and use                                       52

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6.1     Standards for a certification system                                            52
6.2     Impact on other Covid-19 measures                                               53
6.3     Threshold for introduction and removal                                          55
6.4     Cost                                                                            57
6.5     Forms of certification and accessibility                                        58

7       International Travel                                                            59

7.1     Current rules for inbound travel                                                59
7.2     Outbound Travel                                                                 62

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Summary

Covid-19 status certification involves the use of testing, infection or
vaccination information to demonstrate, in different settings, that a person
has a lower risk of transmitting the Covid-19 virus to others. 1

Certification would evidence that a person has acquired some degree of
immunity to the Covid-19 virus through prior infection or vaccination.
Certification could also be provided when a person uses a recent negative
test result to show that they do not have active infection.

This paper discusses a range of issues relating to the implementation and use
of certification in England.

Domestic use

In its Spring 2021 roadmap, the Government committed to reviewing “whether
Covid-status certification could play a role in reopening our economy,
reducing restrictions on social contact and improving safety”.

As part of the review, led by the Cabinet Office, the Government considered
evidence from academics, industry representatives and civil liberties groups.

In July 2021 the Government published the Covid-status certification review
report. This set out that the Government would not mandate the domestic
use of certification as a condition of entry for visitors to any setting at the
present time. However, the report raised the possibility of “keeping events
going and businesses open if the country is facing a difficult situation in
autumn or winter”. The report said that the Government would keep “the
wider application of certification under consideration”.

The Government said that it would make the NHS Covid Pass available as a
means for individuals to demonstrate their Covid status, and for
organisations from Step 4 of England’s Covid-19 roadmap.

On the 19 July 2021 England entered Step 4 of the Covid-19 roadmap, at which
point the majority of Covid-19 restrictions ended. Speaking at a press
conference on the same day, Prime Minister Boris Johnson expressed concern
about the continuing risk of transmission and announced that from
September, full vaccination would be a condition of entry to nightclubs and
other large capacity venues. 2

1
    Cabinet Office, Covid-19 Response- Spring 2021 (Roadmap), 22 Feb 2021
2
    BBC News, Covid: Two jabs needed to enter nightclubs from September, 20 Jul 2021

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As with other aspects of Covid-19, the scientific evidence with regard to
certification is far from complete. Uncertainty remains about the extent and
duration of immunity provided by natural infection or vaccination, and the
extent to which these reduce the rate of transmission. It therefore remains
unclear whether certification, as presently proposed, would be a reliable and
consistent indicator of a person’s Covid-19 status or (in)ability to transmit the
Covid-19 virus to others.

Additionally, uncertainty remains about whether the proposed methods of
certification can be delivered from an operational perspective.

These issues been considered in reports published by scientific institutions,
such as the Ada Lovelace Institute and the Royal Society.

Similarly, the Public Administration and Constitutional Affairs Committee has
set out its own standards for a certification system in a June 2021 report.

The response to the proposed introduction of certification requirements for
domestic purposes has been varied.

The Royal College of General Practitioners has said that it has no objection in
principle to the use of certification but stressed the importance of detail on
implementation. Some music and events industry stakeholders have
supported the introduction of a temporary industry-wide certification scheme
as a route to lifting capacity restrictions on venues.

Civil liberties groups have raised concerns about what they consider to be
unwarranted infringement of people’s privacy, whilst equality campaigners
have highlighted the potential for discrimination against those unable, or
unwilling, to provide certification. Business and industry stakeholders,
particularly in the hospitality sector, have raised concerns about the need for
a Covid-19 certification scheme and the costs and practicalities involved in
implementing such a scheme.

Employment and equality

At present, there is no legal obligation for a business to require its staff or
customers to show an NHS Covid Pass before entering their premises. The
guidance on working safely during Covid-19 only recommends the use of the
Pass for nightclubs and other large crowded settings where people will be in
close proximity. The Government has indicated that it might legislate to make
this a legal requirement towards the end of September 2021.

Businesses may decide to require staff or customers to show their vaccination
status using the NHS Covid Pass. If they decide to do so, businesses will need
to ensure they are complying with employment and equality legislation. If an
employer dismisses an employee who is not or cannot be vaccinated, it could
face a claim for unfair dismissal or unlawful discrimination.

The Government has legislated to make vaccination a condition for working in
a care home, with limited exceptions for people under the age of 18 and those

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who cannot be vaccinated for clinical reasons. These rules come into effect on
11 November 2021.

Travel

The NHS Covid Pass can be used during outbound and inbound travel.

A number of countries exempt fully vaccinated travellers from a requirement
to quarantine on arrival. Some of these countries accept the NHS Covid Pass
as evidence that a person is fully vaccinated.

From 19 July 2021, people arriving in the UK from amber list countries (except
France) are no longer required to quarantine or test on Day 8 if they are fully
vaccinated in the UK. The guidance on entering England says people can use
the NHS Covid Pass to show their vaccination status.

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1   What is Covid-19 status certification?

    In simple terms, Covid-19 status certification is a means through which an
    individual can demonstrate that they are lower risk of transmitting the Covid-
    19 virus to others.

        Covid-19 terminology: the virus and the disease
        Covid-19 disease is an infectious disease caused by the Covid-19 virus. The
        symptoms of Covid-19 disease include a high temperature, a continuous cough
        and a loss or change to sense of smell or taste.

        The scientific name of the virus that causes Covid-19 disease is severe acute
        respiratory syndrome coronavirus 2, abbreviated to SARS-CoV-2.

        SARS-CoV-2 is one type of coronavirus- a specific family of viruses with similar
        features.

    The Royal Society captured this succinctly by recommending that a
    certification scheme be able to confirm that:

    •      A person is not infectious or,
    •      A person is immune to Covid-19 illness and will not become infectious 3

    In practical terms, certification would evidence at least one of the following:

    •      A person has acquired immunity through a full course of a Covid-19
           vaccine
    •      A person has acquired natural immunity through infection
    •      A person has recently produced a negative test result

    Certification through the NHS Covid Pass will be enabled by:

                 a. Full vaccination: 14 days after completing a full course of
                 vaccination, whether that requires two doses or one dose (according
                 to the MHRA authorised schedule);

    3
        The Royal Society, Twelve criteria for the development and use of Covid-19 vaccine passports, 14 Feb
        2021

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            b. Testing: evidence of a negative polymerase chain reaction (PCR)
            or lateral flow test taken with 48 hours of entry to a venue, with both
            on-site (where available) and at-home tests being accepted; and

            c. Natural immunity: proof of a positive PCR, lasting for 180 days
            from the date of the positive test and following completion of the
            self-isolation period. 4

Certification has been described using other terms, such as “immunity
passport”.

Another term, “vaccine passport”, which evidences that a person has
received a full course of a Covid-19 vaccination, should be considered
separately as it does not make use of testing data or naturally acquired
immunity in characterising a person’s status.

4
          Cabinet Office, Covid-Status Certification Review: Report, Jul 2021

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2   Policy background

    The Government’s position on the potential use of certification has developed
    across the course of the pandemic.

    In January 2021, the Minister for Covid-19 vaccine deployment, Nadhim
    Zahawi, said that the Government had ‘no plans to introduce Covid-19 vaccine
    passports’. 5 Mr Zahawi indicated that vaccine record cards would be issued
    to patients with details of vaccination on receipt of a Covid-19 vaccine, as
    with other vaccination programmes. Mr Zahawi said that this would “not
    constitute an immunity passport and [would] not be used as a form of
    identification”.

    In the February 2021 Covid-19 roadmap, the Government said that it would
    review the role that certification might play in reopening the economy,
    reducing restrictions on social contact and improving safety. 6

    In an April 2021 update to the review, the Government indicated that
    certification might be introduced for domestic use and to facilitate
    international travel. 7

    Providing evidence to the Public Administration and Constitutional Affairs
    Committee (PACAC) in May 2021, the Minister for the Cabinet Office, Michael
    Gove set out the potential value that certification might have in terms of risk
    reduction:

                  Certification can be a tool that means we reduce the risk of
                  transmission and make venues and activities safer, but both
                  Professor Wolff and David Davis are right to stress that there is a
                  balance here. You can never make any venue or activity completely
                  safe and quite rightly, as has been pointed out, even two doses of
                  vaccination does not automatically inoculate someone completely
                  against the risk of infection, transmission or indeed ill health. What it
                  does do is dramatically reduce the risk. If one can have confidence
                  that people in a venue have been vaccinated, or have immunity in
                  another way or have recently received a valid test that confirms their
                  negative status, you know that that venue will be safer. Set against
                  that of course must be the question about the cost and the hassle
                  factor that certification will involve. There always must be a balance

    5
         PQ 133629, 25 Jan 2021
    6
         Cabinet Office, Covid-19 Response- Spring 2021 (Roadmap), 22 Feb 2021
    7
         Cabinet Office, Roadmap Reviews: Update, 5 Apr 2021

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                    between the two and, in that sense, I think both previous witnesses
                    were right to stress that. 8

      In July 2021, the Government published a report of its findings from the review
      on certification, announcing that it would not mandate the use of certification
      in domestic settings at the present time, but did raise the possibility of it
      providing a means of “keeping events going and businesses open if the
      country is facing a difficult situation in autumn or winter”. 9

      On the 19 July 2021 England entered Step 4 of the Covid-19 roadmap, at which
      point the majority of Covid-19 restrictions ended. Speaking at a press
      conference on the same day, Prime Minister Boris Johnson expressed concern
      about the continuing risk of transmission and announced that from
      September, full vaccination would be a condition of entry to nightclubs and
      other large capacity venues. 10

      The proposed introduction and use of domestic certification has been highly
      controversial. Some have supported the proposals for its potential benefit in
      enabling a wider reopening of the economy and supporting the public health
      response to Covid-19. Others have considered it to be an infringement on
      personal liberty. Business and industry leaders have also expressed concern
      about logistical and financial barriers to use whilst equalities groups have
      highlighted the potential for discrimination against those who are unable or
      unwilling to make use of certification.

2.1   Government review on certification

      In February 2021, the Government published the Spring 2021 roadmap (the
      roadmap) in which it set out plans to lift Covid-19 restrictions. 11 Within this,
      the Government committed to reviewing the potential role of certification:

                    The Government will review whether COVID-status certification could
                    play a role in reopening our economy, reducing restrictions on social
                    contact and improving safety. This will include assessing to what
                    extent certification would be effective in reducing risk, and the
                    potential uses to enable access to settings or a relaxation of COVID-
                    Secure mitigations. 12

      Acknowledging the potential wider implications of Covid status certification,
      the Government said that it would:

      8
           Public Administration and Constitutional Affairs Committee, Oral evidence: Covid 19 vaccine
           certification, 27 May 2021, HC 42- II, 2021-22, para 72
      9
           Cabinet Office, Covid-Status Certification Review: Report, Jul 2021
      10
           BBC News, Covid: Two jabs needed to enter nightclubs from September, 20 Jul 2021
      11
           Cabinet Office, Covid-19 Response- Spring 2021 (Roadmap), 22 Feb 2021
      12
           Cabinet Office, Covid-19 Response- Spring 2021 (Roadmap), 22 Feb 2021

      12                                                       Commons Library Research Briefing, 28 July 2021
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                … also consider the ethical, equalities, privacy, legal and
                operational aspects of this approach and what limits, if any, should
                be placed on organisations using certification. It will draw on
                external advice to develop recommendations that take into account
                any social and economic impacts, and implications for
                disproportionately impacted groups and individuals’ privacy and
                security. 13

The review’s Terms of Reference set out its scope:

            •     Whether there is a case for introducing COVID-status certification,
                  including:

                      – the extent to which certification would be effective in
                        reducing risk, including evidence on the likely clinical and
                        behavioural impacts in different settings taking
                        consideration of emerging evidence on vaccine efficacy,
                        effectiveness, and effect on transmission;
                      – the extent to which certification would be effective in
                        reopening parts of the economy and society more quickly
                        and more safely than otherwise;
                      – the ethical, equalities, privacy, legal and operational
                        aspects of COVID-status certification;
                      – the implications of certification for those unable or
                        unwilling to get vaccinated or tested, including the
                        equalities implications; and
                      – the impacts of certification on those groups
                        disproportionately affected by the pandemic.

            •     The mechanics of how COVID-status certification would work,
                  including:

                      – how COVID status would be conferred, including through
                        vaccination and the use of different testing technologies;
                      – the mechanisms through which COVID-status could be
                        demonstrated, including technological and non-
                        technological options.
                      – what limits, if any, should be placed on which
                        organisations could use certification for which purposes;
                        and
                      – for how long the use of COVID-status certification may be
                        relevant. 14

13
     Cabinet Office, Covid-19 Response- Spring 2021 (Roadmap), 22 Feb 2021
14
     Cabinet Office, Terms of Reference: COVID-status Certification Review, last updated 5 Apr 2021

13                                                       Commons Library Research Briefing, 28 July 2021
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As part of the review, the Government held a consultation between 15 and 29
March 2021 and invited stakeholders to submit evidence. Over 50,000
responses were submitted. 15

On 5 April 2021, the Government published an update to the review and said
that “Covid-status certification could have an important role to play both
domestically and internationally, as a temporary measure”. 16 The
Government set out the rights of establishments to request proof of Covid
status:

            Likewise, in the UK, businesses and other organisations are able to
            ask customers for proof of COVID-status in order to access their
            premises, as long as they are compliant with equalities legislation.
            The Government believes that introducing a ban on this would in
            most cases be an unjustified intrusion on how businesses choose to
            make their premises safe - although, as set out below, there may be
            exceptions where the Government needs to intervene to ensure
            equitable access to essential services. It is therefore right that the
            Government provides a means of easily demonstrating COVID-status,
            in order to ensure UK citizens and residents are not denied
            opportunities to travel or attend certain venues or events. 17

The Government identified certification as potentially having a role in settings
such as theatres, nightclubs and mass events to help manage risks where
large number of people are brought together in close proximity. 18 In addition,
it clarified that it had identified certain settings, “such as essential public
services, public transport and essential shops” where, it said, Covid-status
certification “should never be required” so as to ensure universal access. 19

The Government also indicated that certification was likely to play a role in
international travel during the pandemic:

            Even without Government intervention, COVID-status certification is
            likely to become a feature of our lives until the threat from the
            pandemic recedes. Other countries are already developing their own
            certification systems, such as the “Green Pass” in Israel and the
            “digital green certificate” in the European Union. Negative tests are
            already required to enter the UK and many other countries and, as
            vaccination programmes roll out worldwide, countries have made
            clear they will soon require proof of vaccination in order to cross the
            border. 20

15
   Cabinet Office, Roadmap Reviews: Update, 6 Jul 2021
16
   Cabinet Office, Roadmap Reviews: Update, 5 Apr 2021
17
   Cabinet Office, Roadmap Reviews: Update, 5 Apr 2021
18
   Cabinet Office, Roadmap Reviews: Update, 5 Apr 2021
19
   Cabinet Office, Roadmap Reviews: Update, 5 Apr 2021
20
   Cabinet Office, Roadmap Reviews: Update, 5 Apr 2021

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      The Government said that it would begin to trial certification in certain
      settings, including large events, through the Events Research Programme.

2.2   Public Administration and Constitutional
      Affairs Committee inquiry

      Following the announcement of the Government’s review on certification, the
      Public Administration and Constitutional Affairs Committee (PACAC) launched
      an inquiry to “consider potential ethical, legal and operational issues and the
      efficacy and appropriateness of a certificate system”. 21 The inquiry primarily
      focused on the domestic use of certification.

      In a May 2021 oral evidence session, the Committee took evidence from:

      •       Michael Gove, the Minister for the Cabinet Office
      •       Kathy Hall, Director General, Delivery, Covid-19 Task Force, Cabinet
              Office, and
      •       Dr Sue Hopkins, Epidemiological Consultant at Public Health England

      The Committee asked a wide range of questions about scientific evidence
      underpinning the Government’s proposals and the policy implications on the
      public, organisations and businesses.

      Other witnesses providing oral evidence to the Committee include academics,
      industry representatives for sports, hospitality and events and civil liberties
      group Big Brother Watch.

      Public Administration and Constitutional Affairs
      Committee report
      PACAC published its report on Covid status certification on 12 June 2021. 22

      The Committee set out it’s serious concerns about the extent of consideration
      the Government had given to the potential gains and limitations of a
      certification scheme:

                    Given the significance and seriousness of introducing such a Covid-
                    status certification system, the Committee was surprised at the lack
                    of consideration by the Government of a number of issues and
                    concerns with their suggested approach, in particular the scientific
                    case for that system. It is imperative that if the Government seeks to
                    bring forward any proposals for a Covid-status certification system,

      21
           Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, accessed
           16 Jul 2021
      22
           Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
           2021, HC 42-II 2021-22

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            the criteria against which the efficacy of that system has been
            assessed, together with a cost-benefit analysis of the system, and
            full financial costings, are published in advance of those proposals.
            We would also expect detailed modelling of the potential impacts of
            the introduction or non-introduction of such a system in the context
            of the different scenarios for unlocking to be published alongside any
            such announcement. The Committee was struck by the fact that the
            best assessment the Minister could make in favour of certificates was
            to say that it was a “finely balanced judgement”. 23

PACAC were highly critical of the Government’s account of what extent of
consideration had been given to proposals to introduce certification:

            It is clear that the idea of certificates has been under consideration
            within government for at least six months. Ministers and officials
            have given conflicting statements on the possibility of certification
            being introduced as a measure, and on the extent to which proposals
            were actively under review. At times, these statements have been
            directly contradictory. At the very least, this demonstrates a lack of
            coordination and effective interworking between different
            departments and teams in the Government’s response to Covid. On
            at least two occasions, a Minister has said that certificates were
            actively being considered, only for the suggestion to be immediately
            denied by another Minister. Given that the review into the potential
            use of Covid-status certification was subsequently launched, this
            indicates either that several senior members of the Government were
            unaware of the Government’s policy direction in this area, or there
            was an effort to downplay to the public the seriousness with which
            the introduction of a Covid-status certification system was being
            considered. Either way, the Government’s approach to certification
            has risked damaging trust in government and in the measures put in
            place to tackle the pandemic. 24

The Committee considered that the Government had not provided sufficient
information in a number of key areas:

            Given the large number of areas where the Government was unable
            to provide the Committee with information and answers in regards
            to: criteria against which the efficacy of that system is to be
            assessed; the cost-benefit analysis proposals; modelling of different
            scenarios with and without a certificate system, combined with the
            Minister’s own assessment that the case of a Covid-status certificate
            system is “finely balanced”, the Committee does not think the

23
   Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
   2021, HC 42-II 2021-22, summary
24
   Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
   2021, HC 42-II 2021-22, para 7

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                    Government has made a case for any form of domestic Covid-status
                    certification system. 25

      The Committee concluded:

                    Overall, we found that the Government has not established a clear
                    scientific case, nor a good overriding public interest case for the
                    introduction of a Covid-status certification system. There remain a
                    large number of uncertainties about the rationale for an operation of
                    such a system, as well as serious ethical concerns in regards to
                    discrimination and infringement of individual rights and significant
                    data protection concerns. When we consider that the Government’s
                    own assessment that the case for introduction is “finely balanced”, it
                    is our clear recommendation that the Government abandon the idea
                    of using a Covid-status certification system domestically. 26

      Prior to the introduction of a certification system, PACAC recommended that
      the Government:

      •        Publish the criteria against which the efficacy of that system is to be
               assessed, with a statement and explanation of whether or not the
               Government believes that the system is able to satisfy those criteria
      •        Carry out and publish a cost-benefit analysis including financial, social
               and societal costs and benefits
      •        Publish detailed modelling, or if this has not been carried out, explain
               why they have opted not to use modelling and what account they have
               taken of different scenarios 27

2.3   Government report on certification

      On 6 July 2021, the Cabinet Office published the Covid-Status Certification
      Review report, where the Government announced that it would not introduce
      certification as a condition of entry on a mandatory basis:

                    Having considered a wide range of evidence as part of the review,
                    the Government has concluded that it will not mandate the use of

      25
           Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
           2021, HC 42-II 2021-22, para 28
      26
           Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
           2021, HC 42-II 2021-22, summary
      27
           Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
           2021, HC 42-II 2021-22, paras 24 & 25

      17                                                        Commons Library Research Briefing, 28 July 2021
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                    COVID-status certification as a condition of entry for visitors to any
                    setting at the present time. 28

      The report acknowledged a public health benefit but judged that “the burden-
      particularly on those who have not yet been offered a full course of
      vaccination and would therefore require repeated testing, and possibly on
      organisations – would be disproportionate to the public health benefit at this
      stage of the pandemic”.

      Notably, the Government said that organisations could choose whether or not
      to make use of certification:

                    The Government believes that to ban certification in domestic
                    settings would, in most cases, be an unjustified intrusion on how
                    organisations choose to make their premises safe. Essential settings
                    should not use certification, but others can decide to use it at their
                    own discretion in compliance with legal obligations.

      Additionally, the Government did not rule out the use of certification at a later
      point:

                    The review recognises the concerns expressed over certification.
                    However, it is possible that certification could provide a means of
                    keeping events going and businesses open if the country is facing a
                    difficult situation in autumn or winter. Therefore, the Government will
                    keep the wider application of certification under consideration. The
                    Events Research Programme is trialling the use of certification in
                    large events, and the Government will continue to assess the findings
                    from the programme.

2.4   Certification requirements for nightclubs and
      large capacity venues

      On the 19 July 2021 England entered Step 4 of the Covid-19 roadmap, at which
      point the majority of Covid-19 restrictions ended. Speaking at a press
      conference on the same day, Prime Minister Boris Johnson expressed concern
      about the continuing risk of transmission and announced that from
      September, full vaccination would be a condition of entry to nightclubs and
      other large capacity venues. 29 Mr Johnson set out plans to restrict entry to
      certain venues to those who have had a full course of vaccination from
      September:

                    I should serve notice now that by the end of September, when all
                    over-18s will have had their chance to be double-jabbed, we are

      28
           Cabinet Office, Covid-Status Certification Review: Report, 6 Jul 2021
      29
           BBC News, Covid: Two jabs needed to enter nightclubs from September, 20 Jul 2021

      18                                                      Commons Library Research Briefing, 28 July 2021
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                  planning to make full vaccination the condition of entry to nightclubs
                  and other venues where large crowds gather. 30

      It has also been reported that the Government is considering other settings
      where vaccination may become be a requirement of entry. 31

2.5   Exemptions

      In the July review report on certification, the Government set out
      arrangements for exemptions from certification requirements:

                  There are a small number of exemptions, where if individuals meet
                  one of the following criteria, they will be able to demonstrate their
                  exempt status:

                          a. Those who have received a trial vaccine, including those
                          who are blinded 32 or may have a placebo, as part of a
                          formally-approved COVID-19 vaccine trial in the UK; and

                          b. Exceptional circumstances for individuals where a clinician
                          recommends vaccine deferral or that vaccination is not
                          appropriate and where testing is also not recommended on
                          clinical grounds. 33

      The Government also set out exemptions for children and young people under
      the age of 18:

                  Given that vaccination is not recommended for those below 18, the
                  Government recommends that children under 18 are exempt from
                  having to demonstrate their COVID status. The Government believes
                  that repeat testing of this group would be disproportionate for the
                  purposes of gaining COVID status to visit settings. 34

      30
          The Guardian, No 10 refuses to rule out Covid passports for entry into pubs, 20 Jul 2021
      31
          The Guardian, No 10 refuses to rule out Covid passports for entry into pubs, 20 Jul 2021
      32
         In clinical trials, “blinding” refers to an arrangement in which trial participants are unaware of which
          treatment group they have been assigned to. This is done to prevent participants from being
          influenced by that knowledge in a way that might compromise the validity of the findings. For further
          explanation see: Cancer Research UK, Randomised trials, accessed 27 Jul 2021
      33
          Cabinet Office, Covid-Status Certification Review: Report, 6 Jul 2021
      34
          Cabinet Office, Covid-Status Certification Review: Report, 6 Jul 2021

      19                                                       Commons Library Research Briefing, 28 July 2021
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2.6   Response to proposals

      Opposition view
      Leader of the Opposition, Sir Keir Starmer is reported to have said that he
      would scrutinise government proposals on certification before deciding
      whether to oppose them. 35 Sir Keir also said that the use of domestic
      certification for everyday social activities would be “against the British
      instinct”. Speaking about their use in pubs, Sir Keir advised the Government
      not to leave the decision to pub landlords.

      Shadow Health Secretary Jonathan Ashworth indicated that he would support
      the use of certification for larger events but not for uses such as everyday
      retail. 36

      Professional bodies and academics
      The Royal College of General Practitioners set out that it had no objection in
      principle to the use of certification but stressed the importance of detail on
      implementation. 37 The College recommended that certification be used
      primarily for international travel purposes and not for domestic use, due to
      the “risk of unintended consequences in terms of the diversion of healthcare
      resources from patient care and in terms of equalities”. The College also
      highlighted workload pressures on general practice and said that the use of a
      certification system should have no impact on GP workload.

      Referring to the association of antibody presence with negative PCR test
      results, some academics consider that there is now a scientific premise for
      certification. 38 Other academics have expressed caution, calling for detailed
      understanding about the protection offered by Covid-19 vaccines before
      knowing if certification is viable. 39 Some have also considered the
      behavioural implications, suggesting that telling a person that they may be
      ‘immune’ to infection may reduce adherence to precautionary measures such
      as social distancing. 40

      35
         The Telegraph, Exclusive: Covid vaccine passports would be un-British, says Sir Keir Starmer, 31 Mar
         2021
      36
         The Guardian, Labour opposed to ‘discriminatory’ and ‘confusing’ Covid status certificates, 6 Apr 2021
      37
         Royal College of General Practitioners, Covid-status Certification Review, accessed 16 Jul 2021
      38
         Professor Richard Tedder, Senior Research Investigator in Medical Virology, Imperial College London,
         Science Media Centre, Expert comments about immunity passports, 1 Dec 2020
      39
         Professor Deborah Dunn-Walters, Chair of the British Society for Immunology COVID-19 and
         Immunology taskforce and Professor of Immunology at the University of Surrey, Science Media Centre,
         Expert comments about immunity passports, 1 Dec 2020
      40
         Prof Richard Tedder, Senior Research Investigator in Medical Virology, Imperial College London,
         Science Media Centre, Expert comments about immunity passports, 1 Dec 2020

      20                                                     Commons Library Research Briefing, 28 July 2021
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Industry
Business and industry stakeholders, particularly in the hospitality sector,
have raised concerns about the need for a Covid-19 certification scheme and
the costs and practicalities involved in implementing such a scheme.

The Confederation of British Industry (CBI) in April 2021 set out
recommendations for any Covid-19 certification scheme to have the
confidence of businesses. These included that any certification scheme should
be aligned with existing Covid-19 policies already in place, be simple and
accessible to use and be applied consistently across the UK. 41

Hospitality trade bodies have strongly opposed the introduction of a Covid-
certification scheme. Kate Nicholls, Chief Executive of trade body
UKHospitality said in March 2021 that a vaccination certification scheme
would be “simply unworkable” and could cause confusion and conflict among
businesses, customers and staff. 42 The industry has highlighted the costs and
burden that a certification scheme would bring to businesses in the sector,
which have already had significant restrictions on their trade. 43 For example,
representatives of beer and pub said on 1 April:

              Pubs will already be trading at a loss when they reopen with all the
              existing restrictions and covid-secure measures in place. Adding
              further disproportionate and discriminatory measures threatens the
              very survival of thousands of businesses. It’s unfair to single out our
              sector again with these added impractical burdens that will have
              economic consequences and risk our recovery. 44

Retail industry stakeholders have also said that while they can see the
potential for a certification scheme to support the re-opening of international
travel, it would not be appropriate for a domestic retail setting. 45

Some music and events industry stakeholders have supported the
introduction of a temporary industry-wide certification scheme as a route to
lifting capacity restrictions on venues. 46 Bill Bush (Director of Policy at the
Premier League) and Richard Jordan (a theatre producer) told the PACAC
committee that for their sectors, removing social distancing limitations was
the priority. 47 Bill Bush said that although the Premier League would like to
avoid certification if possible, if such a scheme were the only way to avoid

41
     CBI, COVID-status certification: How to introduce vaccine and testing passports, 1 April 2021.
42
     UKHospitality, Vaccine passport scheme unworkable, says UKHospitality, 25 March 2020.
43
     Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
     2021, HC 42-II 2021-22, paras 52 & 53
44
     British Beer and Pub Association, Pub trade dismayed at Government backsliding on reopening
     restrictions, 1 April 2021
45
     Covid vaccine passports could be needed in high street shops, Retail Gazette, 7 April 2021.
46
     British music and events industry backs COVID-19 certification scheme, Reuters 23 April 2021.
47
     Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
     2021, HC 42-II 2021-22, paras 50 & 51

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social distancing rules, then it would be the “lesser of evils”. 48 The UK Cinema
Association has argued against the introduction of a Covid-certification
scheme. 49

Civil liberties groups
In an April 2021 report, civil liberties group Big Brother Watch, set out strong
objections against a “two-tier society” and the potential disproportionate
impact on marginalised groups:

            COVID-status certificates would create a two-tier society and a
            subclass of citizenry, in which minority ethnic groups, migrants,
            poorer people and people with lower education would be
            disproportionately represented. The policy would likely result in
            unlawful discrimination against pregnant women, disabled
            people, young people and, potentially, religious groups. The best
            way to ensure marginalised groups are included in public health
            measures is to create an enabling, not a punitive, environment. 50

The report also raised concerns about the scientific basis for certification,
pointing to “insufficient evidence” that vaccinations or natural immunity
prevents transmission.

The report’s concluding recommendation was that the Government “should
legislate to prohibit Covid-status certification being used to segregate or
exclude individuals from general businesses, events, services or jobs”.

Similar concerns have been shared across the political spectrum, with a
cross-party group of 79 Members and 14 peers joining a wider campaign
pledge organised by Big Brother Watch to “oppose the divisive and
discriminatory use of Covid status certification to deny individuals access to
general services, businesses or jobs”. 51

Another civil liberties group, Liberty, commented on the wider implications of
introducing certification, which it considered “could pave the way for a full ID
system- an idea which has repeatedly been rejected as incompatible with
building a rights-respecting society”. 52

A petition hosted on the Parliament website calling on the Government to
commit to “not rolling out any e-vaccination status/immunity passports to
the British public” has gained over 375,000 signatures. 53 The opposition is

48
   Public Administration and Constitutional Affairs Committee, Covid 19 Vaccine Certification, 12 Jun
   2021, HC 42-II 2021-22, paras 50 & 51
49
   UK Cinema Association, UK Cinema Association reiterates opposition to use of COVID-status
   certificates, 1 April 2021
50
   Big Brother Watch, The case against a two-tier Britain under Covid certification, 2 Apr 2021
51
   Big Brother Watch, MPs launch cross-party campaign against Covid passes, accessed 16 Jul 2021
52
   Liberty, Liberty responds to “vaccine passport” plans, 13 Jan 2021
53
   UK Government and Parliament petitions, Do not rollout Covid-19 vaccine passports, accessed 28 Jul
   2021

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based on concerns that “such passports could be used to restrict the rights of
people who have refused a Covid-19 vaccine, which would be unacceptable”.

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3     The NHS Covid Pass

      The NHS Covid Pass is available in England and Wales and shows details of a
      person’s Covid-19 vaccination details or test results- their ‘Covid-19 status’.

      The Pass is available to those over the age of 16 who are registered with a GP
      and have an NHS number. The Pass displays the type of vaccine received,
      date and batch number, with an accompanying QR code.

3.1   Using the NHS Covid Pass in England

      The Cabinet Office commissioned NHSX 54 to develop the NHS Covid. Following
      this, the Westminster Government set out that certification through the NHS
      Covid Pass would be acquired by:

                    a. Full vaccination: 14 days after completing a full course of
                    vaccination, whether that requires two doses or one dose (according
                    to the MHRA authorised schedule);

                    b. Testing: evidence of a negative PCR or lateral flow test taken with
                    48 hours of entry to a venue, with both on-site (where available) and
                    at-home tests being accepted; and

                    c. Natural immunity: proof of a positive PCR, lasting for 180 days
                    from the date of the positive test and following completion of the
                    self-isolation period. 55

      The NHS Covid Pass website explains that the pass can be used for travel
      abroad, or at events and venues in England asking for proof of Covid-19
      status.

      People aged 16 or over can get an NHS Covid Pass for travel abroad. People
      aged 18 or over can get an NHS Covid Pass for domestic events.

      54
           NHSX Covid Pass
      55
           Cabinet Office, Covid-Status Certification Review: Report, 6 Jul 2021

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                                 The website sets out the requirements for international travel and domestic
                                 events which are reproduced below:

Covid Pass- travel abroad
What you need to get a pass                                      When you can get a pass

1 or 2 doses of a Covid-19 vaccine used in the UK Usually within 24 hours of having your vaccination –
                                                  however it can take up to 5 days for your records to
                                                  be updated
Source: NHS, NHS Covid Pass, last reviewed 25 Jul 2021

Covid Pass- domestic events
What you need to get a pass                                      When you can get a pass
To be fully vaccinated with a Covid-19 vaccine                   2 weeks after your 2nd dose, or 2 weeks after 1
used in the UK                                                   dose of the Janssen vaccine
                                                                 As soon as you get your result
Negative PCR test or rapid lateral flow test
                                                                 If you did a rapid lateral flow test at home, report
within the past 48 hours
                                                                 your lateral flow test result on GOV.UK first
                                                                 After you've finished self-isolating and up to 180
Positive PCR test within the past 6 months
                                                                 days after taking the test
Source: Source: NHS, NHS Covid Pass, last reviewed 25 Jul 2021

3.2                              Obtaining an NHS Covid Pass in England

                                 People can obtain a Covid Pass digitally, either through the NHS App or the
                                 online NHS Covid Pass service. Digital versions of the Covid Pass are valid for
                                 specified time periods:

                                               How long digital versions are valid for

                                               If you've had:

                                           •     a vaccine used in the UK – your pass lasts for 30 days, but the 30
                                                 day period refreshes every time you log in

                                           •     a negative PCR test or rapid lateral flow test – your pass is valid
                                                 for 48 hours after a negative result

                                           •     a positive PCR test – your pass lasts 30 days, but the 30 day period
                                                 refreshes every time you log in (for up to 180 days after you took
                                                 the test)

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                    If you download your COVID Pass as a PDF, always check the expiry
                    date before using it.

                    If you're fully vaccinated or had a positive test result, the barcode on
                    a PDF is valid for 30 days. 56

      Paper versions of the Covid Pass, showing vaccination status only, are also
      available and do not have an expiry date.

      The Government has published guidance for demonstrating Covid-19
      vaccination status. 57

      The Government has also published guidance explaining how the Pass may be
      used in businesses and venues:

                    We encourage organisations in certain settings to use the NHS
                    COVID Pass as a condition of entry, in order to reduce the risk of
                    COVID-19. This will especially be the case in large, crowded settings
                    (such as nightclubs) where people are likely to be in close proximity
                    to others outside their household.

                    To support organisations and individuals in these settings, the NHS
                    COVID Pass will be made available through the NHS App, NHS.UK, or
                    as a letter that can be requested by ringing NHS 119. Visitors will also
                    be able to show text or email confirmation of test results.
                    Organisations should ensure they are in compliance with all legal
                    obligations, including on equalities.

                    There are some settings where the NHS COVID Pass should not be
                    used as a condition of entry, in order to ensure access for all. This
                    includes essential services and essential retailers which have been
                    able to stay open throughout the pandemic. 58

3.3   Obtaining proof of Covid-19 status for clinical
      trial participants

      The NHS Covid Pass website explains that people who have received a Covid-
      19 vaccine as part of an official clinical in trial in England do not need to use
      the NHS Covid Pass. 59 It advises that these individuals should have received a
      letter identifying their Covid-19 status as “fully vaccinated.

      The Be Part of Research website, operated by the National Institute for Health
      Research, provides several responses to FAQs on certification requirements

      56
           NHS, NHS Covid Pass, accessed 26 Jul 2021
      57
           DHSC, Demonstrating your Covid-19 vaccination status, last updated 16 Jul 2021
      58
           Cabinet Office, Coronavirus: how to stay safe and help prevent the spread, last updated 22 Jul 2021
      59
           NHS, Get your NHS Covid Pass letter, accessed 28 Jul 2021

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      for clinical trial participants and advises on how they can demonstrate their
      vaccination status. 60

3.4   Obtaining proof of Covid-19 status in devolved
      nations

      The Welsh Government has published information about how the NHS Covid
      Pass is being used in Wales.

      The NHS Covid Pass is not available in Scotland and Northern Ireland.

      Vaccinated people in Scotland can receive an NHS coronavirus vaccination
      status letter. 61

      Vaccinated people in Northern Ireland can obtain Covid-19 certificates via the
      COVIDCert NI mobile app, a digital certificate or a paper certificate. 62

      60
           Be Part of Research, Vaccine passports/ certification and travel, 28 Jul 2021
      61
           NHS Inform Get a record of your coronavirus (COVID-19) vaccination status Last updated 20 Jun 2021
      62
           NI Direct, Coronavirus (Covid-19): Covid certificate for NI residents, 26 Jul 2021

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4   Scientific evidence

    Consideration must be given to a range of scientific factors in order to
    determine the feasibility, practicality and ultimately success of any
    certification scheme.

    Decisions on the use of certification systems are likely to be underpinned by
    the scientific understanding of Covid-19 and its transmission, and any
    potential gains on reducing the impact of the pandemic on everyday life.

          Covid-19 terminology: the virus and the disease
         Covid-19 disease is an infectious disease caused by the Covid-19 virus. The
         symptoms of Covid-19 disease include a high temperature, a continuous cough
         and a loss or change to sense of smell or taste.

         The scientific name of the virus that causes Covid-19 disease is severe acute
         respiratory syndrome coronavirus 2, abbreviated to SARS-CoV-2.

         SARS-CoV-2 is one type of coronavirus- a specific family of viruses with similar
         features.

    When asked about the scientific case for introducing certification certificates,
    Minister for the Cabinet Office Michael Gove said:

                  The scientific case would be that, if you have a group of people in a
                  venue and the people in that venue you are confident have either had
                  the disease or are vaccinated or have recently tested negative, the
                  risk of a super-spreader event, the risk of transmission, diminishes. 63

    Dr Sue Hopkins provided estimates of the reduction in transmission risk
    through the requirement of certification and testing for event attendance:

                  Most events that people go to are smaller events, meeting indoors.
                  That is where most of the transmission occurs. Clearly the risk of a
                  large event, both travelling to the event, the socialising around the
                  event and the event itself, can potentially be reduced by the use of
                  testing, vaccination or, alternatively, knowing people’s prior
                  infection status. All those things together are likely to reduce the risk

    63
         Public Administration and Constitutional Affairs Committee, Oral evidence: Covid 19 vaccine
         certification, 27 May 2021, HC 42- II, 2021-22, para 119

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                    of transmission by 30% to 50%, not eliminating it as we have
                    mentioned earlier but maybe even higher.

                    […]

                    A negative lateral flow test shortly before entering the event reduces
                    the risk of transmission by about 30% to 50%. 64

      In its June 2021 report, PACAC identified four factors that need to be
      considered in order to demonstrate a clear scientific case for introduction of a
      certification system:

      •       Transmission of the virus
      •       The effectiveness of vaccines on symptomatic disease, hospitalisation,
              mortality, infection and transmission
      •       The implications of new variants
      •       The accuracy of testing

      Similarly, in its May 2021 report, Checkpoints for vaccine passports, the Ada
      Lovelace Institute questioned the impact of vaccination, transmission and
      testing on certification:

                    […] the first question to ask of a COVID vaccine passport system is
                    whether an individual’s status, for example that they have been
                    vaccinated, conveys meaningful information about the risk they pose
                    to others? Does the scientific evidence base we have on COVID-19
                    vaccines, antibodies and viral testing, support making that link, and
                    if so, how certain should we be about an individual’s risk based on
                    those proxies? 65

      Below, we provide an overview of the current scientific evidence that
      examines these factors within the context of certification.

      It is clear that a great deal is still unknown with respect to the science of
      SARS-CoV-2. As data from long-term studies continue to become available it
      is likely that these uncertainties will be addressed.

4.1   Immunity

      By way of vaccination, recent infection or a negative test result, an inferred
      principle of certification is that it demonstrates that a person is unable to
      transmit SARS-CoV-2, or, at least, much less likely to transmit the virus, than
      a person without certification.

      64
           Public Administration and Constitutional Affairs Committee, Oral evidence: Covid 19 vaccine
           certification, 27 May 2021, HC 42- II, 2021-22, para 93
      65
           Ada Lovelace Institute, Checkpoints for vaccine passports. 10 May 2021

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This approach is based on our understanding of how immunity to the SARS-
CoV-2 virus is conferred.

The Scientific Advisory Group for Emergencies (SAGE) provides scientific and
technical advice to support government decision makers during emergencies.
The advice provided by SAGE does not represent official government policy.
SAGE also relies on external scientific advice from expert groups, which for
Covid-19 includes the New and Emerging Respiratory Virus Threats Advisory
Group (NERVTAG).
NERVTAG explains that there are two types of immunity to consider with
respect to Covid-19:

            Sterilizing immunity means that a person is protected against both
            infection and illness. Therefore, as well as being themselves
            protected from illness they cannot be a source of infection for others.

            Non-sterilizing immunity means that a person can still get infected
            but not become ill. Therefore, although themselves protected from
            illness, they may still be able to become infected, shed virus and be a
            source of infection for others. 66

In November 2020, NERVTAG said 67 that the level of sterilising immunity
provided by Covid-19 natural infection or immunisation is not yet fully
understood and, consequently the risk of reinfection remains.

NERVTAG also reported that that whilst reinfection upon re-exposure to SARS-
CoV-2 is rare, it does occur, and that most reinfections are mild, but some are
severe. 68

Public Health England’s (PHE) Sarscov2 Immunity & REinfection EvaluatioN
(SIREN) study examined reinfection rates in healthcare workers. Researchers
were able to quantify the risk of reinfection, reporting that a previous history
of SARS-CoV-2 infection was associated with an 84% lower risk of
reinfection. 69

When considering immunity, it is also important to recognise that the immune
response may differ between individuals, as explained by the British Society
for Immunology (BSI):

            Does everyone make the same immune response to SARS-CoV-2?

            No. Immune responses can vary hugely between different
            individuals. Some people seem to make a very effective immune
            response such that they cannot be infected again and therefore will
            not get sick again from SARS-CoV-2 and will not pass the virus to

66
   NERVTAG, Update note on immunity certification, 3 Feb 2021, published 5 Jul 2021
67
   NERVTAG, Certifying COVID-19 immunity - 19 November 2020, published 4 Dec 2020
68
   NERVTAG, Certifying COVID-19 immunity - 19 November 2020, published 4 Dec 2020
69
   PHE, SIREN, accessed 26 Jul 2021

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              anyone else (so called ‘sterilising’ immunity). Other people make
              antibodies and are protected from disease, but not from future
              infection by the virus. In theory these people could still pass the virus
              to other people. People vary in the number of antibodies they make
              after infection, in the quality of those antibodies (how good they are
              at preventing infection) and in the number and quality of the T cell
              response they make. We don’t yet know exactly how important these
              variations in antibodies and T cells are in terms of levels of protective
              immunity but ongoing research (by the UK Coronavirus Immunology
              Consortium) is designed to answer this question. 70

Duration of immunity
One of the crucial unanswered questions about Covid-19 is how long immunity
lasts in individuals, following either vaccination or natural exposure to the
virus. Scientists have placed a range of estimates on immunity duration.

NERVTAG, drawing on knowledge of Covid-19 and other respiratory viruses,
initially placed a conservative estimate of immunity duration of 90 days:

              The length of immunity conferred by natural infection or vaccination
              is currently not known. Waning immunity is believed to partly
              underlie the propensity for other coronaviruses to reinfect after 1-2
              years. Studies on MERS-CoV [Middle East respiratory syndrome
              coronavirus] and SARS-CoV [severe acute respiratory syndrome]
              found waning antibody levels over this time period. Reinfections with
              seasonal coronaviruses occurs frequently at 12 months, sometimes
              as early as 6 months but not within three months. Therefore, based
              on the variability in the data and differential responses in the
              population we conservatively estimate that a protective immune
              response after SARS-CoV-2 infection or vaccination may last for 90
              days (moderate confidence). 71

In February 2021, NERVTAG said that the duration of immunity beyond 6
months (following natural infection) and 3 months (following vaccination) is
not well understood. 72 In February 2021, the BSI suggested that immunity
might last for a year. 73 The SIREN study reported that previous SARS-CoV-2
infection protects most individuals against reinfection for an average of 7
months. 74

70
     V. Hall et.al., SARS-CoV-2 infection rates of an antibody-positive compared with antibody-negative
     health-care workers in England: a large, multicentre, prospective cohort study (SIREN), The Lancet,
     Vol 397, p.1459-1469, 9 Apr 2021
71
     NERVTAG, Certifying COVID-19 immunity - 19 November 2020, published 4 Dec 2020
72
     NERVTAG, Update note on immunity certification, 3 Feb 2021, published 5 Jul 2021
73
     British Society for Immunology, Immunity & Covid-19, 3 Feb 2021
74
     V. Hall et.al., SARS-CoV-2 infection rates of an antibody-positive compared with antibody-negative
     health-care workers in England: a large, multicentre, prospective cohort study (SIREN), The Lancet,
     Vol 397, p.1459-1469, 17 Apr 2021

31                                                       Commons Library Research Briefing, 28 July 2021
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