Who Is Opposed to COVID-19 Vaccination Certificates and Why? A Multi-Country Observational Study From Asia

Background: There are ongoing calls to harmonise and increase the use of COVID-19 vaccination certificates (CVCs) in Asia. Identifying groups in Asian societies who oppose CVCs and understanding their reasons are necessary steps towards addressing public concerns and formulating an effective CVCs policy in the region. Methods: An online cross-sectional survey was conducted from June to October 2021 across nine countries in Asia. Multivariable logistical regression analyses were performed to identify potential opposers of CVCs. Findings: Six groups of people were identified as potential opposers of CVCs: (i) those unvaccinated (OR: 2·01, 95% CI 1·65 - 2·46), especially those who are hesitant and have no access to COVID-19 vaccines, (ii) those who do not want existing NPIs to continue (OR: 2·97, 95% CI: 2·51 - 3·53), (iii) those who have low level of trust in governments (OR: 1·25, 95% CI: 1·02 - 2·52), (iv) those with no travel plans (OR: 1·58, 95% CI: 1·31 - 1·90), (v) those who expect no personal financial gains from CVCs (OR: 2·35, 95% CI: 1·98 - 2·78), and (vi) those who disagree with using CVCs for employment, education, events, hospitality, and domestic travel. Interpretation: Addressing recurring public health bottlenecks such as vaccine access and hesitancy, adherence to policies, and public trust, and changing the narrative from ‘societal-benefit’ to ‘personal-benefit’ may be necessary and help increase wider adoption of CVCs in Asia.Funding Information: This study was funded by the Royal Thai government through the National Research Council of Thailand (NRCT) under CORESIA grant (64121050HM010L0). Funds from the Japan Society for the Promotion of Science Core-to-Core Program (JPJSCCB20200002), and the Wellcome Trust Research Laboratory, Division of Gastrointestinal Sciences, Christian Medical College (CMC), Vellore through its departmental Research Fund, were used to field the surveys in Japan and India, respectively. Declaration of Interests: All authors of this paper declare no conflict of interest.Ethics Approval Statement: Approval was granted by the relevant ethics review boards in the countries requiring it to conduct this study. Informed consent was obtained prior to participating in the voluntary survey.