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. 2026 Feb 20;22(1):2622178. doi: 10.1080/21645515.2026.2622178

A scoping review of vaccine certificate implementation in Canada and OECD countries during the COVID-19 pandemic: Outcomes and lessons learned

Adhiba Nilormi a,*, Cécile M Bensimon a,b,*, Maya Thomas c, Slater Wiles c, Kumanan Wilson a,c,d,e,✉
PMCID: PMC12928656  PMID: 41719449

ABSTRACT

Vaccine certificates were introduced during the COVID-19 pandemic to document vaccination status, promote uptake and enable safer reopening of society. While these policies supported public health efforts, their implementation raised operational, ethical and legal concerns, sparking debate about their future use in health emergencies. We conducted a scoping review to synthesize the implementation processes, challenges and outcomes of vaccine certificate systems in Canada and other OECD countries. An academic search was conducted in August 2024, across Ovid MEDLINE, Embase and Scopus using controlled vocabulary and key words for sources published from 2020 onward. Grey literature was searched using Google and targeted government and organizational websites. Data were synthesized descriptively and analyzed deductively based on three pre-identified themes – public health, technological, and ethical-legal considerations – derived from the UK Royal Society’s framework on COVID-19 vaccine certificate design. The search captured 128 sources (72 academic and 56 gray literature), covering all OECD countries except Chile, Colombia, Costa Rica, Mexico and Norway. Identified subthemes included: (1) purpose and trade-offs; (2) public health, socio-economic and health system impacts, (3) technological infrastructure and data security; (4) equity and accessibility; (5) privacy and surveillance; and (6) public acceptance and trust. Vaccine certificates aimed to support public health goals but posed challenges in digital implementation, particularly in creating secure and interoperable systems and raised concerns around equity, discrimination and privacy. Vaccine certificates show promise for future public health use. However, their success will depend on addressing ethical concerns, ensuring interoperability and strengthening digital infrastructure, regulations and public trust.

KEYWORDS: Vaccine certificates, proof of vaccination, COVID-19 pandemic, digital health, scoping review, public health policy, pandemic response, Canada, OECD countries

Introduction

The COVID-19 pandemic prompted governments worldwide to implement a suite of public health interventions, including physical distancing, lockdowns, travel restrictions, diagnostic testing strategies, and large-scale vaccination programs.1 Vaccination was a central component of pandemic response and contributed to the gradual resumption of social and economic activities in many settings.2,3 As jurisdictions moved toward reopening strategies, several introduced vaccine certificates – documents that verify an individual’s COVID-19 vaccination status – to regulate access to selected public, commercial, or social activities and environments.3,4

Vaccine certificates are defined as documentation used to verify vaccination status for domestic use cases (e.g., workplace entry, public venues, recreational activities), which are conceptually distinct from (a) vaccine mandates that impose requirements within specific institutional settings, and (b) international vaccine “passports” designed to facilitate cross-border travel.3,5,6 The implementation of vaccine certificates varied across jurisdictions and was associated with a range of anticipated benefits and practical, ethical, legal, and social concerns. Public discourse reflected divergent perspectives on whether their use was justified, proportionate, or ethically acceptable, and questions remain regarding the criteria that would warrant adoption in future health emergencies.7–9

Given the rapid development of policy interventions during the pandemic, evidence related to the implementation of vaccine certificate systems emerged across heterogeneous academic and non-academic sources, including policy documents and government reports.10 Scoping reviews are well suited to map the breadth, depth, and characteristics of such heterogeneous evidence, particularly for complex and interdisciplinary policy questions where conceptual clarity and synthesis of implementation processes are required.11 Existing reviews have primarily focused on public perceptions and acceptability12 or technical features of vaccine certificates;10 however, there is limited comparative synthesis of implementation processes, technology considerations, and cross-jurisdictional lessons specific to high-income countries, including Canada.

The objective of this scoping review is to identify, describe, and synthesize the literature on COVID-19 vaccine certificate systems in Canada and other OECD countries, with attention to implementation approaches, reported challenges, and key contextual considerations. Findings are categorized into three overarching themes: (1) public health considerations, (2) technological infrastructure, and (3) ethical-legal considerations. This review aims to inform future policy planning, digital public health infrastructure development, and preparedness for subsequent public health emergencies.

Methods

This scoping review followed Arksey and O’Malley’s13 framework and was reported in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) (Supplement 1; Appendix E).

Identifying the research question

The primary research question was:

What are the implementation processes, challenges, outcomes and lessons learned from COVID-19 vaccine certificate solutions in Canadian provinces and territories and other OECD countries?

OECD countries were selected due to shared characteristics such as public health governance, digital infrastructure, and pandemic response approaches that enable relevant cross-jurisdictional comparisons. The 38 OECD countries are listed in Supplement 1; Appendix A.

Identifying relevant studies

Academic literature search

The search strategy was developed iteratively with a medical librarian (RS). Searches were conducted on August 21, 2024 by the medical librarian (RS) in three databases selected for their comprehensive and multidisciplinary coverage of literature on vaccine certificates: Ovid MEDLINE, Embase and Scopus. We used a combination of controlled vocabulary (e.g., MeSH) and keywords. Full search strategies are provided in Supplement 1; Appendix B. No language filters were applied at the search stage. Searches were restricted at the search stage to publications from January 1, 2020, onward to align with the COVID-19 pandemic and limited to Canada and OECD countries.

Grey literature search

A targeted grey literature search was conducted to supplement academic sources and identify implementation details of vaccine certificate solutions not captured in peer-reviewed literature. The search was conducted by MT and SW on September 13, 2024, using structured Google queries and direct searches of official government and public health websites across eligible OECD jurisdictions. Google search terms included combinations such as, “COVID-19,” “vaccine certificate,” “proof of vaccination,” “immunization passport,” “digital vaccination passport,” tailored to each jurisdiction. Google search results were screened until saturation was reached, generally within the first 5–10 pages of results, consistent with established grey literature searching guidance.14 The full search strategy and a table of targeted websites are provided in Supplement 1; Appendix C.

Study selection

Sources were included if they:

  • Focused on COVID-19 vaccine certificates implemented for domestic or international use in Canada or other OECD countries

  • Described implementation features, governance frameworks, or reported impacts

  • Were published from January 1, 2020 to the date of final search

All formats were eligible, including research articles, reports, guidance documents, websites, commentaries, policy briefs, and organizational or technical publications. Sources that focused exclusively on immunity-based certification (e.g., “immunity passports”) were excluded. Only English-language full texts were included due to feasibility.

Charting the data

All identified records were imported into Covidence for deduplication and screening. Titles, abstracts, and full texts were screened independently by two reviewers (MT and SW). Discrepancies were resolved through discussion or consultation with a third reviewer (AN or CB). Reasons for exclusion at full-text stage were documented.

Data were extracted independently by two reviewers (MT and SW) using a structured charting form developed collaboratively by the research team. Extracted data included article characteristics (e.g., source type, study design, publication date and country/region), implementation features (e.g., jurisdiction, implementation period, format, implementation process, stakeholders involved, and policies governing use) and assessment of the pre-developed themes and subthemes (Supplement 2).

Collating, summarizing and reporting the results

We synthesized the implementation and impact of vaccine certificate solutions using a deductive thematic approach based on three pre-identified themes: public health considerations, technological considerations and ethical-legal considerations. These themes were developed a priori based on the UK Royal Society’s criteria for the development and use of COVID-19 vaccine certificates15 and used to structure our extraction table. Content relevant to each theme or subtheme was then charted accordingly during data extraction. Not all sources included information relevant to every theme, and cells were left blank where data were not available.

Results

Characteristics of included articles

A total of 128 sources met the inclusion criteria (Figure 1). The majority were peer-reviewed academic research papers (n = 59), followed by government websites (n = 22), news articles (n = 20), blogs (n = 9), commentaries/editorials (n = 6), book chapters (n = 3), letter to the editor/correspondence (n = 2) and conference paper (n = 1). The rest of the articles were other reports, guidelines and websites (n = 6) (Table 1).

Figure 1.

Figure 1.

Open in a new tab

PRISMA flowchart of included articles.

Table 1.

Characteristics of articles.

Article Type n Percentage (%)
Research paper 59 46.1
Government website/source 22 17.2
News article 20 15.6
Blog 9 7.0
Commentary/editorial 6 4.7
Book chapter 3 2.3
Letter to the editor/correspondence 2 1.6
Conference paper 1 0.8
Other (e.g., report, guideline and website) 6 4.7
Study design (n = 59)
Observational 26 44.1
Conceptual/theoretical 17 28.8
Qualitative 5 8.5
Modeling 5 8.5
Mixed-methods 4 6.8
Scoping review 1 1.7
Narrative review 1 1.7
Open in a new tab

The peer-reviewed academic research papers had 7 main types of study designs: observational (n = 26), conceptual/theoretical papers (n = 17), qualitative (n = 5), modeling (n = 5), mixed-methods (n = 4), scoping review (n = 1) and narrative review (n = 1).

COVID-19 vaccine certificate solutions identified

Our review captured a range of vaccine certificate solutions implemented across Canada and various OECD jurisdictions during the COVID-19 pandemic (Supplementary Table 2). In Canada, a federal COVID-19 proof of vaccination policy was implemented on October 30, 2021, to facilitate safe domestic and international travel.16 The acceptance of the pan-Canadian standardized proof of vaccination was at the discretion of the travel destination, as it was not part of an international accreditation system.17 Within each of the 10 provinces and the territory of Yukon, vaccine certificates were also implemented domestically to reopen the economy and enable safe access to social, cultural and recreational activities over the course of September to November 2021.18

The United States did not adopt a federal-level vaccine certificate policy; implementation of vaccine certificates varied by state.17 For example, the State of New York launched the “Key to NYC” order which required proof of vaccination through the NY State Excelsior Pass or the NYC COVID Safe mobile application to enter indoor dining, wellness and leisure spaces.19

In the European Union, the EU Digital COVID Certificate (EU DCC) was introduced on July 1, 2021, as a standardized multinational vaccine certificate system to facilitate safe travel across member states.20 It was also recognized by 51 external countries.21 The certificate was issued nationally and connected via a central EU DCC gateway.20 The implementation of the certificate within each nation varied slightly depending on national regulations and technological infrastructure, prominent examples from our search include Italy’s Green Pass, France’s Health Pass, Lithuania’s Opportunity Passport, Czech Republic’s Tečka application, Germany’s CovPass and Corona-Warn-App and Denmark’s Coronapas.

Other notable examples of vaccine certificate solutions include Israel’s Green Pass, one of the first systems to be implemented,4 the UK’s NHS COVID Pass and Australia’s separate digital COVID-19 passes for international travel and domestic activities.17 Our search did not capture vaccine certificate systems from the following OECD countries: Chile, Colombia, Costa Rica, Mexico and Norway.

Thematic analysis

Findings were synthesized across the three thematic categories: public health considerations, technological considerations and ethical-legal considerations. Six subthemes were identified across sources: (1) purpose of vaccine certificates (including trade-offs and competing objectives), (2) impacts of the use of vaccine certificates (including public health impact, impact on social and economic activities and impact on health systems), (3) technologies used (including data security and protection measures and operational challenges such as, accommodating vaccine efficacy and variants and international standardization), (4) equity and accessibility (including access and potential for discrimination), (5) privacy and surveillance and, (6) public acceptance and trust (Supplement 2). Definitions and descriptions for each theme and subtheme are provided in Supplement 1; Appendix D.

Public health considerations

Purpose of vaccine certificates

Sources described multiple intended purposes of vaccine certificates, including:

  • Increasing vaccination rates, particularly among groups with higher vaccine hesitancy22–24

  • Enabling the safe reopening of social, economic, and cultural activities (n = 30)25,26

  • Reducing COVID-19 transmission and promoting public health (n = 22), particularly in response to the circulation of more contagious variants27

  • Supporting cross-border movement and international travel (e.g., the EU DCC, Japan’s vaccine passport, and Iceland’s certificate of vaccination) (n = 18)17,28–30

  • Incentivizing vaccination by offering fewer restrictions and greater privileges to vaccinated individuals without resorting to mandates (n = 12)12,25,31

Trade-offs and competing objectives

Implementing vaccine certificates involved navigating competing priorities. A prominent trade-off (n = 27) was between promoting public health and preserving individual autonomy. Several sources raised concerns about personal freedom and potential discrimination based on immunity status.32–35

As vaccine certificate systems evolved to rely more on digital tools, a second trade-off (n = 20) emerged between enabling health credential verification and addressing concerns related to data privacy, surveillance, and misuse of personal health information by the government and third parties.36–38

The dual goals of vaccine certificates to support economic recovery and protect public health also posed challenges. Some studies (n = 15) noted risks related to increased viral transmission during reopening, especially with emerging variants.32,34 Businesses were often tasked with enforcing certificate requirements without adequate support, resulting in additional operational and financial pressures.22,39

In many jurisdictions, the rapid rollout and implementation of vaccine certificate policies was prioritized to achieve higher vaccination rates at the expense of public trust and compliance. Studies (n = 8) noted that these fast tracked and restrictive measures were often polarizing and could lead to further erosion of public trust in the government and public health authorities.40–43

Impacts of use of vaccine certificates
Public health impacts

A number of sources described associations between vaccine certificates and increased vaccination rates and decreased COVID-19 infection rates and severe outcomes (n = 20). One study reported a 16.9% point increase in adult vaccination rates in New York City, resulting in approximately 410,201 additional vaccinations.22 In Lithuania, the Opportunity Passport required for entry into public spaces was predicted to reduce infection rates by an estimated 26,000 to 57,000 infections and prevent 330 to 720 deaths.44

While vaccine certificates were suggested to increase vaccination rates and minimize transmission, particularly during the Delta wave, some studies reported that high levels of vaccine hesitancy remained – and in some cases, may have even worsened in response to the introduction of certificates.35,45,46 In France, a survey found that 42% of individuals who received the first vaccine dose remained hesitant about receiving additional doses.47

Impact on social and economic activities

Vaccine certificate systems enabled the reopening of businesses and public venues positively impacting social and economic activities (n = 18). They also reactivated tourism and hospitality sectors across many OECD countries. In Japan, vaccine certificates facilitated the readmission of foreign travelers,48 and within the EU, the EU DCC successfully supported cross-border mobility between member states.20

Economic recovery was another significant impact, as certificates enabled businesses to operate at higher capacities and increased economic consumption among the public.20,49 However, hospitality businesses expressed concerns over the added burden of implementing vaccine certificates and missed revenue from the exclusion of unvaccinated consumers and partial activity under capacity restrictions.50,51

Impact on health systems

Vaccine certificates were suggested to indirectly help to reduce health system burdens by increasing vaccination rates and decreasing the rate of severe illness (n = 15). In Israel, during the months following the implementation of the Green Pass, a decline in the number of severely ill patients requiring hospitalization was observed.50 However, the literature lacked direct evaluations of health system cost savings.

The impact of vaccine certificates on health systems differed between jurisdictions. In Lithuania, high vaccination rates due to successful implementation of vaccine certificates were associated with lower mortality rates and reduced strain on healthcare facilities during the Delta wave.44,52 By contrast, regions such as Bulgaria, Latvia, and Romania, which had lower vaccination rates and lifted restrictions earlier, experienced higher COVID-19 mortality rates and greater strain on healthcare systems.52

Technological considerations

Technologies used

The implementation of vaccine certificates relied heavily on digital technologies to ensure data security, interoperability and standardization across jurisdictions (n = 35). Quick Response (QR) code systems were the most common, integrated with national or provincial health registries to verify vaccination status. The EU DCC used public key infrastructure (PKI), electronic seals, a centralized gateway and decentralized storage to verify credentials while adhering to the Health Level Seven (HL7) Fast Healthcare Interoperability Resource (FHIR) standards.20 Zero-Knowledge Proof (ZKP) and blockchain technologies, employing Ethereum-based smart contracts and InterPlanetary File System (IPFS) were further used to enhance data security and user privacy.20,40

Despite the predominance of digital solutions, paper-based certificates were also used in some jurisdictions (n = 10) to enhance accessibility for populations without access to technology, although they were more susceptible to forgery risks.53,54

Across all digital systems, features like cryptographic protocols, attribute-based credentials, and decentralized data management were key to balancing security, privacy, and functionality while complying with international standards such as General Data Protection Regulation (GDPR) and electronic IDentification, Authentication, and Trust Services (eIDAS) 2.0.36,55

Data security and protection measures

Data security and protection measures were key to the design of digital vaccine certificate systems (n = 20). For example, Italy’s Green Pass utilized blockchain and re-encryption schemes for secure storage,40 while Germany integrated two-factor authentication into its CovPass app for added protection.56 Conversely, U.S. CDC-issued physical vaccination cards lacked basic security features, including watermarks, fluorescent fibers, and holograms, making them vulnerable to counterfeiting.53

Concerns related to data privacy were frequently cited (n = 20), especially around the potential risk of disclosure of sensitive health information during verification of QR credentials. To minimize such risks, some systems adopted restrictions to the display of information to only essential details, such as name and vaccination status, minimizing additional information shared with third parties.37

Operational challenges

Implementation of vaccine certificates posed operational challenges around standardization, interoperability, integration within existing technology, and technological equity. While the EU DCC exemplified multinational collaboration and interoperability across jurisdictions, most systems were limited to national or regional use due to the absence of standardized and interoperable systems as well as concerns around data sharing, storage, security and privacy.

Technical barriers involved challenges in the integration and linking of health data from different sources and ensuring regional compatibility (n = 12). The emergence of variants like Omicron further exposed operational limitations of vaccine certificates, as many systems struggled to stay up to date with waning immune protection, booster requirements, and differences in vaccine effectiveness.57

Equity, ethical and legal considerations

Equity and accessibility
Access

Most jurisdictions provided the public access to digital vaccination certificates free of charge (n = 7), however barriers to accessibility remained for those without smartphones or with digital literacy challenges.58 Governments incurred substantial costs to implementation of vaccine certificates (n = 10), including investments in digital infrastructure, promotional campaigns for the public, and enforcement measures.55,58 Businesses in the hospitality sector faced indirect costs related to staffing and compliance.4

In some jurisdictions (n = 12), unvaccinated individuals bore the costs of frequent testing for maintaining valid certification to access restricted services and settings.59,60 In Italy, while salivary antigen tests were low cost, the government excluded the use of such tests for unvaccinated individuals to obtain certification, limiting affordability.25

Potential for discrimination

Several studies (n = 30) highlighted concerns around the potential for vaccine certificates to exacerbate existing inequalities or create new forms of discrimination.

Studies (n = 10) noted that limited access to vaccination and other resources, particularly in low-income countries and marginalized communities, heightened inequities around vaccine certifications. For example, Italy’s Green Pass was criticized for excluding affordable testing options for unvaccinated individuals to obtain certification, disproportionately impacting lower-income groups.25 Additionally, vaccine certificate policies also raised concerns about deepening social divisions between vaccinated and unvaccinated individuals (n = 20). With restrictions on access to public spaces and services for the unvaccinated, these measures risked reinforcing stigma and contributing to social isolation.41,61

Privacy and surveillance

Vaccine certificates were also subject to concerns and criticism related to privacy and surveillance, especially around the potential for misuse of personal sensitive health information (n = 10). Processes to verify the authenticity of QR codes and record holder identity often required individuals to disclose personal health data to third parties, sparking debates over data protection. Italy’s Green Pass, the EU DCC, and Israel’s Green Pass all faced scrutiny for potential breaches of privacy regulations.25,34,36

Public acceptance and compliance

Public acceptance and compliance with vaccine certificates varied widely across jurisdictions and demographic groups (n = 30). In Canada, acceptance dropped significantly over time from 66% in November 2021 to 43% in March 2022 while opposition increased from 16% to 21%.62 This decline coincided with the “Freedom Convoy” protests in Ottawa, Canada, where large crowds gathered to protest against vaccination certificates, mandates and other pandemic measures.62

Support for vaccine certificates was generally lower among rural populations, younger individuals, visible minorities, right-leaning political groups and those in trades – groups that also typically exhibit higher rates of vaccine hesitancy.62–64

Discussion

Our findings are organized into three major categories: (1) public health considerations, (2) technological considerations, and (3) ethical/legal considerations. These categories reflect the multifaceted challenges and opportunities associated with vaccine certificates and align with the criteria outlined by the UK Royal Society for the development and use of COVID-19 vaccine certificates.15

The use of vaccine certificates is complex primarily due to the technological considerations involved in designing and operationalizing systems.65 Second, the system’s success hinges on addressing numerous legal and ethical questions across a broad spectrum, such as data protection and privacy requirements, equity, accessibility and discrimination.66 Furthermore, vaccine certificates intersect with various legal and regulatory frameworks, including international and regional human rights law, data protection and privacy laws, nondiscrimination laws, and occupational health and safety regulations.54

Public health considerations

The role of vaccine certificates evolved over time, serving dual aims: (1) to protect and promote population health, and (2) to restore social and economic functioning.67 These goals were reflected in increased vaccine uptake, the reopening of public spaces, and – at times – the protection of health system capacity and access to care for vulnerable populations.68

One underexplored objective in the literature is the role of vaccine certificates in supporting a proportionate response to restrictions on civil liberties. Certificates offered a mechanism to replace broad lockdowns with more targeted restrictions, thereby enabling autonomy for vaccinated individuals while minimizing unnecessary societal disruption.69 However, this also raises critical questions about whose autonomy was protected or constrained, and under what justification.

Despite these potential benefits, many jurisdictions lacked a consistent or clearly communicated rationale for implementing vaccine certificates – particularly as their purpose evolved.70 This lack of clarity contributed to public confusion and, in some cases, growing opposition, which may explain declining support for vaccine certificates over time.12

Technological considerations

Technological issues were consistently identified as central to vaccine certificates’ implementation feasibility. Jurisdictions adopted a range of credential formats, verification mechanisms, and data protection approaches, resulting in differing degrees of interoperability, scalability, and operational complexity.67,71–73 Efforts to balance data minimization, privacy-by-design, cybersecurity safeguards, and ease of verification were evident across systems but were variably documented. The literature also underscored the influence of preexisting digital health infrastructure and governance capacity on implementation choices and timelines.

Ethical and legal considerations

Sources identified concerns that certificate-based systems could disproportionately affect individuals facing barriers related to technology access, digital literacy, socioeconomic status, immigration status, disability, or mistrust of institutions.5,12,72,74 Potential implications related to discrimination, exclusion, stigmatization, and privacy or surveillance concerns were widely discussed, particularly where policy changes occurred rapidly or where long-term use parameters were unclear. These observations reflect broader tensions inherent to emergency public health policymaking, including balancing collective health goals, feasibility, rights protection, and public confidence.

Limitations

This study had some limitations. First, we restricted inclusion to English-language full-texts due to feasibility limitations, which may have limited our ability to capture sources published in the official languages of some jurisdictions. To mitigate this, we used a broad search strategy and included gray literature to capture a wide range of publicly available content. Second, much of the gray literature on vaccine certificates was produced during the height of the pandemic and may have since been archived or removed from public access. We addressed this by reviewing the first 5–10 pages of Google search results and checking government and organizational websites to ensure that we captured all relevant sources. Third, the depth of documentation and public records around vaccine certificate implementation varied across jurisdictions. We addressed this by synthesizing themes based on what was consistently reported and noting areas where data was sparse. Due to the heterogeneous and largely descriptive nature of the literature, and consistent with PRISMA-ScR guidance, we did not conduct formal critical appraisal of included sources, as the objective was to map key concepts and contextual factors, rather than evaluate the strength of evidence or estimate effect sizes. Lastly, inconsistent terminology across sources (e.g., ‘vaccine passport,’ ‘green pass,’ ‘COVID certificate’) may have impacted retrieval. We minimized this by developing an inclusive, peer-reviewed search strategy with a medical librarian and incorporating jurisdiction specific terminology where possible.

Implications for policy and practice

The implementation of vaccine certificates offers both opportunities and challenges. To ensure their effectiveness, policymakers must take a comprehensive approach that balances technological, ethical, and legal considerations. Key policy and practice recommendations include:

Develop robust digital infrastructure

To support secure and effective vaccine certificate systems, it is essential to develop and maintain robust digital infrastructure.75 This includes the creation of secure, interoperable platforms that can facilitate seamless verification of vaccination status across various settings, such as travel, healthcare, and public spaces. Digital solutions must be designed with scalability in mind, able to accommodate the large-scale, cross-border demands that may arise during future pandemics or vaccination campaigns.

Future vaccine certificate systems should be supported by clear governance and oversight mechanisms. This includes transparent decision-making on when certificates are implemented, updated, or withdrawn and publicly available criteria for eligibility, exemptions, and acceptable alternatives. Routine auditing and independent oversight can help detect inequities, privacy risks, or unintended harms early and support timely policy correction.

Ensure equitable access to technology

Policymakers must address the issue of digital exclusion by ensuring that all populations have equitable access to the necessary technology.42 This requires low-barrier options for individuals without smartphones, reliable internet, or strong digital literacy, including accessible paper alternatives and in-person support for obtaining and using certificates. Implementation plans should proactively address barriers faced by rural communities, older adults, newcomers, and socio-economically marginalized groups. Without these supports, certificates risk widening existing inequities in participation in public life.

Establish clear guidelines and regulations

Clear, transparent guidelines and regulations must be established to to support consistent use and foster public trust.54 These guidelines should include clear standards for data protection, privacy, and access control (e.g., limits on retention and secondary uses, strong security safeguards to avoid, among other things misuse of personal health information), as well as clear communication to the public about what information is collected, who can access it, and for what purposes. Guidance should also outline proportionality, acceptable settings for use, and sunset criteria to avoid unnecessary use of certificates once public health benefits no longer justify restrictions.

Foster collaboration across government levels

The development and implementation of vaccine certificate systems require collaboration between different levels of government, as well as between government agencies and the private sector.67 Efforts should focus on further developing existing systems to standardize and strengthen solutions, ensuring that national, regional, and international frameworks align. This includes coordinating across borders to create interoperable systems that can be used globally, particularly in relation to cross-border travel and international public health responses. Collaboration will also be essential for ensuring that vaccine certificate systems are adaptable and resilient to future public health challenges.

Future directions

Future research should focus on:

  1. Establishing global standards for interoperability and cross-border recognition:

    To ensure vaccine certificates are accepted internationally, there is a need to harmonize technical and legal standards. This includes aligning data formats, verification protocols, and privacy safeguards across countries, enabling seamless use while respecting national regulations.

  2. Developing low-cost, offline-compatible solutions for communities with limited digital access:

    Digital inequity can exclude vulnerable populations from accessing vaccine certificates. Future research should prioritize inclusive approaches such as paper-based alternatives, QR codes that function without real-time internet access, or mobile apps designed for low-connectivity environments.

  3. Enhancing security protocols to address emerging cybersecurity threats:

    As digital health records become more widely implemented, they face increased risk from fraud and unauthorized access. Strengthening encryption methods, authentication systems, and regular auditing practices is essential to protect the integrity of individual data and maintain public trust.

  4. Creating dynamic systems that can integrate evolving scientific insights and policy requirements:

    Vaccine knowledge and public health policies evolve rapidly. Systems must be designed to adapt – whether incorporating new vaccine types or new variants, changing recommendations, or shifting public health measures. Flexibility and scalability are critical for long-term relevance and reliability.

Through these efforts, vaccine certificates can become a more effective and equitable tool in global public health strategies, promoting both safety and accessibility across diverse populations and jurisdictions.

Conclusion

Vaccine certificates hold promise as a tool for enhancing public health responses and enabling societal recovery. However, their successful implementation hinges on addressing significant technological, ethical, and legal challenges. Policymakers must develop robust digital infrastructure, ensure equitable access, establish clear regulations, and foster international collaboration. As the landscape evolves, ongoing efforts to build public trust and address these challenges will be essential to optimizing the effectiveness of vaccine certificates.

Supplementary Material

Supplemental Material
KHVI_A_2622178_SM8507.docx (210.5KB, docx)
Suppl 2.xlsx
KHVI_A_2622178_SM3256.xlsx (206KB, xlsx)
Suppl 1.docx
KHVI_A_2622178_SM3255.docx (42.8KB, docx)

Acknowledgments

We would like to acknowledge our librarian, Risa Shorr at The Ottawa Hospital Research Institute for conducting the academic search.

Biographies

Adhiba Nilormi is an MPH graduate of the University of Guelph. She is currently a research coordinator at the Bruyère Health Research Institute.

Cécile M. Bensimon is the Chair of the Research Ethics Board (REB) at the Children’s Hospital of Eastern Ontario (CHEO). She holds appointments as an Adjunct Professor at the University of Ottawa Faculty of Health Sciences and an Affiliate Investigator at Bruyère Health Research Institute.

Kumanan Wilson is CEO and Chief Scientific Officer of Bruyere Health Research Institute and Professor of Medicine at the University of Ottawa where he has been studying vaccination policy and technology.

Funding Statement

This work was supported by the Canadian Institutes of Health Research under Grant number [FO3-184636].

Disclosure statement

KW is the co-founder of CANImmunize Inc. and has served as a member of the independent data safety advisory board for Medicago and Moderna. All other authors report no competing interests.

Data availability statement

All data analyzed during this study are included in this published article [and its supplementary information files].

Ethical considerations

This scoping review did not involve human participants or the collection of primary data; therefore, research ethics approval was not required.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/21645515.2026.2622178

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Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

Supplemental Material
KHVI_A_2622178_SM8507.docx (210.5KB, docx)
Suppl 2.xlsx
KHVI_A_2622178_SM3256.xlsx (206KB, xlsx)
Suppl 1.docx
KHVI_A_2622178_SM3255.docx (42.8KB, docx)

Data Availability Statement

All data analyzed during this study are included in this published article [and its supplementary information files].

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