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In the COVID-19 pandemic, governments have, among other measures,1,2 mandated the use of COVID certificates to prove vaccination, recovery, or a recent negative test, and have required them to access shops, restaurants, schools, universities, or workplaces.3 While arguments for and against COVID certificates have focused on reducing transmission and ethical concerns,4,5 the incentive effect of COVID certificates on vaccine uptake, health outcomes, and the economy has not yet been investigated. To estimate this effect, we construct counterfactuals based on innovation diffusion theory6 for France, Germany, and Italy. We estimate that the announcement of COVID certificates during summer 2021 led to increased vaccine uptake in France of 13.0 (95% CI 9.7–14.9) percentage points (p.p.) of the total population up to the end of the year, in Germany 6.2 (2.6–6.9) p.p., and in Italy 9.7 (5.4–12.3) p.p. Further, this averted an additional 3,979 (3,453–4,298) deaths in France, 1,133 (-312–1,358) in Germany, and 1,331 (502–1,794) in Italy; and prevented gross domestic product (GDP) losses of €6.0 (5.9–6.1) billion in France, €1.4 (1.3–1.5) billion in Germany, and €2.1 (2.0–2.2) billion in Italy. Notably, the application of COVID certificates substantially reduced the pressure on intensive care units (ICUs) and, in France, averted occupancy levels being exceeded where prior lockdowns were instated. Varying government communication efforts and restrictions associated with COVID certificates may explain country differences, such as the smaller effect in Germany. Overall, our findings are more sizeable than predicted.7 This analysis may help inform decisions about when and how to employ COVID certificates to increase vaccine uptake and thus avoid stringent interventions, such as closures, curfews, and lockdowns, with major social and economic consequences.

In the COVID-19 pandemic, governments have used various interventions,1,2 including COVID certificates as proof of vaccination, recovery, or a recent negative test, required for individuals to access shops, restaurants, and education or workplaces.3 While arguments for and against COVID certificates have focused on reducing transmission and ethical concerns,4,5 the effect of the certificates on vaccine uptake, public health, and the economy requires investigation. We construct counterfactuals based on innovation diffusion theory6 and validate them with econometric methods7 to evaluate the impact of incentives created by COVID certificates in France, Germany, and Italy. We estimate that from their announcement during summer 2021 to the end of the year, the intervention led to increased vaccine uptake in France of 13.0 (95% CI 9.7–14.9) percentage points (p.p.) of the total population, in Germany 6.2 (2.6–6.9) p.p., and in Italy 9.7 (5.4–12.3) p.p.; averted an additional 3,979 (3,453–4,298) deaths in France (i.e., 31.7%), 1,133 (-312–1,358) in Germany (5.6%), and 1,331 (502–1,794) in Italy (14.0%); and prevented gross domestic product (GDP) losses of €6.0 (5.9–6.1) billion in France, €1.4 (1.3–1.5) billion in Germany, and €2.1 (2.0–2.2) billion in Italy. Notably, the application of COVID certificates substantially reduced the pressure on intensive care units (ICUs) and, in France, averted surpassing the occupancy levels where prior lockdowns were instated. Overall, our findings are more substantial than predicted8 and may help to inform decisions about when and how to employ COVID certificates to increase vaccination and thus avoid stringent interventions, such as closures, curfews, and lockdowns, with large social and economic consequences.