'Immunity Passports' for SARS-CoV-2: an online experimental study of the impact of antibody test terminology on perceived risk and behaviour

BMJ Open. 2020 Aug 30;10(8):e040448. doi: 10.1136/bmjopen-2020-040448.


Objective: To assess the impact of describing an antibody-positive test result using the terms Immunity and Passport or Certificate, alone or in combination, on perceived risk of becoming infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and protective behaviours.

Design: 2×3 experimental design.

Setting: Online.

Participants: 1204 adults from a UK research panel.

Intervention: Participants were randomised to receive one of six descriptions of an antibody test and results showing SARS-CoV-2 antibodies, differing in the terms describing the type of test (Immunity vs Antibody) and the test result (Passport vs Certificate vs Test).

Main outcome measures: Primary outcome: proportion of participants perceiving no risk of infection with SARS-CoV-2 given an antibody-positive test result. Other outcomes include: intended changes to frequency of hand washing and physical distancing.

Results: When using the term Immunity (vs Antibody), 19.1% of participants (95% CI 16.1% to 22.5%) (vs 9.8% (95% CI 7.5% to 12.4%)) perceived no risk of catching coronavirus given an antibody-positive test result (adjusted OR (AOR): 2.91 (95% CI 1.52 to 5.55)). Using the terms Passport or Certificate-as opposed to Test-had no significant effect (AOR: 1.24 (95% CI 0.62 to 2.48) and AOR: 0.96 (95% CI 0.47 to 1.99) respectively). There was no significant interaction between the effects of the test and result terminology. Across groups, perceiving no risk of infection was associated with an intention to wash hands less frequently (AOR: 2.32 (95% CI 1.25 to 4.28)); there was no significant association with intended avoidance of physical contact (AOR: 1.37 (95% CI 0.93 to 2.03)).

Conclusions: Using the term Immunity (vs Antibody) to describe antibody tests for SARS-CoV-2 increases the proportion of people believing that an antibody-positive result means they have no risk of catching coronavirus in the future, a perception that may be associated with less frequent hand washing.

Trial registration number: Open Science Framework: https://osf.io/tjwz8/files/.

Keywords: immunology; public health.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Antibodies, Viral* / blood
  • Betacoronavirus
  • COVID-19
  • Certification
  • Communication*
  • Coronavirus Infections* / blood
  • Coronavirus Infections* / prevention & control
  • Coronavirus Infections* / virology
  • Disclosure
  • Female
  • Health Behavior*
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Immunity*
  • Internet
  • Male
  • Odds Ratio
  • Pandemics* / prevention & control
  • Pneumonia, Viral* / blood
  • Pneumonia, Viral* / prevention & control
  • Pneumonia, Viral* / virology
  • Risk Assessment
  • SARS-CoV-2
  • United Kingdom


  • Antibodies, Viral