Would You Use a Digital Vaccine Record? Here’s What Washingtonians Decided
When Washington State launched its digital vaccine verification tool, WA Verify, during the COVID-19 pandemic, it was designed to make sharing proof of vaccination faster and more convenient. But how did Washington residents actually feel about using it, and what shaped their willingness to adopt digital public health tools? A new study collaboration between the University of Washington Department of Epidemiology and the Washington State Department of Health explores these questions through a statewide survey, uncovering how issues of trust, privacy, and technology access influence public adoption.
The findings reveal a paradox: most Washingtonians were ready to embrace digital health tools, but a significant minority had concerns that technology alone can’t resolve.
Understanding who used WA Verify and why
For Andrea Molino, lead author and PhD candidate in the University of Washington Department of Epidemiology, the study offered an opportunity to examine real-world attitudes toward one of the COVID-19 pandemic’s most widely used public health technologies. WA Verify allowed residents to access a digital version of their COVID-19 vaccination status via QR code, a tool used for everything from entering bars to streamlining check-ins at healthcare facilities.
In addition to identifying and characterizing barriers and facilitators for adopting WA Verify, the team also wanted to understand if adoption (or refusal to) of WA Verify was affected by concerns about data security and privacy, attitudes toward public health policies, and tech –readiness.
The research drew on responses from a statewide survey of roughly 1,500 Washington households. The foremost finding was encouraging: roughly three-quarters of respondents either used WA Verify themselves or said they would be willing to use similar tools in the future. “That’s great news,” Molino says. “It indicates that the adoption of future public health tools could also be high.”
At the same time, concerns around data security were common—especially among those who said they would not be willing to use WA Verify. These concerns were tied not just to the tool itself, but to broader feelings about government and public health agencies.
Trust: the through-line in public health modernization
The timing of the study aligned with broader discussions about modernizing public health data and the surge of digital tools during the pandemic. For example, the CDC’s Data Modernization Initiative aims to help agencies collect and use health information more efficiently—essential capabilities that the pandemic exposed as dangerously outdated. “Modernization in public health is a hot topic for a reason,” Molino says. “These initiatives will hopefully lead to public health being able to use larger amounts and different types of data more efficiently, and also in a timely manner. If you have more data sources that are more interoperable, it could enable a faster response to public health emergencies.”
But the WA Verify system study suggests that building better technology is only half the challenge. The harder part is building trust in the institutions behind that technology. “It’s possible to have both effective digital tools and strong privacy protections,” Molino says. She notes for example, that one aspect of the WA Verify tool not discussed in the paper is that it displayed only the same information as a paper COVID-19 vaccine card, no additional health records, and users retained full control over when and with whom to share their QR-code based verification record. “But the first step is clear communication about how the technology works and what information is or isn’t being shared. Lack of trust isn’t something you fix with a single flyer or explanation—it requires sustained, long-term communication that varies across communities.”
She added that public health agencies, especially at the local level, often lack the resources needed for this long-term investment. Trust-building is essential, but difficult. “In 2022, I wrote a commentary for the American Journal of Epidemiology about how friends and family would reach out to me for guidance during the pandemic. I wasn’t telling them anything they couldn’t Google themselves, but hearing it from someone they knew mattered. That kind of pre-existing relationship made the information more trustworthy to them. I think a similar principle applies here—local, familiar sources are better positioned to build trust and shift opinions.”
When digital tools aren’t accessible
Not everyone wants or is able to adopt digital tools. On the question of tech readiness or accessibility, Molino stressed the importance of maintaining alternatives for those who opt out, lack access, or aren’t ready for digital systems. While Molino agrees that no one mode of technology will work for everyone, she also notes that this barrier shouldn’t keep public health researchers from developing tools that benefit large portions of the population. The answer lies in acknowledging and addressing the underlying inequalities that shape people’s access. For example, during WA Verify’s rollout, residents could request or print a paper version of the QR code, or could continue using their paper COVID-19 vaccine card. As public health agencies consider future digital systems, they will need to offer multiple access points, ensuring no one is excluded.
What’s next?
Because the survey was cross-sectional, Molino hopes future research will dig deeper into the why behind people’s decisions. The cross-sectional nature of the survey led to some interpretation limitations. “We can’t tell whether someone’s opposition to vaccine verification existed before the pandemic or if it developed when they encountered a tool like WA Verify,” she says. “We have strong quantitative data, but the next step should be qualitative work—interviews or focus groups—to understand which concerns actually drove people’s decisions.”
She believes these insights are essential for any public health agency designing digital tools for emergencies or routine care.
“There’s just a fair bit of heterogeneity in the population around feelings toward these tools. Understanding that diversity of perspectives will ultimately impact how these technologies are adopted moving forward.”