Factors affecting hesitancy toward COVID-19 vaccine booster doses in Canada: a cross-national survey

Jeanna Parsons Leigh; Emily A FitzGerald; Stephana J Moss; Rebecca Brundin-Mather; Alexandra Dodds; Henry T Stelfox; Ève Dubé; Kirsten M Fiest; Donna Halperin; Sofia B Ahmed; Shannon E MacDonald; Sharon E Straus; Terra Manca; Josh Ng Kamstra; Andrea Soo; Shelly Longmore; Shelly Kupsch; Bonnie Sept; Scott Halperin

doi:10.17269/s41997-023-00823-z

Factors affecting hesitancy toward COVID-19 vaccine booster doses in Canada: a cross-national survey

Can J Public Health. 2024 Feb;115(1):26-39. doi: 10.17269/s41997-023-00823-z. Epub 2023 Nov 22.

Authors

Jeanna Parsons Leigh^{1

2

3}, Emily A FitzGerald⁴, Stephana J Moss^{4

5}, Rebecca Brundin-Mather⁶, Alexandra Dodds⁴, Henry T Stelfox^{6

7}, Ève Dubé^{8

9}, Kirsten M Fiest^{6

7

10}, Donna Halperin^{11

12}, Sofia B Ahmed^{7

13

14}, Shannon E MacDonald^{15

16}, Sharon E Straus^{17

18

19}, Terra Manca^{16

20}, Josh Ng Kamstra^{21

22}, Andrea Soo^{6

23}, Shelly Longmore⁶, Shelly Kupsch⁶, Bonnie Sept⁶, Scott Halperin^{11

24

25}

Affiliations

¹ Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada. j.parsonsleigh@dal.ca.
² Department of Critical Care Medicine, Dalhousie University, Halifax, NS, Canada. j.parsonsleigh@dal.ca.
³ Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada. j.parsonsleigh@dal.ca.
⁴ Faculty of Health, School of Health Administration, Dalhousie University, Halifax, NS, Canada.
⁵ CRISMA Center, Department of Critical Care, University of Pittsburgh, Pittsburgh, USA.
⁶ Department of Critical Care Medicine, University of Calgary, Calgary, AB, Canada.
⁷ O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.
⁸ Centre de Recherche du CHU de Québec, Université Laval, Québec, Canada.
⁹ Institut National de Santé Publique du Québec, Québec, Canada.
¹⁰ Department of Psychiatry & Hotchkiss Brain Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
¹¹ Canadian Center for Vaccinology & IWK Health Centre, Halifax, NS, Canada.
¹² Rankin School of Nursing, St. Francis Xavier University, Antigonish, NS, Canada.
¹³ Department of Medicine, University of Calgary, Calgary, AB, Canada.
¹⁴ Libin Cardiovascular Institute, University of Calgary, Calgary, AB, Canada.
¹⁵ School of Public Health, University of Alberta, Edmonton, AB, Canada.
¹⁶ Faculty of Nursing, University of Alberta, Edmonton, AB, Canada.
¹⁷ Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.
¹⁸ Department of Medicine, University of Toronto, Toronto, ON, Canada.
¹⁹ Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
²⁰ Sociology and Social Anthropology, Dalhousie University, Halifax, NS, Canada.
²¹ Department of Surgery, John A. Burns School of Medicine, University of Hawaii at Manoa, Honolulu, HI, USA.
²² Department of Surgery, The Queen's Medical Center, Honolulu, HI, USA.
²³ Alberta Health Services, Calgary, AB, Canada.
²⁴ Department of Pediatrics, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.
²⁵ Department of Microbiology and Immunology, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada.

Abstract
in English, French

Objective: COVID-19 transmission, emergence of variants of concern, and weakened immunity have led to recommended vaccine booster doses for COVID-19. Vaccine hesitancy challenges broad immunization coverage. We deployed a cross-national survey to investigate knowledge, beliefs, and behaviours toward continued COVID-19 vaccination.

Methods: We administered a national, cross-sectional online survey among adults in Canada between March 16 and March 26, 2022. We utilized descriptive statistics to summarize our sample, and tested for demographic differences, perceptions of vaccine effectiveness, recommended doses, and trust in decisions, using the Rao-Scott correction for weighted chi-squared tests. Multivariable logistic regression was adjusted for relevant covariates to identify sociodemographic factors and beliefs associated with vaccine hesitancy.

Results: We collected 2202 completed questionnaires. Lower education status (high school: odds ratio (OR) 1.90, 95% confidence interval (CI) 1.29, 2.81) and having children (OR 1.89, CI 1.39, 2.57) were associated with increased odds of experiencing hesitancy toward a booster dose, while higher income ($100,000-$149,999: OR 0.60, CI 0.39, 0.91; $150,000 or more: OR 0.49, CI 0.29, 0.82) was associated with decreased odds. Disbelief in vaccine effectiveness (against infection: OR 3.69, CI 1.98, 6.90; serious illness: OR 3.15, CI 1.69, 5.86), disagreeing with government decision-making (somewhat disagree: OR 2.70, CI 1.38, 5.29; strongly disagree: OR 4.62, CI 2.20, 9.7), and beliefs in over-vaccinating (OR 2.07, CI 1.53, 2.80) were found associated with booster dose hesitancy.

Conclusion: COVID-19 vaccine hesitancy may develop or increase regarding subsequent vaccines. Our findings indicate factors to consider when targeting vaccine-hesitant populations.

RéSUMé: OBJECTIF: La transmission de la COVID-19, l’émergence de variants préoccupants et l’affaiblissement de l’immunité ont conduit à recommander des doses de rappel de vaccin contre la COVID-19. L’hésitation à la vaccination remet en question une large couverture vaccinale. Nous avons déployé une enquête transnationale pour étudier les connaissances, les croyances et les comportements en faveur de la poursuite de la vaccination contre la COVID-19. MéTHODES: Nous avons mené une enquête nationale transversale en ligne auprès d’adultes au Canada, entre le 16 et le 26 mars 2022. Nous avons utilisé des statistiques descriptives pour résumer notre échantillon et testé les différences démographiques, les perceptions de l’efficacité des vaccins, les doses recommandées et la confiance dans les décisions, en utilisant la correction de Rao-Scott pour les tests du chi carré pondérés. La régression logistique multivariée a été ajustée pour les covariables pertinentes afin d’identifier les facteurs sociodémographiques et les croyances associés à l’hésitation à la vaccination. RéSULTATS: Nous avons collecté 2 202 questionnaires remplis. Un faible niveau d’éducation (lycée : rapport de cotes (OR) 1,90, intervalle de confiance (IC) à 95% 1,29, 2,81) et le fait d’avoir des enfants (OR 1,89, IC 1,39, 2,57) étaient associés à une probabilité accrue d’éprouver une hésitation à l’égard d’une dose de rappel, tandis qu’un revenu plus élevé (100 000 $–149 999 $ : OR 0,60, IC 0,39, 0,91; 150 000 $ ou plus : OR 0,49, IC 0,29, 0,82) était associé à une diminution des probabilités. Incrédulité dans l’efficacité du vaccin (contre l’infection : OR 3,69, IC 1,98, 6,90; maladie grave : OR 3,15, IC 1,69, 5,86), en désaccord avec la prise de décision du gouvernement (plutôt en désaccord : OR 2,70, IC 1,38, 5,29; fortement en désaccord : OR 4,62, IC 2,20, 9,7) et la croyance dans le sur-vaccination (OR 2,07, IC 1,53, 2,80) ont été associées à une hésitation à recevoir une dose de rappel. CONCLUSION: Une hésitation à l’égard du vaccin contre la COVID-19 peut se développer ou augmenter à l’égard des vaccins ultérieurs. Nos résultats indiquent des facteurs à prendre en compte lors du ciblage des populations hésitantes à la vaccination.

Keywords: COVID-19; Questionnaire; SARS-CoV-2; Survey; Vaccination; Vaccine hesitancy.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
COVID-19 Vaccines
COVID-19* / epidemiology
COVID-19* / prevention & control
Canada / epidemiology
Child
Cross-Sectional Studies
Humans
Immunization, Secondary*
Vaccination

Factors affecting hesitancy toward COVID-19 vaccine booster doses in Canada: a cross-national survey

Authors

Affiliations

Abstract
in English, French

Publication types

MeSH terms

Substances

Supplementary concepts

Grants and funding

Abstract in English, French

Publication types

MeSH terms

Substances

Supplementary concepts

Grants and funding

Abstract
in English, French