Informing efforts beyond tailored promotional campaigns by understanding contextual factors shaping vaccine hesitancy among equity-deserving populations in Canada: an exploratory qualitative study

Abstract

Background Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deserving groups, accounting for unique lived experiences, remains a gap in the literature. We aim to identify and begin to understand and document the unique contextual factors shaping hesitancy by equity-deserving groups as it relates to relationships with government and health authorities. Methods Participants were recruited and interviewed between Aug-Dec 2021. Semi-structured interviews using a convergent interviewing technique were conducted with individuals from the general population, as well as individuals who identify as First Nations, Métis, or Inuit, members of the LGBT2SQ + community, low-income Canadians, Black Canadians, and newcomers. Interviews were audio recorded and transcribed by a team of researchers. Memos were written following interviews and used to complement the thematic analysis of the interview data. Themes are presented in the results section. Results The rationale for hesitancy among equity-deserving groups is consistent with literature documenting hesitancy in the general population. Contextual factors surrounding equity-deserving groups’ attitudes and beliefs, however, are unique and relate to a history of oppression, discrimination, and genocide. We identified factors unique to subgroups; for example, religious or fatalistic beliefs among participant who identify as FNMI, fear associated with lack of testing and speed of vaccines’ production among participants who identify as FNMI, Black, and LGBT2SQ + , distrust of the healthcare system for LGBT2SQ + and Black Canadians, and distrust of the government and opposition to vaccine mandates for participating who identify as LGBT2SQ + , low-income, FNMI, or Black Canadian. Newcomers stood out as very trusting of the government and accepting of COVID-19 vaccination. Conclusions While our data on vaccine hesitancy largely mirror concerns reported in the vast body of literature citing rationale for COVID-19 hesitancy in high-income countries, the contextual factors identified in our work point to the need for wider systemic change. Our results may be used to support efforts, beyond tailored promotion campaigns, to support the confident acceptance of vaccines for COVID-19 and the acceptance of novel vaccines as future infectious diseases emerge.

Strengthening access to and confidence in COVID-19 vaccines among equity-deserving populations across Canada: An exploratory qualitative study

“…The rapid spread of the novel coronavirus prompted all high-resource countries to institute a myriad of prevention and control measures and invest massively in developing, procuring, and distributing vaccines (2). With the increased availability of COVID-19 vaccines, calls for vaccine equity within and among countries emerged (3)(4)(5)(6)(7)(8). Vaccine equity in the context of the COVID-19 pandemic was seen as an imperative to "end this pandemic, restart economies, and begin to tackle the other great challenges of our time" (4).…”

“…Studies from high-income countries have shown that vaccine hesitancy and poor access to vaccination services are higher among Black, Indigenous, and other minoritized populations than non-racialized people due to historical and current systemic racism and distrust of the health system (6)(7)(8). In Canada, specifically, an analysis based on the 2020 Canadian Community Health Survey (CCHS), an ongoing yearly cross-sectional survey conducted by Statistics Canada, found that Canadians who self-identify as off-reserve First Nations, Black, or Arab were less likely to have received at least one dose of a COVID -19 vaccine (11).…”

Restoring public trust in COVID-19 vaccine among Africans, Caribbean, and Black Canadians Community based participatory research (CBPR)

“…Challenges with vaccine hesitancy among minority groups do not stem from their innate vulnerabilities, instead the key drivers are socio-economic factors such as social status, access to social goods, housing, employment, and healthcare services [4,5,6]. Within the Canadian context, one key study found that vaccine hesitancy among Black Canadians primarily stemmed from "the denial of their rights and feeling that decisions were being made for members of the Black community and hesitancy related to medical distrust" [3] (p. 9)…”

“…There is a growing body of research to show the linkages between social determinants, COVID-19 infections and racialization. These social determinants places vulnerable ACB individuals a greater risk of disease and psychological stress (3,5,8). In Canada, heavy policing and social distancing rules were enforced on minority groups, particularly within Black communities reinforcing the mistrust within our social and health systems [1].…”

“…One recent study coined the term vaccine mistrust ( a subtheme of public mistrust used in reference to Black individuals) de ned it as "a lack of con dence in the healthcare system, providers, treatments, and immunizations because of failure to them " [6, p. 1]. The ndings showed vaccine mistrust was highest among Black Canadians compared to other racialized groups such as Arab and Indigenous communities due to higher rates of racial discrimination in healthcare services and conspiracy theories [3]. Additionally, Black Francophones tend to have higher rates of vaccine mistrust compared to Black Anglophones due to language barrier impacting access to health services.…”