Royal society of Canada COVID-19 report: Enhancing COVID-19 vaccine acceptance in Canada

Abstract

COVID-19 vaccine acceptance exists on a continuum from a minority who strongly oppose vaccination, to the “moveable middle” heterogeneous group with varying uncertainty levels about acceptance or hesitancy, to the majority who state willingness to be vaccinated. Intention for vaccine acceptance varies over time. COVID-19 vaccination decisions are influenced by many factors including knowledge, attitudes, and beliefs; social networks; communication environment; COVID-19 community rate; cultural and religious influences; ease of access; and the organization of health and community services and policies. Reflecting vaccine acceptance complexity, the Royal Society of Canada Working Group on COVID-19 Vaccine Acceptance developed a framework with four major factor domains that influence vaccine acceptance (people, communities, health care workers; immunization knowledge; health care and public health systems including federal/provincial/territorial/indigenous factors)—each influencing the others and all influenced by education, infection control, extent of collaborations, and communications about COVID-19 immunization. The Working Group then developed 37 interrelated recommendations to support COVID vaccine acceptance nested under four categories of responsibility: 1. People and Communities, 2. Health Care Workers, 3. Health Care System and Local Public Health Units, and 4. Federal/Provincial/Territorial/Indigenous. To optimize outcomes, all must be engaged to ensure co-development and broad ownership.

COVID-19 vaccine hesitancy

“…Vaccine acceptance exists on a continuum, ranging from a minority who stridently oppose all vaccinations to the majority who are willing to accept all recommended vaccines. Vaccine-hesitant individuals are a heterogeneous group with varying levels of indecision and concerns in the middle of this continuum 5 . This group is of particular interest to public health services, as many vaccine-hesitant individuals may be amenable to changing their vaccination attitudes and behaviours if their concerns are adequately addressed and systemic barriers in access to health services are removed (for example, discrimination, stigmatization, racism and gender barriers).…”

“…At the individual level, various sociodemographic characteristics (for example, age, gender, socioeconomic status and geographical location) and many other factors (for example, low perceived risk of VPD, concerns regarding vaccine safety and/or effectiveness, belief in alternative prevention measures for VPD and/or negative past experiences with health services) are associated with suboptimal vaccine uptake 5 . For people living with chronic medical conditions, additional barriers to vaccine acceptance include real and perceived contraindications, risks of individual vaccines with respect to specific medical conditions and a lack of awareness of vaccine recommendations among specialists caring for these patients 2 .…”

“…Second, the COVID ‘infodemic’ — an overabundance of information, some of which is true and some false or misleading — complicates how people search for and access reliable information about vaccination. Misinformation and disinformation can substantially reduce vaccine acceptance 7 and might influence the vaccine advice of health-care providers 5 . Political decisions such as policy responses to the pandemic have also been influenced by the infodemic, and by partisan ideas about the risk of COVID-19 and the effectiveness of preventive measures 8 .…”

“…The immunization knowledge domain highlights the importance of reliable information regarding vaccination (that is, easily accessible, accurate and up-to-date information tailored for targeted subgroups of the general population and of health-care providers). Each individual domain influences the other domains and all domains are influenced by the broader context (for example, the extent of collaborations and communications about COVID-19 vaccination) 5 . Although developed for Canada, the principles are broadly applicable to other countries worldwide.…”

Between persuasion and compulsion: The case of COVID-19 vaccination in Canada

“…It is well recognized that tailored multi-level strategies based on an in-depth understanding of the barriers to immunization in communities and groups are very effective. While incentive and disincentive measures may increase vaccine uptake at some point, neither of these approaches address the underlying causes of vaccine hesitancy and intersectionality in factors leading to sub-optimal vaccine uptake rates [52] . Evidence-based and behaviourally informed strategies should be used for education, outreach, and for reducing barriers in access before considering – or in parallel to – implementing incentives or imposing vaccination [30] , [53] , [54] , [55] .…”