Understanding national trends in COVID-19 vaccine hesitancy in Canada: results from five sequential cross-sectional representative surveys spanning April 2020-March 2021.

To examine rates of vaccine hesitancy and their correlates among Canadian adults between April 2020 and March 2021. Five sequential cross-sectional age, sex and province-weighted population-based samples who completed online surveys. Canada. A total of 15 019 Canadians aged 18 years and over were recruited through a recognised polling firm (Leger Opinion). Respondents were 51.5% female with a mean age of 48.1 (SD 17.2) years (range 18-95 years) and predominantly white (80.8%). Rates of vaccine hesitancy over the five surveys (time points) and their sociodemographic, clinical and psychological correlates. A total of 42.2% of respondents reported some degree of vaccine hesitancy, which was lowest during surveys 1 (April 2020) and 5 (March 2021) and highest during survey 3 (November 2020). Fully adjusted multivariate logistic regression analyses revealed that women, those aged 50 and younger, non-white, those with high school education or less, and those with annual household incomes below the poverty line in Canada were significantly more likely to report vaccine hesitancy, as were essential and healthcare workers, parents of children under the age of 18 and those who do not get regular influenza vaccines. Endorsing prevention behaviours as important for reducing virus transmission and high COVID-19 health concerns were associated with 77% and 54% reduction in vaccine hesitancy, respectively. Having high personal financial concerns was associated with 1.33 times increased odds of vaccine hesitancy. Results highlight the importance of targeting vaccine efforts to specific groups by emphasising the outsized health benefits compared with risks of vaccination. Future research should monitor changes in vaccine intentions and behaviour to better understand underlying factors.

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Competing interests: KL is a member of the Canadian COVID-19 Expert Advisory Panel (Health Canada); has served on the advisory board or as a consultant for Schering-Plough, Takeda, AbbVie, Almirall, Janssen, GSK, Novartis, Boehringer Ingelheim (BI) and Sojecci; has received sponsorship for investigator-generated research grants from GlaxoSmithKline (GSK) and AbbVie, speaker fees from GSK, Astra-Zeneca, Astellas, Novartis, Takeda, AbbVie, Merck, Boehringer Ingelheim, Bayer, Pfizer, Xfacto and Air Liquide; and has received support for educational materials from Merck, none of which are related to the current article. MV has served on the advisory board for Diabetes Canada and has received sponsorship for investigator-generated research grants from Novo Nordisk, Abbott Diabetes Care and Bausch Health, and consultation and speaker fees from Abbott Diabetes Care, Novo Nordisk, Abbvie, Boehringer Ingelheim and Lifescan, none of which are related to the current article. JP is a member of the Ontario Immunization Advisory Committee (Public Health Ontario) and a member of the Ontario COVID-19 Science Advisory Table. SB is a member of the Health Canada COVID Alert Application Working Group; has served on the advisory board for Bayer and Sanofi; and has received sponsorship for investigator-generated research grants from GSK, Moderna and Abbvie, consultation fees from Schering-Plough, Merck, Astra Zeneca, Sygesa, Bayer, Sanofi, Lucilab and Respiplus, and speaker fees from Novartis, Respiplus and Janssen, none of which are related to the current article.