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In the fall of 2020, about 84% of Canadian adults over age 50 who were surveyed about vaccine willingness said they were likely to get a shot once one became available, according to new data.

Another 10% said they were unsure, and 6% said they were unlikely to get vaccinated. The results of the survey are similar to the current vaccination rates in Canada, which may suggest that most people were certain about their choice in 2020 — and may remain that way as the pandemic continues.

“We were pleased to find during our survey that willingness to receive a COVID-19 vaccine was very high among older Canadian adults at the end of 2020, even before vaccines became available. This demonstrates that confidence in COVID-19 vaccines grew as the first evidence of the safety and efficacy of these vaccines was being reported,” lead author Nicole Basta, PhD, an associate professor of epidemiology at McGill University in Montreal, Quebec, told Medscape Medical News.

“Unfortunately, a very similar proportion of individuals who reported that they were very or somewhat unwilling to receive a COVID-19 vaccine during our survey at the end of 2020 remain unvaccinated today, more than a year after COVID-19 vaccines became widely available in this age group in Canada,” she said. “This is worrisome and demonstrates just how difficult it is to increase vaccine willingness.”

The findings were published online February 15 in the American Journal of Epidemiology.

Age and Willingness

Researchers at McGill and McMaster Universities surveyed nearly 24,000 adults who participated in the Canadian Longitudinal Study on Aging between September and December 2020 to understand the factors associated with willingness to receive a COVID-19 vaccination.

The participants were asked, “If a safe and effective COVID-19 vaccine were available to you, how likely would you be to choose to get the vaccine?” They were then asked to select the reasons why they would or wouldn’t receive a shot.

Among those aged 50 to 96 years, 84.1% said they were very or somewhat willing to receive a vaccine, and 15.9% said they were uncertain or very or somewhat unwilling. In addition, 72.7% said they were very likely to receive a vaccine, 11.5% said they were somewhat likely, 9.9% said they were uncertain, 1.8% were somewhat unlikely to receive a vaccine, and 4.2% were very unlikely.

Within every sociodemographic category, most participants indicated that they were very likely to receive a vaccine. Those who were aged 65 years or older, male, White, had higher education and income levels, and lived in urban areas were significantly more likely to report willingness to receive a COVID-19 vaccine.

On the other hand, those who were younger (between age 50 and 64 years), female, non-White, had lower education and income, and lived in a rural area were less willing to receive a vaccine.

“Certain groups are less likely to receive vaccination, which mirrors what we found in the United States,” Preeti Malani, MD, chief health officer for the University of Michigan, told Medscape Medical News. Malani was not involved in the study.

“They’re very ‘dug in’ in terms of not getting vaccinated,” she added. “Nobody is shifting. There are nearly zero new first vaccinations now.”

Desire for Protection

After controlling for sociodemographic factors, Basta and colleagues found that adults who had recently received an influenza vaccine or who were planning to receive one during fall 2020 were significantly more likely to be willing to receive a COVID-19 vaccine. About 30% of participants had received a flu shot early in the 2020 season, and 51% planned to receive one.

In addition, those who believed they hadn’t been infected with SARS-CoV-2 and those who had experienced negative pandemic consequences were more likely to express willingness to get vaccinated. About 87% of participants believed it was unlikely that they had been infected so far, and 61% reported overall negative consequences in their lives.

Among the 20,000 participants who said they were very likely or somewhat likely to receive a vaccine, 37.5% selected “I want to protect myself” and 25.7% selected “I want to protect my family and loved ones” as reasons. About 24% selected “I want to contribute to ending COVID-19 outbreaks.”

Among the 3775 participants who were uncertain or unlikely to receive a vaccine, about 64% said, “I am concerned about the safety of the vaccine.” About 18% said, “I am concerned about how well the vaccine will protect,” and 8% selected “other.”

As the pandemic continues, additional focus groups could shed light on why a portion of the population remains unvaccinated, Malani said.

“Unless we can find a way to address the concerns that these individuals have, I’m not hopeful that they’re going to change their minds,” she said. “This is the time where it should stay on our radar, and we should spend the summer months really talking about these concerns and getting the message out there.”

Targeted Outreach

Older adults, who are known to face increased risks for severe COVID-19, remain a primary group for targeted outreach to improve COVID-19 vaccine uptake in Canada, the researchers write.

As of April 3, about 86% of the eligible population in Canada is considered fully vaccinated, which includes 89% of adults between age 50 and 59 years, 93% of those aged 60 to 69 years, 96.5% of those aged 70 to 79 years, and 97.5% of those aged 80 years and older, according to the Public Health Agency of Canada.

Multiple tailored approaches could be used to reach the remaining groups in countries where vaccine uptake has plateaued, as in Canada, the researchers write, including promotion of the community-wide benefits of vaccination and combating misinformation about COVID-19 vaccines.

“It is very important that the same level of investment that has been devoted to developing vaccines is devoted to vaccine delivery, vaccine equity, and vaccine epidemiology so we can ensure that the technological success of developing vaccines translates into the public health success of ensuring the highest vaccination coverage possible,” Basta said. “This is critically important even in year 3 of the pandemic so that we can prepare for future waves and prevent severe outcomes, especially among the most vulnerable.”

The study was funded by the Juravinski Research Institute, McMaster University, the McMaster Institute for Research on Aging, the Nova Scotia COVID-19 Health Research Coalition, and the Public Health Agency of Canada. Basta and Malani have reported no relevant financial relationships.

Am J Epidemiol. Published online February 15, 2022. Full text

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