Transition to endemic: acceptance of additional COVID-19 vaccine doses among Canadian adults in a national cross-sectional survey

Abstract

Background: Additional doses of COVID-19 vaccine have been proposed as solutions to waning immunity and decreased effectiveness of primary doses against infection with new SARS-CoV-2 variants. However, the effectiveness of additional vaccine doses relies on widespread population acceptance. We aimed to assess the acceptance of additional COVID-19 vaccine doses (third and annual doses) among Canadian adults and determine associated factors.

Methods: We conducted a national, cross-sectional online survey among Canadian adults from October 14 to November 12, 2021. Weighted multinomial logistic regression analyses were used to identify sociodemographic and health-related factors associated with third and annual dose acceptance and indecision, compared to refusal. We also assessed influences on vaccine decision-making, and preferences for future vaccine delivery.

Results: Of 6010 respondents, 70% reported they would accept a third dose, while 15.2% were undecided. For annual doses, 64% reported acceptance, while 17.5% were undecided. Factors associated with third dose acceptance and indecision were similar to those associated with annual dose acceptance and indecision. Previous COVID-19 vaccine receipt, no history of COVID-19 disease, intention to receive an influenza vaccine, and increasing age were strongly associated with both acceptance and indecision. Chronic illness was associated with higher odds of acceptance, while self-reported disability was associated with higher odds of being undecided. Higher education attainment and higher income were associated with higher odds of accepting additional doses. Minority first language was associated with being undecided about additional doses, while visible minority identity was associated with being undecided about a third dose and refusing an annual dose. All respondents reported government recommendations were an important influence on their decision-making and identified pharmacy-based delivery and drop-in appointments as desirable. Co-administration of COVID-19 and influenza vaccines was viewed positively by 75.5% of the dose 3 acceptance group, 12.3% of the undecided group, and 8.4% of the refusal group.

Conclusions: To increase acceptance, targeted interventions among visible minority and minority language populations, and those with a disability, are required. Offering vaccination at pharmacies and through drop-in appointments are important to facilitate uptake, while offering COVID-19/influenza vaccine co-administration may have little benefit among those undecided about additional doses.

Keywords: Annual; Booster dose; COVID-19; Immunization; Seasonal; Third dose; Vaccine.

Conflict of interest statement

MS has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, Sanofi-Pasteur, Seqirus, Symvivo and VBI Vaccines. All funds have been paid to his institute, and he has not received any personal payments.

© 2022. The Author(s).

Figures

Fig. 1

Influences on COVID-19 vaccine decision making by dose 3 intention group Respondents were asked to select all answers that apply

Fig. 2

Primary motivation for previous COVID-19 vaccine receipt by dose 3 intention group aRespondents who chose not to answer the question were removed from the denominator

Fig. 3

Agreement with COVID-19 vaccine co-administration with (a) influenza vaccine, and (b) routine vaccines, by dose 3 intention group. Included only respondents who had received at least one dose of COVID-19 vaccine

Fig. 4

Preferred vaccination location by dose 3 intention group. Included only respondents who had received at least one dose of COVID-19 vaccine Respondents were asked to choose one answer

Fig. 5

Recommendations for making the vaccination process easier by dose 3 intention group. Included only respondents who had received at least one dose of COVID-19 vaccine Respondents were asked to select all answers that applied