Mitigating Vaccine Hesitancy for Future Pandemics: Lessons from COVID-19

Brian Ellis-Legault is completing his Masters of Public Health at Simon Fraser University.

The recent rise in COVID-19 hospitalizations across Canada should serve as a stark reminder that the impacts of this pandemic are far from fleeting.¹ As researchers predict a high probability of similarly scaled pandemics occurring in the coming decades,² it is critical that public health actors take concrete steps to improve on our nation’s pandemic response. 

Canada has fared well among high-income nations when it comes to COVID-19 vaccination, with over 80% of our total population having received at least one dose.³ Ontario data shows that of 38 million doses administered in the province, only 0.06% involved adverse reactions, of which 94.5% were non-serious.⁴ An analysis of over 55,000 COVID-19 hospitalizations across Canada from 2020-22 further demonstrates that ICU admissions and deaths were significantly higher among unvaccinated patients compared to those who received at least one dose.⁵ 

However, nearly 1 in 5 Canadians opted not to receive a single dose of the COVID-19 vaccine.³ Not only does vaccine hesitancy pose a significant risk to individual health, but it has placed an unnecessary burden on the healthcare system during critical moments throughout the pandemic. 

Recommendation #1: Prioritize interventions targeting misinformation

While some of the non-vaccinated population are unable or unwilling to be vaccinated for legitimate reasons, many have been led astray by misinformation. A report by the Council of Canadian Academies estimates that misinformation influenced over 2 million Canadians to avoid vaccination between March and November 2021, resulting in an estimated 2800 deaths and $300 million in hospital costs.⁶ These figures would be much larger if measured across the full pandemic. 

In most cases, vaccine-hesitant individuals influenced by misinformation genuinely believe that they are making the best decision for themselves or their families. It is a failure by public health that misinformation has been allowed to have such an impact. As such, future pandemic responses should include a significant increase in resources allocated to mitigating the proliferation of misinformation online. Moreover, public health promotion should leverage data from COVID-19 to promptly disseminate messaging that targets specific sub-populations who are especially susceptible. 

Recommendation #2: Keep politicians at arm’s length from public communication on vaccination

The politicization of vaccination is another key factor contributing to hesitancy. Multiple studies on COVID-19 vaccination attitudes and beliefs among Canadians have highlighted ‘non-liberal’ political orientation being associated with hesitancy or refusal, demonstrating what is likely ideological pushback against the current government rather than informed decision-making.^7,8 Hesitant parents also explain that seeing politicians encourage vaccination makes them question the true motivation underlying vaccination campaigns.⁹ It is reasonable to believe that most vaccine-accepting Canadians are not doing so because their prime minister or MP told them to – in fact, national surveys repeatedly indicate that Canadians trust medical professionals and scientists far more than politicians.^10-12 Communication regarding vaccination should be delivered by public health experts themselves, rather than politicians. This will help mitigate concerns about political interference in public health institutions and lessen politicization of the matter. 

Recommendation #3: Improve coordination of vaccine-related messaging between federal, provincial, and regional levels 

During their initial rollout, public health authorities at various levels released differing statements on the efficacy and safety of particular COVID-19 vaccines. In many cases these statements were confusing and even contradictory. Unsurprisingly, multiple studies have highlighted inconsistent public health messaging as a main contributor to COVID-19 vaccine hesitancy among Canadians.^13,14 While difficult in the rapidly evolving context of a pandemic, public health actors should coordinate messaging to ensure that all Canadians are receiving up-to-date vaccine-related information that is not only evidence-informed but consistent. 

References

1. Public Health Agency of Canada. 2023 [cited 2023 Oct 26]. COVID-19 daily epidemiology update: Current situation. 

2. Marani M, Katul GG, Pan WK, Parolari AJ. Intensity and frequency of extreme novel epidemics. Proceedings of the National Academy of Sciences. 2021 Aug 31;118(35):e2105482118. 

3. Public Health Agency of Canada. 2023 [cited 2023 Nov 7]. Demographics: COVID-19 vaccination coverage in Canada - Canada.ca. 

4. Adverse Events Following Immunization (AEFIs) for COVID-19 in Ontario: December 13, 2020 to October 8, 2023. 

5. Mitchell R, Cayen J, Thampi N, Frenette C, Bartoszko J, Choi KB, et al. Trends in Severe Outcomes Among Adult and Pediatric Patients Hospitalized With COVID-19 in the Canadian Nosocomial Infection Surveillance Program, March 2020 to May 2022. JAMA Network Open. 2023 Apr 20;6(4):e239050. 

6. Fault Lines [Internet]. CCA Reports. [cited 2023 Nov 7]. 

7. Benham JL, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, et al. COVID-19 Vaccine–Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis. JMIR Public Health and Surveillance. 2021 Dec 23;7(12):e30424

8. Gravelle TB, Phillips JB, Reifler J, Scotto TJ. Estimating the size of “anti-vax” and vaccine hesitant populations in the US, UK, and Canada: comparative latent class modeling of vaccine attitudes. Hum Vaccin Immunother. 2022 Dec 31;18(1):2008214

9. Wigle J, Hodwitz K, Juando-Prats C, Allan K, Li X, Howard L, et al. Parents’ perspectives on SARS-CoV-2 vaccinations for children: a qualitative analysis. CMAJ. 2023 Feb 21;195(7):E259–66

10. Proof Strategies. CanTrust Index - 2020 Report [Internet]. 2020 Apr p. 47

11. Proof Strategies. CanTrust Index - 2021 Report [Internet]. 2021 Feb p. 33

12. Proof Strategies. CanTrust Index - 2022 Report [Internet]. 2022 Feb p. 33

13. Fullerton MM, Benham J, Graves A, Fazel S, Doucette EJ, Oxoby RJ, et al. Challenges and recommendations for COVID-19 public health messaging: a Canada-wide qualitative study using virtual focus groups. BMJ Open. 2022 Apr 1;12(4):e054635 

14. Capurro G, Tustin J, Jardine CG, Driedger SM. When good messages go wrong: Perspectives on COVID-19 vaccines and vaccine communication from generally vaccine accepting individuals in Canada. Hum Vaccin Immunother. 18(7):2145822.