Vaccine hesitancy is part of the complex decision-making process underlying an individual’s decision for vaccination. It includes a continuum of attitudes ranging from total acceptance of all vaccines, acceptance of some vaccines, to complete refusal of all vaccines (Dubé et al. 2013). It may apply to vaccines in general or to specific vaccines and may be a “default” position or a “reactive” one, i.e., related to localised, one-time events such as the introduction of new vaccines (Dubé et al. 2013). Frameworks such as the WHO SAGE working group’s 3Cs model of vaccine hesitancy as well as the 5C psychological antecedents of vaccination models offer sound measures for many factors of vaccine hesitancy, such as Confidence, Complacency, Constraints, Calculation, and Collective response (Betsch et al. 2018), but do not fully capture the complexity and interaction of factors, particularly in urgent contexts such as COVID-19 pandemic, during which new knowledge has emerged at an unprecedented pace (Silva et al., 2020) and during which social and political tensions are exacerbated. Vaccine hesitancy is often discussed as a barrier to achieving optimal vaccination rates; the conversation has been refuelled as widespread acceptance of COVID-19 vaccines is anticipated to reduce COVID-19 morbidity as well as the need for further restrictive measures.
Research on vaccine hesitancy in Canada is limited but data on COVID-19 vaccine hesitancy among Canadians is emerging, the first studies having been conducted before COVID-19 vaccines were made available to the general public. A study analysing Canadian tweets about COVID-19 vaccine hesitancy from December 2020, around the time where the first vaccines were administered in Canada, identified the following contributing themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, anti-vaccine or confusing messages from authority figures, and lack of legal liability from vaccine companies (Griffith et al. 2021). A survey given to a sample of Saskatchewan adults between May 2020 and April 2021 associated vaccine hesitancy with lower education level, financial instability, identifying as Indigenous, not being concerned about spreading the coronavirus, and low threat perception (Muhajarine et al. 2021). These results are consistent with the literature on demographic determinants of general vaccine hesitancy, which points toward lower income and educational attainment, risk aversion, lower health literacy, rurality, parental status, mistrust in authority, and younger age (Hudson & Montelpare 2021).
Conspiracy beliefs surrounding COVID-19, its origin, and the intentions of entities at different levels of power, have also emerged and taken up space in the public discourse. Conspiracy beliefs have in the past been associated with reluctance to engage in health-protective behaviours (Dunn et al. 2017). Amidst the COVID-19 pandemic, a parallel infodemic has unravelled with massive exchange of information on social media platforms, facilitating and accelerating the spread of false information. Trust in different platforms such as TV, WHO, and other credible sources were associated with higher intentions to get the COVID-19 vaccine as opposed to sources including Facebook and WhatsApp where individuals were exposed to more fake news were associated with lower intentions for the COVID-19 vaccine (Ghaddar et al. 2022). Similar associations have been found with COVID-19 vaccination, such that individuals who adhere to one or more conspiracy theories have lower vaccine intent (Earnshaw et al. 2020).
General attitudes towards vaccines such as trust in pharmaceutical companies and fear of side effects also mediate the relationship individuals have with all vaccines, including COVID-19 (Paul et al. 2021). Exploring general attitudes towards vaccines may help understand the underlying factors of COVID-19 vaccine hesitancy among individuals, and can potentially inform public health communications for the current pandemic, as well as in efforts to strengthen immunisation program outcomes in society.
Other factors have contributed to the decision-making process, such as political climate, public health measures, and lived experiences. These COVID-19-specific vaccine factors, measured in this study, include topics related to current politics, trust in the government and in scientists, opinions of loved ones, and the research, development, and manufacturing of COVID-19 vaccines. Little is known about COVID-19 vaccine hesitancy after vaccines were made widely available and limited research has been done to understand vaccine hesitancy in younger adults, where despite the vaccines being available to the general public, those aged 18 to 40 had consistently lower COVID-19 vaccination rates in Canada (PHAC 2021).
At the time of the present study, regulatory approvals regarding COVID-19 vaccines at the provincial and federal levels were rapidly changing and concerns surrounding certain vaccines were growing. Across the three provinces, the number of COVID-19 cases plummeted over the duration of data collection as vaccine intake rapidly increased (CIHI 2021). In Quebec, vaccines were made available to those over the age of 12 by May 25, leading to the province approaching a 70% one-dose vaccine coverage milestone by mid-June (CIHI 2021; PHAC 2021). In May, both the Quebec government and the Alberta government launched large ad campaigns pushing for mass vaccination against COVID-19 so the population can return to normal life (The Canadian Press 2021; Franklin 2021). By June, Alberta had announced its Open for Summer Plan to ease restrictions and two weeks later had entered two of the three stages put forth by the plan as the one-dose vaccine coverage for the general population (all ages) approached 60% (CIHI 2021; PHAC 2021). Ontario started administering COVID-19 vaccines to the general adult population on May 18 and to youth aged 12 and over on May 23, enabling it to reach a vaccine coverage of almost 65% among adults by the end of the data collection period, when the province entered stage 1 of its reopening plan (CIHI 2021; PHAC 2021).
This study aimed to answer the research question: are conspiracy theory beliefs, general attitudes towards vaccines, and other vaccine factors associated with COVID-19 vaccine hesitancy in the Canadian context? We hypothesised that endorsing conspiracy theories, and negative attitudes towards vaccines in general, would be associated with greater COVID-19 vaccine hesitancy, and ultimately a decrease in vaccine intent. We also hypothesised that COVID-19 vaccine factors would be associated with less vaccine hesitancy, encouraging vaccine intent.