Vaccine Hesitancy in Canada: Scope, Determinants, and Impact of Trust in Parents of Two-Year Old Children

Vaccine hesitancy and trust are two factors impacting vaccine decisions for parents of preschoolers in Canada. However, previous research has left gaps in determining the prevalence and predictors of vaccine decisions (i.e., reluctance, refusal and delay) and the impact of whom parents trust for vaccine information on vaccine decisions. This thesis addressed these gaps through two papers using data from the 2017 Childhood National Immunization Coverage Survey(cNICS) of parents of 2-year-old children who were born in Canada and who had received at least one vaccine. Socio-demographics, vaccine decisions and vaccine knowledge, attitudes and beliefs (KAB) were described (proportion) and analyzed for associations (Chi Square) and predictors (Binomial multivariate logistic regression). \nThe objective of the first paper was to describe and examine the associations and predictors of vaccine decisions. The findings show that 16.8% of parents refused a vaccine for their child, specifically the influenza (73%), rotavirus (13%) and varicella (9%) vaccines; female parents or those from Quebec or the Territories were more likely to refuse. 12.8% were reluctant to accept a vaccine, most often the influenza (34%), measles, mumps, rubella (MMR) (21%) and varicella (19%) vaccines, but eventually accepted them due to advice from a health care provider. About one in eight (13.1%) had delayed a vaccine, most often because their child had health issues (54%) or was too young (18.6%) and was predicted by households of five or six people. Recent immigration to Canada decreased likelihood of refusal, delay, or reluctance; however, after 10 years in Canada, these parents were as likely to refuse or be reluctant as parents born in Canada. Poor KAB increased likelihood of refusal and delay by 5 times, and reluctance by 15 times, while moderate KAB also increased likelihood of refusal (1.6 times), delay (2.3 times) and reluctance (3.6 times). \nThe objective of the second paper was to determine the predictors and impact of whom parents trust for vaccine information. The findings show that 83% of parents trust doctors for vaccine information; 70-79% trust pharmacists, the Provincial Ministry of Health (PMH), nurses and Health Canada/Public Health Agency of Canada (HC/PHAC); 33% trust family and 22% trust friends and alternative health care providers (HCPs). However, parents found to have poor or moderate KAB were less likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC. Parents were also less likely to trust the PMH or HC/PHAC if they had high school education or less or trade/college education, or were widowed, separated, or divorced. Parents who had never been reluctant to vaccinate their 2-year-old child were over 2 times more likely to trust doctors, nurses, pharmacists, PMH and HC/PHAC while parents who trusted family and friends were less likely to delay or refuse vaccines. There was regional variation within Canada. Parents from Quebec were most likely to trust doctors, nurses, pharmacists, friends, PMH and HC/PHAC. Parents from the Territories were less likely to trust doctors, nurses and pharmacists, but more likely to trust family. Parents were less likely to trust doctors if they were from the Prairies, and pharmacists if they were from BC, and parents from the Prairies and BC were less likely to trust HC/PHAC. Parents from Ontario were less likely to trust family or friends, but more likely to trust the PMH.\n In addition to these findings, this study has demonstrated the importance of considering the temporal context as our results show that parents change their vaccine decisions over time (e.g., time since immigration to Canada, changes in marital status, or through conversations with HCPs). Given these findings, vaccine programming is needed that is focused on addressing parents’ concerns within their unique contexts, which ultimately, will protect children from vaccine preventable diseases.

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