Peter John, Peter John Loewen, Manu Savani, Brendan Nyhan, John McAndrews, Sanchayan Banerjee, Richard Koenig, and Blake Lee-Whiting

For full details of research methodology and findings, please see the full project report. We are grateful to the British Academy for generous research funding through the ‘Covid-19 Recovery’ Awards.

Canada: COVID-19 Vaccination Engagement Strategies (December 2020 - February 2022)

Blog - Blake Lee-Whiting

<p>For full details of research methodology and findings, please see the <a href="https://www.thebritishacademy.ac.uk/documents/3756/Overcoming-Barriers-to-Vaccination-by-Empowering-Citizens.pdf">full project report</a>. We are grateful to the British Academy for generous research funding through the ‘Covid-19 Recovery’ Awards. </p><p>For enquiries, please contact Peter John (<a href="mailto:peter.john@kcl.ac.uk">peter.john@kcl.ac.uk</a>) or Manu Savani (<a href="mailto:manu.savani@brunel.ac.uk">manu.savani@brunel.ac.uk</a>).</p>




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  <h3>Key Takeaways:</h3>










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            Public Concerns
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          <p>While the implementation of harder policy measures such as mandates or a tax on the unvaccinated (as proposed in Quebec) could lead to an increased take-up of the vaccine, discontent of the public is expected to be high. Since this can play an important role in the success of a policy (public concerns led to the withdrawal of the proposed tax in Quebec), the announcement and implementation of such policies should be planned carefully. </p>
        
      

      

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            Lottery Programs
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          <p>Canadian provinces used lottery schemes as positive incentives for vaccination. UK policy makers may want to consider such approaches along with further research to investigate public preferences and target groups that may respond favourably to positive incentive schemes. </p>
        
      

      

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                  <img src="https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=1000w" width="2470" height="1503" srcset="https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=100w 100w, https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=300w 300w, https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=500w 500w, https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=750w 750w, https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=1000w 1000w, https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=1500w 1500w, https://images.squarespace-cdn.com/content/v1/625d911bb5b3d215a23a2b95/51f1ad98-2d3c-4f5d-ad7e-346c8b450db8/canada_rates.png?format=2500w 2500w" loading="lazy" />
                
            
          
        
          
        

        
          
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            <p>Source: Our World in Data. Case numbers: Cumulative confirmed COVID-19 cases per billion people (may be lower than true infection numbers due to limited testing) by the COVID-19 Data Repository by the Center for Systems Science and Engineering (CSSE) at John Hopkins University (JHU). Full vaccination numbers: Total number of people who received all doses prescribed by the vaccination protocol per 100 people in the total population, based on national government reports. Booster numbers: Total number of COVID-19 vaccination booster doses administered per 100 people in the total population, based on national government reports.</p>
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  <p>In our survey data, Canada had the highest vaccination rates in the G7, both in terms of fully vaccinated (79%), and partially vaccinated (85%), people. In our survey, 90% of Canadians report having received at least one vaccination, and 9.8% were unvaccinated. Of the unvaccinated respondents in our survey, the main reason given was they did not want the vaccine (87%).  </p><p> Vaccination rates appeared to slow in the later months of 2021, at the same time the Omicron variant was becoming a concern. Canada has the third slowest rollout of boosters of the G7. The federal government intervened high profile and at times controversial policy interventions over December 2021 and January 2022. </p><p>Booster rollout was slower in Canada than in other G7 countries. In our survey, 70% of people had received at least one booster shot, and 30% had not received any booster. Boosters were made available in most provinces and territories at the beginning of December 2021, initially to the elderly and health care workers. Some regions like Nunavut offered boosters to everyone above 12. </p><h4>Vaccination mandates</h4><p>Canada applied some of the strongest policy measures of the G7 to raise vaccination rates, including a mandate for federal government employees, and federally regulated sectors including banking and telecommunication. Unvaccinated federal staff have been put on unpaid leave. Many employers mandated vaccines, including universities.</p><h4>Vaccine Passes</h4><p>Vaccine passes were in place in all provinces and territories, with different rules governing the sectors that they apply to. Some passes mandate vaccines while others adopted a test-or-vaccine approach. The initial impact of vaccine passes which mandated vaccination to access public venues was considerable. Estimates suggest a sharp and quick response in vaccine engagement when announcements were made, with a 34% increase in weekly first-dose uptake estimated in Ontario, and a 300% increase estimated in Alberta. This is a powerful finding but represents a short-term effect and considerable variation between provinces.</p><p>Quebec enacted one of the widest COVID-19 passport programs in September 2021. Proof of vaccination was required for entry to a wide range of public venues including bars, restaurants, and sports venues; any indoor gathering with more than 250 people or outdoor gathering with more than 500; and certain healthcare facilities. Although Quebec originally intended to mandate the vaccine for healthcare workers, concerns about staff shortages meant this policy was not enacted. In January, the Quebec Premier announced a tax on unvaccinated adults, who would be required to pay a ‘health contribution’ fee. While the announcement appears to have led to an increase in first dose vaccination bookings, it was withdrawn on February 1 in response to public discontent and concerns about the social divisions such a tax could create.</p><h4>Vaccine hesitancy </h4><p>While vaccination rates in Canada overall are the highest of the G7, the averages mask disparity in vaccine acceptance amongst some groups. Evidence from British Columbia shows early vaccine uptake was significantly lower in rural areas, where 6.4% of healthcare workers were unvaccinated, compared to 3.3% in urban areas. A vaccine mandate for healthcare workers came into effect in late October 2021. After initially promising uptake – an increase from 1% vaccinating to 1.79% a day after the announcement – vaccination rates fell, and the overall impact of the mandate remains unclear from the early evidence available.</p><p>Our survey shows a significant association between educational background and vaccination status. Political ideology and party identification are also associated with vaccination status. Unvaccinated respondents are likely to place themselves a little further on the ‘right’ of a left-right political spectrum; and more likely to identify with the Conservative Party (27% compared to 20% of vaccinated respondents), the People’s Party of Canada (10% compared to 2% of vaccinated respondents) or no single party (33% compared to 20% of vaccinated respondents). Political ‘outsiders’, those who do not identify with any mainstream party, appear less likely to opt for vaccination. Those who are unvaccinated are also more likely to feel that politicians tend to ignore their community. Vaccination status may be connected to both political identity and a feeling of being on the outside of mainstream politics. </p><h4>Trust in Covid-19 vaccines</h4><p>Public confidence in Covid-19 vaccines has increased the rollout began in December 2020. In general terms, 82% of our Canada respondents trust the Covid vaccine. This varies by province, with Manitoba recording 74%, Nova Scotia 88%, and Newfoundland and Labrador 94%. Quebec, which has notably adopted some of the harder policy approaches to vaccine passports within Canada, reported 83% trust in the Covid vaccine. There is evidence of a rural-urban divide, with 74% of people in rural areas saying they trust the vaccine compared to 83% in urban areas. </p><p> In line with the relationship between vaccination status and political variables, we find similar associations between trust in the vaccination and political views. People who agree more strongly with the statement that politicians ignore their community are less likely to trust the vaccine. Trust in the vaccine is also associated with political ideology, with those who do trust the vaccine more likely to identify on the ‘left’ of the left-right political spectrum.</p><h4>Public acceptance of vaccination mandates</h4><p>Despite its leading status among the G7, political rhetoric has been pushing for higher vaccination uptake. In December 2021, Health Minister Jean-Yves Duclos suggested that provinces were likely to introduce further mandatory vaccination policies in the coming months. However, discussions about universal vaccine mandates are not yet taking place and it is not clear whether extensions to existing mandates will be pursued. With the recent federal vaccine mandate for truck drivers triggering large-scale protests against government policies during the pandemic, the implementation of further hard policy measures has become more unlikely. </p><p>The ‘Freedom Convoy’ began as a truckers’ rally against the mandate with thousands gathering in Ottawa, paralyzing the capital city for several days. But the demonstrations have turned more broadly against the approach of the Canadian Government to the pandemic and have spread to other major cities and key border crossings, such as to the bridge between Detroit and Windsor, which was blocked by protesters for several days before being cleared by the police. Many of the protesters are calling for all Covid-19 mandates to be removed, and similar protests are happening overseas, such as the ‘freedom march’ from Paris to Brussels. These events raise important questions about whether compliance fatigue or saturation may have set in, and whether this is related to Canada having adopted a harder set of federal policies compared to other G7 nations.</p><p> </p>