Supplier Name: Environics Research
Contract Number: 6D034-184641/001/CY
Contract Value: $185,489.50 (including HST)
Award Date: 2019-03-22
Delivery Date: 2019-10-02
Registration Number: POR 138-18
For more information on this report, please contact Health Canada at: hc.cpab.por-rop.dgcap.sc@canada.ca
Ce rapport est aussi disponible en français.
Prepared for Health Canada/Public Health Agency of Canada by Environics Research
October, 2019
This public opinion research report presents the results of quantitative research conducted by Environics on behalf of Health Canada. The research was conducted with the general population from June 14 to July 4, 2019 and with health care professionals from June 17 to September 9, 2019.
This publication may be reproduced for non-commercial purposes only. Prior written permission must be obtained from Health Canada. For more information on this report, please contact Health Canada at:
hc.cpab.por-rop.dgcap.sc@canada.ca or at:
Communications and Public Affairs Branch
Health Canada
200 Eglantine Driveway, Jeanne Mance Building
AL 1915C, Tunney's Pasture
Ottawa, Ontario K1A 0K9
Catalogue Number: H14-339/2020E-PDF
International Standard Book Number (ISBN):978-0-660-32601-6
Cette publication est aussi disponible en français sous le titre Facteurs d'acceptabilité des vaccins pour le grand public et les professionnels de la santé au Canada.
Catalogue Number: H14-339/2020F-PDF (Final report, French)
International Standard Book Number (ISBN): 978-0-660-32602-3
©Her Majesty the Queen in Right of Canada, as represented by the Minister of Health, 2019.
The Public Health Agency of Canada identified the need to conduct quantitative research to understand the factors influencing vaccine acceptability among Canadians and health care professionals.
Use of the findings of this research. The research provides current data on the opinions and attitudes of the Canadian population regarding vaccination in general, and for specific vaccines and vaccine-preventable diseases. The results of this research will inform the development of evidence-based vaccine recommendations that include a consideration of acceptability of vaccines and vaccine programs. Results will be used to support the expansion of the mandate of the National Advisory Committee on Immunization (NACI) to include the systematic consideration of programmatic factors (economics, ethics, equity, feasibility, acceptability) in addition to burden of disease and vaccine characteristics.
The research comprised two data collection phases:
A more detailed methodology is presented in Appendix A of the full report.
The contract value was $185,489.50 (HST included).
An almost nine-in-ten majority of Canadians say vaccinations are an accepted health care practice in their household, and vaccines are generally felt to be safe and effective. Relatively few report vaccine reluctance for any age group, and most demonstrate understanding of the value of herd immunity. Confidence in public health authorities for vaccine recommendations is high, and relatively few report barriers to getting vaccinated. However, there is a notable minority who are concerned about the potential for serious side effects, and about four in ten report having some kind of negative experience or reaction (though not usually serious). The research reveals vaccine effectiveness has the most influence on the acceptability of a vaccine; there is also a high degree of acceptance for newly-approved vaccines if they are recommended by a health care provider.
Strong majorities of health care professionals (HCP) see vaccinations as effective and safe health interventions for their patients. As with the general public, HCPs are most likely to consider effectiveness when deciding on a vaccine recommendation, and HCPs will also take into consideration expert committee recommendations and patient susceptibility. The survey results point to some problems with the vaccine delivery system that may result in Canadians not receiving needed vaccinations. Direct cost to patients may play a role in whether a vaccine is recommended, when that vaccine is not covered by public or private insurance. Majorities of HCPs who administer vaccinations identify at least one of four specific situations as being either a major or moderate barrier to delivery of vaccines in their practices, with the main issues being inadequate reimbursement and storage/handling requirements. The results also indicate HCPs in several professions would benefit if they had greater familiarity with NACI's vaccine guidance and more information about the extent of vaccine testing, which in turn could boost level of confidence in communicating with patients about vaccines, especially in dealing with vaccine reluctance.
I hereby certify as senior officer of Environics that the deliverables fully comply with the Government of Canada political neutrality requirements outlined in the Communications Policy of the Government of Canada, and Procedures for Planning and Contracting Public Opinion Research. Specifically, the deliverables do not include information on electoral voting intentions, political party preferences, standings with the electorate, or ratings of the performance of a political party or its leaders.
Sarah Roberton
Vice President, Public Affairs
Environics Research Group
sarah.roberton@environics.ca 613-699-6884
Supplier name: Environics Research Group
PSPC contract number: 6D034-184641/001/CY
Original contract date: 2019-03-22
For more information, contact Health Canada at hc.cpab.por-rop.dgcap.sc@canada.ca
Vaccines are considered the greatest public health intervention of the 20th century, but in the 21st century there has been increasingly vocal resistance to routine immunizations among certain members of the population. In a Public Health Agency of Canada (PHAC) survey of health professionals conducted by Environics in 2017-18 [1], over six in ten health care professionals indicated patients express reluctance to receive immunizations some of the time, and at least eight in ten felt patient vaccine reluctance is at least somewhat of an issue facing public health.
The National Advisory Committee on Immunization (NACI) provides guidance on vaccination in Canada, and its recently expanded mandate now includes consideration of factors influencing the acceptability of vaccines. International research has established several factors related to vaccination acceptability. It is in the public interest to further research these acceptability factors in the Canadian context, with a special focus on those with the potential to impact marginalized or high-risk populations. In order to provide evidence-informed vaccine recommendations that consider acceptability, NACI required comprehensive data to address the lack of in-depth research in Canada in this area.
The PHAC is the main Government of Canada Agency responsible for public health in Canada. PHAC commissioned public opinion research to inform the mandate of the National Advisory Committee on Immunization (NACI) to provide vaccine guidance that meets the needs of the general public and health care professionals. The findings of this research will also have implications for the Immunization Promotions and Partnership Unit in the Centre for Immunization and Respiratory Infectious Diseases (CIRID), and provincial and territorial immunization programs.
The specific research objectives of this requirement are as follows:
This report begins with an executive summary outlining key findings and conclusions, followed by a detailed analysis of the quantitative survey data for the general population and for health care professionals. A detailed methodology section is provided in Appendix A. Provided under a separate cover are detailed sets of "banner tables" presenting the results of the two surveys for all questions by population segments as defined by region and demographics. These tables are referenced by the survey question in the detailed analysis.
In this report, quantitative results are expressed as percentages unless otherwise noted. Results may not add to 100% due to rounding or multiple responses. Net results cited in the text may not exactly match individual results shown in the tables due to rounding. Results are for the total samples unless otherwise indicated.
Environics conducted an online survey with adult members of the general public. Information on the demographic distribution of the sample is available in the methodology section of this report.
Close to nine in ten agree vaccines are effective; eight in ten agree they are safe. Strong majorities are not reluctant to get vaccinated. The main reason for reluctance is concern about safety or side effects (in four in ten respondents). The vaccines most linked to reluctance are varicella (infants/young children), HPV (older children/adolescents) and inactivated influenza (adults). The main reason for getting vaccinated is self-protection.
When asked to indicate level of agreement with three statements regarding vaccines, close to nine in ten Canadians agree to some extent that vaccines are an effective way to reduce the risk of disease (86%), and eight in ten agree they are safe (80%). However, a notable minority of one in ten (11%) agree they don't have to get vaccinated if everyone else does.
| Q10-12 | Strongly agree | Somewhat agree | Neither | Somewhat disagree | Strongly disagree | Not sure |
|---|---|---|---|---|---|---|
| In general, vaccines are an effective way to reduce the risk of disease | 58% | 29% | 8% | 3% | 3% | 1% |
| In general, vaccines are safe | 46% | 35% | 12% | 4% | 2% | 1% |
| When everyone is vaccinated, I don't have to get vaccinated too | 4% | 7% | 11% | 17% | 60% | 2% |
Q10-12 Please indicate how much you disagree or agree with the following statements:
Base: Total sample (n=2,002)
While overall agreement is consistent by region, strong agreement that vaccines are an effective way to reduce the risk of disease ranges from a low of 49 percent in Quebec up to 72 percent in the Atlantic. Quebecers are less likely to strongly agree that, in general, vaccines are safe (36%, vs. 45% to 58% elsewhere, but their agreement overall is in line with other jurisdictions (Atlantic Canadians are the most likely to agree, both overall and strongly). Agreement that one doesn't have to get vaccinated if others are is quite consistently low across the country.
Overall agreement with the two vaccine-positive statements is generally similar by age, but highest among those age 65 and over. Net agreement that one does not have to get vaccinated if others do is a minority, but higher among, younger Canadians and decreases as age increases (15% age 18 to 29, down to 5% age 65+). A similar pattern is seen for parents of younger children (20% with children up to age 6 and 21% with children age 7 to 12, vs. 14% with children age 13-17 and 8% with no children under 18). Net agreement with the vaccine-positive statements are higher among newcomers to Canada (93% effective, 88% safe) but similar for Indigenous peoples and other Canadians. Agreement that "when everyone is vaccinated, I don't have to get vaccinated too" is higher among Indigenous peoples (29%).
Agreement with the two positive vaccine statements is generally similar by household income (ranging from 76% of those with under $40,000 to 84% for safe, 84% to 89% effective) but both are noted to be highest among those with incomes of $100,000 or more - 85% safe, 89% effective). Agreement with both statements is highest among retired persons (91% effective, 86% safe), those who took the survey in English (87% effective, 83% safe), and those who later in the survey indicate they get vaccinated (88% effective, 82% safe) or that vaccination is accepted in their household (92% effective, 87% safe). Among those who indicate they do not get vaccinated, around three in ten each agree to some extent vaccinations are effective (33%) and safe (29%), and one-quarter (25%) agree they do not have to get vaccinated if all others do.
Those without children under age 18 were asked how often they have been reluctant to receive a recommended vaccination in their lifetime; those with children were asked how often they have felt reluctant to have their child vaccinated. In total, three in ten (29%) have felt reluctance at least sometimes regarding a recommended vaccination.
Seven in ten (71%) adults without children under 18 have rarely or never felt reluctant to personally get a vaccine recommended by a health care professional. Parents express slightly more reluctance, but still, six in ten (61%) have rarely or never felt reluctant to have their child receive a recommended vaccine. One in ten parents say they are always reluctant, but it should be noted this does not necessarily mean they would always refuse a vaccine, just that they experience some concern each time.
| Q13 | Total (n=2,002) |
No children (n=1,481) |
Have children (n=521) |
|---|---|---|---|
| Net: at least somewhat reluctant | 29% | 26% | 38% |
| Always | 7% | 5% | 12% |
| Often | 7% | 7% | 8% |
| Sometimes | 15% | 14% | 18% |
| Net: not reluctant | 69% | 71% | 61% |
| Rarely | 22% | 23% | 18% |
| Never | 47% | 48% | 43% |
Q13 NO CHILDREN UNDER 18: In your lifetime, how often have you been reluctant to receive a vaccine recommended by a healthcare professional?
WITH CHILDREN UNDER 18: In their lifetime, how often have you been reluctant for your child/children to receive a vaccine recommended by a healthcare professional?
Among adults without children, being reluctant to personally receive a vaccine at least sometimes is lowest in BC (19%) and highest in Alberta (29%). Among those with children under age 18, reluctance to have children vaccinated ranges from a low of 22 percent in the Atlantic, up to 42 percent in Ontario.
Vaccine reluctance, both for self or a child, is linked to being younger, and decreases as age increases. Personal vaccine reluctance among adults is similar for Indigenous peoples, newcomers to Canada and others, but among those responding on behalf of children, reluctance is notably higher among Indigenous parents (62%) vs. newcomers (42%) or others (33%). Parental vaccine reluctance does not significantly differ by the age of the children.
Among adults without children under 18, having experienced vaccine reluctance decreases as household income increases (from 29% with less than $40,000 down to 19% with $100,000 or more); it is higher among those with high school or less education (29%) than those with post-graduate education (20%). It is somewhat higher among those who took the survey in French (34% v. 25% of those who took the survey in English). Socioeconomic factors are not as important for reluctance to have children vaccinated. Being reluctant to vaccinate is highest among those who later in the survey say vaccination is not an accepted household health care practice, and among those who indicate they do not get vaccinated themselves.
Adults without children under age 18 were shown a list of adult vaccinations available in Canada and asked to indicate which, if any, they would be reluctant to receive. Those with infants and young children (to age 6), or older children or adolescents (age 7 to 17) were asked if there are any vaccines for those age groups they would be reluctant for their child to receive. Note that, to reduce respondent burden, those with children were not also asked about adult vaccine reluctance.
Majorities of nearly two-thirds or more indicate there is no vaccine they would be reluctant to receive, or to have their child receive. The vaccines causing the most reluctance (each for no more than one in five) are varicella (infants/young children-16%), HPV (older children/adolescents-18%) and inactivated influenza (adults-13%).
The vaccines causing reluctance for each age group of recipients are indicated in the tables below.
| Q14a | Have children 0-6 (n=225) |
|---|---|
| No reluctance | 70% |
| Varicella | 16% |
| DTaP-IPV-Hib | 14% |
| DTaP-HB-IPV-Hib | 14% |
| HA | 14% |
| MMR | 13% |
| HB | 13% |
| HAHB | 10% |
| Meningococcal | 10% |
| Rotavirus | 9% |
| Pneumococcal | 8% |
| MMRV | 8% |
Q14 Please indicate below if there are any vaccines you are reluctant [for your child/children] to receive, for any reason.
| Q14b | Have children 7-17 (n=521) |
|---|---|
| No reluctance | 65% |
| HPV | 18% |
| Varicella | 14% |
| MMR | 13% |
| HA | 13% |
| HB | 13% |
| MMRV | 13% |
| DTaP-IPV / Tdap-IPV | 13% |
| HAHB | 13% |
| Tdap | 12% |
| Meningococcal | 10% |
Q14 Please indicate below if there are any vaccines you are reluctant [for your child/children] to receive, for any reason.
| Q14c | Adults without children (n=1,481) |
|---|---|
| No reluctance | 72% |
| Inactivated influenza | 13% |
| LAIV | 12% |
| HPV | 10% |
| Zostavax | 9% |
| Shingrix | 9% |
| HAHB | 7% |
| HB | 7% |
| Td | 7% |
| HA | 6% |
| Pneumococcal | 6% |
| Tdap | 6% |
| Meningococcal | 6% |
Q14 Please indicate below if there are any vaccines you are reluctant [for your child/children] to receive, for any reason.
Having specific vaccine reluctance for any age of child or for an adult tends to be lowest in Atlantic Canada. While responses are fairly similar by most subgroups, Indigenous parents express somewhat greater concern about vaccines for infants and children that cover more than one disease than do other Canadians.
Those who indicated reluctance for at least one vaccine (n=593) were asked to indicate the main reason behind their concern. To facilitate this, they were shown a list of possible responses and could also specify other reasons not listed. The main reason provided is concern about ingredient safety/potential side effects, mentioned by one in five (21%). One in ten (10%) say they do not think the vaccine is needed, and a similar proportion (10%) express concern about efficacy. Fewer than one in ten cite other individual reasons for being reluctant to receive specific vaccines; these include it not being recommended by a health care provider (7%); preference for natural remedies or prevention (7%); the number of vaccines given at a time (6%); and bad personal experiences (6%).
| Q15 | Reluctant to receive any vaccine (n=593) |
|---|---|
| Concerned about ingredient safety/potential side effects | 21% |
| Don't need it/healthy | 10% |
| Concerned vaccine doesn't work/won't prevent disease | 10% |
| Wasn't recommended by a health care provider | 7% |
| Prefer natural remedies/prevention | 7% |
| Too many vaccines given all at once | 6% |
| Bad past experience with vaccines | 6% |
| Dislike/scared of needles | 5% |
| Too expensive/have to pay out of pocket/not covered | 5% |
| The disease it prevents no longer exists or is very rare | 4% |
| Too many doses required for full protection | 4% |
| Prefer oral/inhaled vaccine | 3% |
| Can't easily get vaccinated/no access | 2% |
| Other | 2% |
| Not sure | 8% |
Q15 What is the main reason why you are reluctant [for your children] to receive certain vaccines?
Base: Those reluctant to receive any vaccine
Responses are similar by region, although BC residents are among the most likely to be concerned the vaccine won't work to prevent disease. Concern about ingredient safety or potential side effects is higher among those who are neither Indigenous nor newcomers to Canada. Those in the lowest household income bracket (under $40,000) are the most likely to indicate they dislike needles (10%), but they are not more likely than others to say vaccinations are too expensive.
All respondents, regardless of whether they expressed any vaccination reluctance, were asked what they would say is the most important reason why they would get vaccinated. To facilitate this, they were shown a list of possible responses; they could specify something else if their reason was not listed. The most important reasons are: to protect themselves and stay healthy (40%); eliminating or decreasing the rate of disease in society (21%); or protecting their family (17%). Fewer than one in ten give other individual reasons for getting vaccinated. Three percent indicate there are no benefits to vaccinations, or they do not get vaccinated.
| Q16 | Total |
|---|---|
| Protecting myself/staying healthy | 40% |
| Eliminating or decreasing the rate of disease in society | 21% |
| Protecting my family from disease | 17% |
| Protecting others (e.g. weak immune system) | 8% |
| Illness is less severe if you do get sick | 6% |
| Multiple/all reasons shown** | <1% |
| Required/recommended | <1% |
| There are no benefits to vaccinations/I don't get vaccinated | 3% |
| Not sure | 4% |
Q16 What would you say is the most important reason why you get vaccinated?
Base: Total sample (n=2,002)
* Answer volunteered, not provided to respondents
Staying healthy is the top reason for receiving vaccinations (40%), across the country and in almost all subgroups; it is especially high among those without children under 18 (47%), those age 65 and over (53%), men (45%), and those in the highest household income (43% $100K+) and education (44% with a university degree) cohorts, and lower among Indigenous peoples (22%). Protecting family from disease is higher among those with children (41%, vs. 8% without) and those with household incomes of $100,000 or more (22%). Protecting people with weaker immune systems is chosen more by residents of Saskatchewan/Manitoba (15%), and those age 18 to 29 (17%).
All respondents were asked if there are any risks they are concerned about related to vaccinations. They were permitted to select from a provided list, or to specify something else; up to three options in total. Four in ten (40%) are concerned about the risk of serious side effects, and around two in ten each are concerned about lack of efficacy (19%) or the ingredients being harmful or toxic (18%). One in seven (14%) worry about vaccines compromising the body's ability to defend itself. Almost no one cites any other specific risks. One-quarter say there are no risks from vaccines that concern them, and one in seven are not sure.
| Q17 | Total |
|---|---|
| Risk of serious side effects | 40% |
| Doesn't work/doesn't help protect against disease | 19% |
| Contain harmful/toxic chemicals | 18% |
| They compromise the ability of the body to defend itself against disease | 14% |
| I am immunosuppressed/can't have live vaccines* | <1% |
| Other | <1% |
| There are no risks from vaccination | 25% |
| Not sure | 15% |
Q17 Are there any risks you are concerned about related to vaccination?
Base: Total sample (n=2,002)
* Answer volunteered, not provided to respondents
Risk of serious side effects is the top response across the country and across population subgroups. It is highest in Ontario (43%) and lowest in the Atlantic (31%), is higher among those under age 55 (43%, vs. 34% of older Canadians), and increases as household income increases (from 35% under $40,000, up to 45% with $100,000 or more). It is also higher among those who do not accept vaccination as a household health care practice (48%, vs. 39% who do).
Being concerned the vaccination won't work is higher in Quebec (23%) than in other regions (15% to 19%), and higher among young people (23% age 18 to 29). That it may contain harmful chemicals is higher among Indigenous peoples (40%), and those with children at home (25%).
Citing any risk is generally higher among those who either have had a negative reaction to a vaccination or who do not get vaccinated; those who have not had a bad reaction are the most likely to say there are no risks from vaccination that concern them (31%).
Majorities of seven in ten or more Canadians are confident public authorities make vaccination recommendations in the best interests of the community, and that people need to get vaccinated to protect others (especially those with compromised immune systems). Infants/children, immunocompromised people and seniors are felt to be the groups most in need of vaccination, by about seven in ten Canadians each.
Respondents were shown a randomized series of statements about vaccine-preventable diseases and asked to indicate their level of agreement with each. Three-quarters (77%) agree overall that they are confident public authorities make vaccine recommendations in the best interests of the community. Around seven in ten each agree they need to be vaccinated to protect others from getting sick (72%), or that they get vaccinated because they can help protect people with weaker immune systems (68%).
A minority of one in ten (11%) agrees with the idea that vaccination is unnecessary because vaccine-preventable diseases are not common anymore. Conversely, a strong three-quarters (74%) majority disagrees with this statement (six in ten strongly so).
| Q18-21 | Strongly agree | Somewhat agree | Neither | Somewhat disagree | Strongly disagree | Not sure |
|---|---|---|---|---|---|---|
| I am confident public authorities make vaccine recommendations that are in the best interests of the community | 43% | 34% | 13% | 5% | 3% | 2% |
| I need to get vaccinated to protect others at home or in my workplace from getting sick | 41% | 32% | 16% | 6% | 5% | 2% |
| I get vaccinated because I can help protect people with weaker immune systems | 36% | 32% | 18% | 7% | 5% | 2% |
| Vaccination is unnecessary because vaccine-preventable diseases are not common anymore | 5% | 7% | 12% | 16% | 58% | 3% |
Q18-21 Please indicate how much you disagree or agree with the following statements:
Base: Total sample (n=2,002)
Overall agreement with these statements is quite similar by region, although Atlantic Canadians are the most likely to agree with the vaccine-positive statements (89% are confident public health authorities make best-interest vaccine recommendations, 84% say they need to get vaccinated to protect others, 79% get vaccinated to protect those with weaker immune systems), and Quebecers are less likely than others to agree they need to get vaccinated to protect others from getting sick (65% net agreement, vs. 73% to 84% elsewhere).
Agreement is generally similar for subgroups of the population, with a few exceptions. Those age 65 and over are the most likely to agree they are confident public authorities make vaccine recommendations in the best interests of the community (86%, vs. 71% to 78% of younger age cohorts), and women are slightly more likely than men to agree they get vaccinated to help people with weaker immune systems (71% vs. 65%). Agreement with vaccine-positive statements are somewhat higher among those who report a chronic illness in the home, those with higher levels of household income and education, those who took the survey in English, and those who accept vaccines as a household health practice. Agreement that vaccination is unnecessary because those diseases are no longer common is a minority, but higher among, Indigenous peoples (26%) and those with children in the home (18%, vs. 9% without children), those who do not accept vaccination as a household health care practice (18%), and those who do not get vaccinated (25%)
Respondents were provided with a list of eight groups of people and asked to indicate for which they believe vaccination against disease is most important. They could select any that applied, and could also write in an answer not shown. Two-thirds or more of Canadians identify infants and children (72%), immunocompromised people (69%) and seniors (66%) as being the groups for whom it is most important to receive vaccinations. Around six in ten also identify health care workers (63%) and those with pre-existing health problems (57%) as being most in need, and just over half (54%) indicate it is important to vaccinate new immigrant and refugees. Four in ten see it as important for pregnant women (40%) or healthy adults (39%) to receive vaccinations.
When given an opportunity to indicate other groups not listed, only a handful did so. Mentions were made of everyone (1%), no one (<1%), and travellers to other countries (<1%). Seven percent were not sure for whom it is most important to receive vaccinations.
| Q22 | Total |
|---|---|
| Infants/children/young people | 72% |
| People with low/weak immune systems | 69% |
| Seniors age 65+ | 66% |
| Health care workers | 63% |
| People with pre-existing health problems | 57% |
| New immigrants and refugees | 54% |
| Women during pregnancy | 40% |
| Healthy adults age 18-64 | 39% |
| All/everyone* | 1% |
| No one* | <1% |
| Travellers to other countries* | <1% |
| Other | <1% |
| Not sure | 7% |
Q22 For which types of people do you believe vaccination against disease is most important?
Base: Total sample (n=2,002)
* Answer volunteered, not provided to respondents
Impressions of which people most require vaccines are quite consistent across the country and most population subgroups. Indicating multiple groups is more common among seniors and those with a chronic illness in the household; women are more likely than men to mention infants (76% vs 69%) or women during pregnancy (46% vs. 35%). Newcomers to Canada are not more likely to indicate newcomers should be vaccinated than are other Canadians. Not being sure which groups need vaccination the most is highest among those who do not get vaccinated (41%) and those who later in the survey do not confirm vaccination as an accepted household health practice (29%).
Soreness is the most commonly reported negative experience following a vaccination. One in ten adults and two in ten parents agree everyday stress is a vaccination barrier. A majority of close to six in ten have not experienced any of six specific potential barriers to vaccination; the most common barriers are wait times and scheduling. Lack of comfort with health care professionals or lack of priority are not notable barriers for the majority.
Canadians were asked if they have ever had a negative experience or reaction after a vaccination. Three options were shown (soreness, fever, rash), with an opportunity to specify another difficulty not listed. They could select any that apply and could also specify another response not shown.
Half (51%) say they have not had any negative post-vaccination experiences, and an additional one in ten either don't know (8%) or say they do not get vaccinated (3%). The most commonly reported negative reactions are: soreness (28%), followed by fever (15%) or rash (9%). Only small percentages cite other negative reactions, including one percent each mentioning feeling unwell/having flu-like symptoms, or dizziness/fainting.
| Q23 | Total |
|---|---|
| Soreness | 28% |
| Fever | 15% |
| Rash | 9% |
| Feeling sick/unwell/had flu-like symptoms* | 1% |
| Dizziness/fainting* | 1% |
| Nausea/vomiting* | <1% |
| Swelling* | <1% |
| Other | 1% |
| No difficulties after a vaccination | 51% |
| I don't get vaccinated | 3% |
| Not sure | 8% |
Q23 Personally, have you ever had a negative experience or reaction after a vaccination?
Base: Total sample (n=2,002)
* Answer volunteered, not provided to respondents
The proportion indicating no difficulties after a vaccination is around half in all jurisdictions; other mentions are generally similar, although citing soreness is lowest in Quebec (21%, vs. 26% to 33% elsewhere). Soreness is also reported more by women (32%) than men (24%), and by those with chronic illness in the home (33% vs. 24%). Mentions of soreness increase as household income or education increases. Citing soreness (43%), fever (30%) or rash (25%) is higher among Indigenous peoples than others. Ontarians are the most likely to indicate they had a rash (11%).
Overall, nearly two-thirds (64%) disagree at least somewhat that everyday stress might prevent them from getting a vaccination. Everyday stress is at least somewhat of a barrier to vaccination for one in ten adults without children and two in ten with children under age 18.
| Q24 | Strongly agree | Somewhat agree | Neither | Somewhat disagree | Strongly disagree | Not sure |
|---|---|---|---|---|---|---|
| Total (n=2,002) |
4% | 9% | 17% | 14% | 50% | 6% |
| Prevents adults from getting vaccinated (n=1,481) |
2% | 7% | 17% | 14% | 52% | 7% |
| Prevents children from getting vaccinated (n=521) |
8% | 14% | 16% | 13% | 45% | 5% |
Q24 To what extent do you agree or disagree that everyday stress prevents you from getting [your child/children] vaccinated?
Base: Total sample (n=2,002)
Agreement that everyday stress is a barrier is highest at 17 percent in Ontario, compared to 8 to 12 percent elsewhere. It is highest among younger people (19% age 18 to 29) and decreases with age (down to 3% of those 65 and over). It is also notably higher among Indigenous Peoples (32%) and newcomers to Canada (24%) than others (11%). There are no clear patterns in overall agreement by household income or education, but higher income earners are more likely to disagree to some extent than are those with incomes under $40,000. Agreement is also higher among those who report having a negative vaccine reaction in the past (21%. vs. 8% of others).
Canadians were shown a list of six possible logistical barriers to vaccination and asked to indicate which, if any, make it difficult or inconvenient to receive vaccinations. They could select any that applied and could also specify another response not shown. Respondents were also able to specify additional applicable barriers. Close to six in ten (57%) say none of these are barriers to vaccination for them; six percent are not sure.
Of the barriers listed, the ones cited by at least one in ten are long wait times to get in to see a physician or other health care provider (17%), scheduling appointments for a vaccination (13%), having other priorities (12%), the office hours of physician/health care provider/clinic (11%), and not having a regular health care provider (10%). Eight percent also identify the distance to the location where they would get vaccinated as a barrier. Few indicate any other barriers, notably cost (1%). Close to six in ten (57%) indicate there are no barriers making vaccination difficult or inconvenient.
| Q25 | Total |
|---|---|
| Long wait times to get in to see HCP | 17% |
| Scheduling an appointment for a vaccination | 13% |
| Having other priorities/too busy | 12% |
| Office hours of physician/health care provider/clinic | 11% |
| Not having a regular health care provider/family physician | 10% |
| Distance/far from vaccination location | 8% |
| Cost not covered by health care* | 1% |
| I don't need/want to be vaccinated* | <1% |
| Other | 1% |
| None of the above | 57% |
| Not sure | 6% |
Q25 Do any of the following make it difficult or inconvenient for you to receive vaccinations?
Base: Total sample (n=2,002)
* Answer volunteered, not provided to respondents
Long wait times to see a health care provider as a barrier to vaccinations is similar across most of the country, but somewhat higher in Quebec (22%), and among younger people (27% age 18 to 29), and Indigenous peoples (27%). Scheduling is an issue for marginally higher proportions of urban dwellers. Reporting each of these as barriers is more common among those who have had a negative reaction to vaccines in the past.
Close to nine in ten (88%) Canadians express some level of comfort with the health care provider who would give them vaccinations. Six in ten are very comfortable. Seven percent are uncomfortable, and four percent are not sure.
| Q26 | Total |
|---|---|
| Very comfortable | 59% |
| Somewhat comfortable | 29% |
| Not very comfortable | 5% |
| Not at all comfortable | 2% |
| Not applicable | 2% |
| Not sure | 4% |
Q26 How comfortable are you with the healthcare professional (e.g., doctor, nurse, pharmacist) who would provide vaccinations for you and your family?
Base: Total sample (n=2,002)
Level of comfort with one's health care provider who would provide vaccinations is very consistent across the country, with Atlantic Canadians being the most likely to say they are very comfortable (69%) and Quebecers the least (54%). Overall comfort increases along with age, and is similar for parents and other adults, although those with children are somewhat less likely to be very comfortable (53% vs. 61% of those without children). Being very comfortable is higher among retired people, those who took the survey in English, those who (later in the survey) say vaccines are an accepted household health care practice, and those who say they have not had a negative reaction to vaccines.
Eight in ten (80%) rate protection against vaccine-preventable diseases as at least a moderate priority when compared to other health issues they face; half of these (40%) say it is a high priority. It is a low health priority for one in ten (14%), and three percent say it is not a priority for them at all versus other health issues. Parents of children under 18 are more likely (85%) to say vaccination is a priority than are those without children (78%).
| Q27 | Total (n=2,002) |
Child under 18 (n=521) |
No child under 18 (n=1,481) |
|---|---|---|---|
| Net: Priority | 80% | 85% | 78% |
| High priority | 40% | 44% | 38% |
| Moderate priority | 40% | 41% | 40% |
| Net: Not a priority | 14% | 9% | 16% |
| Low priority | 11% | 8% | 12% |
| Not a priority at all | 3% | 1% | 4% |
| Not sure | 6% | 7% | 6% |
Q27 How much priority do you place on protecting against vaccine-preventable diseases compared to other health issues facing you and your family?
Regionally, protection against vaccine-preventable diseases being at least a moderate priority is similar across the country, but generally higher in the Atlantic (87%) than elsewhere. It is also high among parents (85%), seniors (88%), newcomers to Canada (91%), those with a chronic illness in the home (85%), and among those in the highest household income cohort (85%). It is a relatively lower priority for those with a high school education or less, even though three-quarters of this group (74%) see it as at least a moderate priority. It is still a priority for four in ten of those who later in the survey do not confirm vaccination is an accepted household practice (9% high, 30% moderate, 25% low, 12% not a priority), and for one-quarter who do not get vaccinated themselves; these two groups are the most likely to say it is not a priority or to not be sure.
Seven in ten adults and almost nine in ten children have reportedly received all needed vaccinations. Vaccination is an accepted health care practice for almost nine in ten. Six in ten strongly agree people should get vaccinated to prevent disease spread; a similar proportion feels they know enough about vaccination. Mainstream health care providers are the most trusted source for vaccine information; three-quarters say they would likely receive a newly approved vaccine if recommended by a health care provider.
To the best of their knowledge, seven in ten (69%) Canadian adults have received all needed vaccinations, and close to nine in ten (86%) parents say their child has had all required vaccinations for their age. Fairly similar proportions of one in ten adults without children and six percent of those with children report not receiving all required vaccines for themselves/their children. The major difference is in the proportion not sure about their vaccination status: one in five adults are unsure if all needed vaccinations have been received, versus only one in ten parents.
| Q28 | Self (n=1,481) |
Child (n=521) |
|---|---|---|
| Yes | 69% | 86% |
| No | 10% | 6% |
| Not sure | 20% | 8% |
Q28 To the best of your knowledge, have [you/your child/children] received all the vaccines required for someone your/their age?
Among adults, having received all required vaccinations does not vary notably by region, but is higher among older (76% age 65+) and younger (73% age 18 to 29) Canadians than those in the middle years, especially age 30 to 44 (62%). It does not notably vary by gender or being a member of a target group (Indigenous/ Newcomer), but it is higher among those reporting a chronic medical condition in the household (75%) than those without (66%). Reporting having received all required vaccinations increases as household income increases, from 66 percent under $60,000 up to 80 percent with $100,000 or more; it is also higher among those with a university degree (74%) than those with high school or less education (62%).
As reported by those with children under age 18, childhood vaccination is highest in the Atlantic region (95%) and similar elsewhere (81% to 90%). There are no notable differences by age of child or parent, or by existence of chronic illness in the home. There is no difference by household income, but university graduates (92%) are more likely than those with high school or less (80%) to indicate their children have received all required vaccinations.
In both cases, having received all required vaccinations is positively linked to vaccinations being an accepted household health care practice (asked later in the survey) and is similar whether or not there has been a negative personal reaction to a vaccine.
Around three-quarters (77%) of Canadians would be at least somewhat likely to get themselves or their child vaccinated with a newly approved vaccine when their health care provider recommends it. Likelihood is somewhat higher when it comes to children (83% overall, 43% very likely) than adults (74% overall, 33% very likely).
| Q29 | Very likely |
Somewhat likely | Not very likely | Not at all likely | Not sure |
|---|---|---|---|---|---|
| Total (n=2,002) |
36% | 41% | 11% | 4% | 9% |
| Adults (n=1,481) |
33% | 41% | 12% | 4% | 9% |
| Children (n=521) |
43% | 40% | 10% | 7% | 3% |
Q29 When a healthcare provider recommends that [you/your child/children] receive a vaccine that is
newly approved for use in Canada, how likely are you to get [your child/children] vaccinated?
Base: Total sample (n=2,002)
For adults, overall likelihood of receiving a newly approved vaccine does not vary notably by region (70% to 75%), except in Atlantic Canada, where it is highest (84%). Likelihood is also higher among seniors (82%), men (78%, vs. 71% of women) and those with a chronic illness in the household (77%, vs. 72% without). It is higher among those in the highest socio-economic groups (82% with household incomes of $100,000 or more, 81% with a post-graduate degree).
As reported by those with children under age 18, overall likelihood of having a child receive a newly approved vaccine when recommended by a health care provider is quite similar by region, age, gender, incidence of chronic illness at home, age of children, and sociodemographic factors.
In both cases, willingness to receive a new vaccine is positively linked to vaccinations being an accepted household health care practice and is similar whether or not there has been a negative personal reaction to a vaccine.
Respondents were asked to indicate if vaccination is an accepted health care practice in their household. Almost nine in ten (86%) say it is, seven percent say it is not, and seven percent are not sure. Parents are marginally more likely to say it is accepted (90%) than are adults without children under 18 (85%).
| Q30 | Total (n=2,002) |
Adults (n=1,481) |
Children (n=521) |
|---|---|---|---|
| Yes | 86% | 85% | 90% |
| No | 7% | 8% | 4% |
| Not sure | 7% | 7% | 6% |
Q30 Is vaccination an accepted healthcare practice in your household?
Vaccination being an accepted household health practice is the dominant response across the country and all population subgroups. It is particularly high in the Atlantic region (92%), among seniors (92%), and those with a chronic illness in the home (91%). It is fairly similar for members of the Indigenous community and newcomers to Canada. It increases along with household income (81% up to 92%) and education (from 79% up to 91%).
It should be noted that three-quarters (76%) of those who say vaccination is an accepted household practice report having received all required vaccines, compared to just one-third (33%) of those for whom vaccination is not accepted.
The minority proportion (7%, n=135) who indicated vaccination is not an accepted health care practice in their household were asked to provide, verbatim, the main reasons why this is the case. No pre-coded responses were provided. The most common response, cited by two in ten (22%), is that vaccines are unnecessary, namely because the person is healthy. Just over one in ten each say either that they don't believe in vaccines/not a good idea/their immune system is enough to keep them well (13%), or that vaccines include dangerous or unsafe ingredients (13%). One in ten each (9%) say it is because they distrust the pharmaceutical industry, they get sick when they get vaccinated or it is because of their side effects. Fewer give other individual responses, including a lack of efficacy or that they live alone or do not have children, so do not have others to protect.
| Q31 | Vaccination not accepted health care practice in household (n=135) |
|---|---|
| They are unnecessary/don't need/are healthy | 22% |
| Don't believe in them/immune system is enough | 13% |
| Dangerous chemicals/ingredients/not safe | 13% |
| Don't trust pharma industry/in it for the money | 9% |
| Get sick when vaccinated (ex. get the flu) | 9% |
| Because of their side effects | 9% |
| They don't work/not effective | 6% |
| I live alone/don't have children | 6% |
| Had them when I was a kid | 4% |
| They cause more harm than good | 2% |
| It is up to the individual's choice | 2% |
| Other | 12% |
| Nothing | 3% |
| DK/NA | 10% |
Q31 What are the main reasons why vaccination is not an accepted healthcare practice in your household?
Base: Vaccination not an accepted healthcare practice in household (n=135)
Responses are generally similar across the country and subgroups; however, it should be noted subgroup base sizes are small and caution is advised in interpreting the results.
Respondents were shown five statements giving opinions people might have about vaccination and asked to indicate their level of agreement with each. Agreement is highest for the two statements that can be seen to be positive regarding vaccination, and lowest for the three statements about vaccine uncertainty.
Over eight in ten (83%) people agree to some extent, six in ten strongly, that people should be vaccinated to prevent the spread of disease. Two-thirds agree (30% strongly) that when they think about getting vaccinated, they weigh the benefits and risks to make the best decision.
Thee in ten agree to some extent (one in ten strongly) that they find medical procedures or injections to be very stressful for themselves or, in the case of parents, for their children; this is notably higher among parents (42% agree overall, 13% strongly) than other adults (24% agree overall, 6% strongly). Fewer than two in ten agree (17%, with 7% agreeing strongly) people should not be required to get vaccinated.
A minority of one-quarter of Canadians with children under 18 at home agree (11% strongly) they do not believe in vaccinating teenagers to prevent against sexually transmitted infections.
| Q32-36 | Strongly agree | Somewhat agree | Neither | Somewhat disagree | Strongly disagree | Not sure |
|---|---|---|---|---|---|---|
| People should be vaccinated to prevent the spread of disease in the community | 59% | 24% | 10% | 2% | 2% | 2% |
| When I think about getting vaccinated, I weigh benefits and risks to make the best decision possible | 30% | 36% | 20% | 6% | 6% | 2% |
| I do not believe in vaccinating teenagers to protect against sexually transmitted infections (Base: have children under 18 n=521) | 11% | 12% | 17% | 16% | 39% | 5% |
| In general, I find medical procedures or injections [for my child/children] to be very stressful | 8% | 21% | 22% | 22% | 26% | 1% |
| People should not be required to get vaccinated | 7% | 10% | 16% | 19% | 46% | 2% |
Q32-36 To what extent do you agree or disagree with the following statements:
Base: Total sample (n=2,002)
Net agreement with these statements is similar by region, with Atlantic Canadians being the most likely to agree strongly that people should be vaccinated to prevent the spread of disease in the community (72%, vs 51% to 66% elsewhere). Net agreement is also generally similar by age, with some exceptions. Older Canadians are somewhat more likely to agree people should be vaccinated to prevent the spread of disease in the community, and the proportion agreeing they weigh vaccination benefits and risks increases as age increases. Agreement that medical procedures (for self or children) are stressful decreases as age increases, and is somewhat higher among, women (32%), Indigenous peoples (42%), and those with children under 18 (42%) than among the general population (29%).
Six in ten Canadians agree they know enough about vaccination; the remainder are divided between saying they don't know enough and they aren't sure. Those who have a child under age 18 are marginally more likely to say they know enough than those with no children, the latter of whom are somewhat more likely to be unsure.
| Q37 | Total (n=2,002) |
Adults without children (n=1,481) |
Have children under 18 (n=521) |
|---|---|---|---|
| Yes | 62% | 60% | 67% |
| No | 19% | 20% | 18% |
| Not sure | 19% | 20% | 15% |
Q37 Do you feel that you know enough about vaccination?
The proportion agreeing they know enough about vaccination is similar across the country, ranging from a low of 58 percent in Quebec to a high of 65 percent in Alberta. It is also generally similar by most subgroups, but Indigenous persons are more likely (71%) than other Canadians (61%) to say they know enough. Knowing enough is also higher among those with chronic illness in the home (65% vs. 59% without), and children under 18 (67%, vs. 60% without) and it increases along with increases in education level and household income. It is also higher among those who have experienced a negative vaccine reaction (66%, vs. 60% who have not had a reaction, and 45% who do not get vaccinated) and those who accept vaccination in their household (66%, vs. 34% who do not). In addition, one-third of those who do not have vaccination as an accepted household health practice, or who do not personally get vaccinated, feel they do not know enough about vaccinations.
Canadians were shown the names of six groups who might provide information about vaccinations and asked to indicate their level of trust with each. The group most likely to be trusted, and to be trusted completely, is mainstream health care providers (83% trust at least somewhat), followed by government public health organizations (72% overall trust). Half (53%) trust family and friends at least somewhat. Minorities of Canadians trust the vaccination information provided by pharmaceutical companies (47%), alternative health care providers (36%) and leaders of cultural or religious groups (15%).
| Q38-43 | Trust completely | Trust somewhat | Neither | Distrust somewhat | Distrust completely | Not sure |
|---|---|---|---|---|---|---|
| Mainstream health care providers | 49% | 34% | 9% | 3% | 2% | 3% |
| Government public health organizations | 31% | 40% | 17% | 5% | 3% | 3% |
| My family and friends | 17% | 36% | 34% | 6% | 2% | 4% |
| Pharmaceutical companies | 12% | 35% | 26% | 15% | 8% | 4% |
| Alternative health care providers | 9% | 26% | 29% | 17% | 12% | 6% |
| Leaders of cultural or religious groups | 5% | 10% | 27% | 20% | 32% | 6% |
Q38 How much do you trust the vaccination information provided by the following:
Base: Total sample (n=2,002)
Overall trust in these information providers is quite similar by region (notably, for government public health organizations, overall trust ranges from 69% in Quebec to 79% in the Atlantic). Atlantic Canadians are the most likely to completely trust mainstream health care providers (59%, vs. 45% to 53% elsewhere). Complete trust in leaders of cultural groups to provide vaccine-related information is a small minority, but slightly higher among, Ontarians (7%); complete trust in alternative health providers is somewhat higher among younger Canadians (14% age 18 to 29); complete trust in mainstream health providers is higher among those age 55 and over (58%), and highest among seniors (63%).
Having complete trust in vaccine information from alternative health care providers and cultural leaders is still a minority, but somewhat higher among, Indigenous peoples (23% alternative, 14% cultural). Having complete trust in government public health organizations is highest among seniors (38%), newcomers to Canada (42%), those with chronic illness in the home (35%), and those in the highest socioeconomic strata (38% of those with $100,000 and over household incomes, and 40% with post-graduate university education). Trust in mainstream health care providers and government public health organizations is positively linked to household vaccine acceptance. The majority of those who do not get vaccinated personally do not completely trust any of these sources.
Conjoint analysis reveals vaccine effectiveness has a 33.2 percent share of impact on a decision between two vaccines.
Conjoint analysis is a technique used to simulate, in a controlled survey environment, the scenario Canadians face when deciding whether or not to get an offered vaccination. When faced with these types of decisions, people do not rate or rank each individual factor, but instead make a choice out of the panoply of (possibly imperfect) options available to them. The idea behind conjoint analysis is that by observing respondents' choices we have a better sense of what features they prioritize, rather than by asking them directly.
In this survey, respondents were asked to choose between one of two different vaccinations, then repeated this exercise ten times. Each vaccine differed in terms of four factors: the effectiveness of the vaccine (protects half or almost all vaccinated people); safety (mild side effects, in either 40% or 5% of recipients); burden of disease (vaccine protects against a severe disease or mild one); and level of susceptibility (vaccine protects a rare or common disease). The results indicate the average share of impact that each of those dimensions had on respondents' choices.
Vaccine effectiveness has the largest impact on choice of vaccination (at 33.2 share of impact). After effectiveness, the factors most impacting decision-making are burden of disease (30.07) and susceptibility to the disease (24.73). The factor with the lowest impact is vaccine safety (12.01).
| Q9 | Total |
|---|---|
| Vaccine effectiveness | 33.20 |
| Burden of disease | 30.07 |
| Susceptibility | 24.73 |
| Vaccine safety | 12.01 |
Q9 If you are offered a vaccine, and these are the only options available, which ONE would you choose for yourself?
Based on total sample (n=2,002)
There are hardly any regional variations on the impact the different factors have. Vaccine safety is the least important factor in all jurisdictions but has somewhat more of an impact in Saskatchewan/Manitoba (12.22) and Ontario (12.58) than elsewhere (from 10.83 in the Atlantic to 11.86 in Quebec). Vaccine safety is also more of a factor for those under age 55, especially those age 18 to 29 (12.93) than older Canadians (10.68 age 65 and over), and for men (12.39) than women (11.60); women are more likely than men to factor in burden of disease (31.22, vs. 28.73). There is no appreciable difference in Indigenous people or newcomers to Canada, or by socioeconomic factors (household income and education). However, vaccine safety does tend to be more of a factor for those living in larger communities (12.13 urban, 12.45 medium, vs. 10.85 small and 11.73 rural/reserve).
Effectiveness of the vaccine has a relatively larger impact on those with children under 18 (34.97 vs. 32.58 without) but in both cases it is the top factor. Those without children place somewhat more reliance on burden of disease (30.61) than do parents (28.51). Susceptibility to the disease is more of a factor for those who have someone with a chronic health condition in the home (25.46, vs. 24.00 without).
Those for whom vaccines are an accepted household medical practice place more importance on vaccine effectiveness (33.51, vs. 31.21 for whom it is not accepted). Those who do not accept them are more likely to be concerned with vaccine safety (14.70 vs. 11.57). Those who do not get vaccinated are the least likely to factor in vaccine efficacy (29.40) and the most likely to factor in safety (15.28).
Environics conducted a separate online survey of health care professionals (HCPs) to determine their impressions of the issue of vaccine hesitancy in Canada. The survey was limited to HCPs who either administer or discuss vaccinations with their patients. Information on the demographic distribution of the sample is available in the methodology section of this report.
Due to disparities in how each type of HCP provides vaccines and the regulatory/professional frameworks for doing so in different regions of Canada, no regional comparisons are made and no attempt is made to provide an 'overall' measure for HCPs in Canada. Note that, at the time of the survey, pharmacists in Quebec were not authorized to administer vaccinations. However, several did qualify for the survey as they do provide vaccination advice.
HCPs strongly agree vaccines are, in general, effective (72% to 99%), safe (68% to 95%), and have more benefits than risks (74% to 99%). Majorities of from 85 percent to 96 percent report they have rarely or never been reluctant to recommend a vaccination in their career. Majorities also indicate that there are no specific infant/young child (67% to 97%), older child/teen (89% to 96%) or adult (52% to 76%) vaccines they are reluctant to recommend; recommendation reluctance is mainly linked to lack of effectiveness or availability of alternatives. From 18 percent to 67 percent in the selected occupations see no drawbacks, but lack of efficacy and the potential for side effects concern some. Few (4 percent up to 28%) are concerned about multiple vaccinations at a single visit.
Health care professionals were asked to indicate their level of agreement with four statements about vaccines. Majorities of close to three-quarters or more in each occupation strongly agree with each of three positive statements: that, in general, vaccines are effective in reducing disease, have benefits outweighing their risks, and are safe. In contrast, very few strongly agree Canadian children are receiving too many vaccines. Overall agreement (strongly/somewhat) with this negative statement ranges from a low of 1 percent of pediatricians to a high of 14 percent of midwives.
Because total agreement with vaccine-positive statements is so high, the table below shows the percentage strongly agreeing with each statement.
| Q6-9 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| In general, vaccines are an effective way to reduce the risk of disease | 94% | 72% | 93% | 93% | 98% | 99% |
| In general, vaccines have benefits that outweigh their risks | 94% | 74% | 90% | 90% | 99% | 99% |
| In general, vaccines are safe | 90% | 68% | 85% | 82% | 87% | 95% |
| Canadian children are receiving too many vaccines | 1% | - | 4% | - | - | 1% |
Q6-9 Please indicate how much you disagree or agree with the following statements:
HCPs were asked to indicate how frequently in their career they have been reluctant to recommend a vaccination to a patient for whom it was indicated. Strong majorities in each occupation say this has rarely or never happened (ranging from 85% to 96% by occupation). That it has happened at least sometimes ranges from a low of 4 percent of pediatricians and nurses, to a high of 15 percent of midwives.
| Q10 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| NET: At least sometimes | 9% | 15% | 4% | 12% | 11% | 4% |
| Often | 4% | - | - | 2% | 1% | - |
| Sometimes | 4% | 15% | 4% | 10% | 10% | 4% |
| NET: Rarely/never | 91% | 85% | 96% | 86% | 89% | 96% |
| Rarely | 31% | 48% | 30% | 47% | 41% | 27% |
| Never | 60% | 37% | 65% | 40% | 48% | 68% |
| Not sure | - | - | <1%% | 2% | - | - |
Q10 In your career, how often have you been reluctant to recommend a vaccine to a patient for whom it was indicated?
HCPs who administer or give advice regarding vaccines for infants and young children (age 0-6) were asked to indicate, from a list, if there are any vaccines they are reluctant to recommend, for any reason. Strong majorities in each profession (67% to 97%) indicate there are no vaccines for this age group they are reluctant to recommend. Midwives, nurses and pediatricians indicate more of these different types of vaccines causing reluctance than do family physicians. For the minorities of respondents with concerns, the vaccines for this age group most likely to cause reluctance are rotavirus (from 3 % to 11%) and varicella (from 3% to 31%).
The table below indicates the proportion of HCPs in each occupation reporting reluctance to recommend each vaccine. The bases of pharmacists and OB-GYNOB-GYNs in the sample who indicate they have patient interactions regarding infant vaccinations are extremely small and caution is required in interpreting those results.
| Q11-1 Professionals dealing with vaccines for age 0-6 |
Family physicians (n=74) |
Midwives (n=40*) |
Nurses (n=59) |
Pharma-cists (n=13**) |
OB-GYN (n=2**) |
Pedia-tricians (n=91) |
|---|---|---|---|---|---|---|
| Rotavirus | 4% | 11% | 3% | (1) | - | 8% |
| Varicella (chickenpox) | 3% | 31% | 3% | - | - | 2% |
| Hepatitis B (HB) | 1% | 2% | 3% | - | - | - |
| Measles, Mumps, Rubella (MMR) | 1% | 3% | - | (1) | (1) | 2% |
| Measles, Mumps, Rubella, Varicella (MMRV) | 1% | 5% | 3% | (1) | - | 4% |
| Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (DTaP-IPV-Hib) | - | 3% | - | - | - | 1% |
| Diphtheria, tetanus, pertussis, hepatitis B, polio, haemophilus influenzae type (DTaP-HB-IPV-Hib) | - | 3% | 3% | - | - | - |
| Hepatitis A (HA) | - | - | 3% | - | - | 2% |
| Hepatitis A & B (HAHB) | - | - | 3% | - | - | 2% |
| Meningococcal | - | 2% | 3% | - | - | - |
| Pneumococcal | - | 2% | - | - | - | 1% |
| There are no infant vaccines I am reluctant to recommend | 93% | 67% | 97% | (14) | (1) | 90% |
Q11-1 Please indicate below if there are any vaccines you are reluctant to recommend to patients, for any reason.
BASE: Professionals dealing with vaccines for infants
*Note very small base size (<50) - exercise caution in interpreting results / **Note extremely small base size (<25) - actual (weighted) n's used (in brackets)
HCPs who indicated they administer or give advice regarding vaccinations for older children/adolescents (ages 7 to 17) were asked to indicate from a list if there are any vaccines they are reluctant to recommend, for any reason. Strong majorities in each profession indicate there are no vaccines for this age group they are reluctant to recommend (89% to 96%). Among the few who indicate reluctance, the most mentioned vaccines are for HPV and varicella.
The table below indicates the proportion in each occupation who report reluctance to recommend each vaccine. Pharmacists and paediatricians report reluctance over more kinds of vaccines for this age group than do family physicians.
The base of OB-GYN indicating they have patient interactions regarding child/adolescent vaccinations is extremely small and caution is required in interpreting those results. No midwives indicated they deal with vaccinations for this age group.
| Q11-2 Professionals dealing with vaccines for ages 7-17 |
Family physicians (n=77) |
Midwives (n=0) |
Nurses (n=69) |
Pharma-cists (n=90) |
OB-GYN (n=12**) |
Pedia-tricians (n=89) |
|---|---|---|---|---|---|---|
| Human papillomavirus (HPV) | 4% | - | 4% | 8% | - | 2% |
| Varicella (chickenpox) | 2% | - | <1% | 5% | - | 5% |
| Measles, Mumps, Rubella (MMR) | 1% | - | - | 3% | (1) | 4% |
| Measles, Mumps, Rubella, Varicella (MMRV) | 1% | - | - | 3% | - | 5% |
| Diphtheria, tetanus, pertussis, polio (DTaP-IPV) / Tetanus, diphtheria, pertussis, polio (Tdap-IPV) | - | - | - | 2% | - | 1% |
| Tetanus, diphtheria, pertussis (Tdap) | - | - | - | 2% | - | 1% |
| Hepatitis A (HA) | - | - | - | 1% | - | 1% |
| Hepatitis B (HB) | - | - | - | 1% | - | - |
| Hepatitis A & B (HAHB) | - | - | - | - | - | 1% |
| Meningococcal | - | - | - | 1% | - | 1% |
| There are no child/adolescent vaccines I am reluctant to recommend | 96% | - | 96% | 89% | (9) | 92% |
Q11-2 Please indicate below if there are any vaccines you are reluctant to recommend to patients, for any reason.
BASE: Professionals dealing with vaccines for children/adolescents
**Note extremely small base size (<25) - actual (weighted) n's used (in brackets)
HCPs who administer or give advice regarding adult vaccinations were asked to indicate from a list if there are any vaccines they are reluctant to recommend, for any reason. The table below indicates the proportion in each occupation who report reluctance to recommend each vaccine. Majorities in each profession (from 52% to 76%) indicate there are no adult vaccines they are reluctant to recommend.
Zostavax (8% to 30%), live attenuated influenza (3% to 29%) and Shingrix (3% to 8%) are among the vaccines most likely to cause reluctance. Notable minorities of midwives indicate reluctance to recommend the HPV (23%), inactivated influenza (21%) and Tdap vaccines (17%) to their adult patients. One in ten nurses and just under one in ten OB-GYN are reluctant to recommend the HPV vaccine.
| Q11-3 Professionals dealing with vaccines for adults |
Family physicians (n=99) |
Midwives (n=60) |
Nurses (n=138) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=33*) |
|---|---|---|---|---|---|---|
| Shingles zoster vaccine live (Zostavax) | 19% | 10% | 8% | 30% | 11% | 16% |
| Live attenuated influenza (LAIV) | 8% | 29% | 7% | 16% | 3% | 17% |
| Shingle recombinant zoster vaccine (Shingrix) | 7% | 7% | 3% | 8% | 4% | 7% |
| Human papillomavirus (HPV) | 5% | 23% | 10% | 5% | 8% | 3% |
| Inactivated influenza | 4% | 21% | 5% | 2% | 1% | 4% |
| Meningococcal | 1% | - | 1% | 2% | 2% | 3% |
| Tetanus, diphtheria (Td) | 1% | - | 3% | 2% | 1% | 3% |
| Tetanus, diphtheria, pertussis (Tdap) | 1% | 17% | 1% | 2% | 1% | 3% |
| Hepatitis A (HA) | 1% | - | 1% | 2% | 1% | 3% |
| Hepatitis B (HB) | 1% | - | 4% | 1% | - | 3% |
| Hepatitis A & B (HAHB) | 1% | - | 1% | 1% | 1% | 3% |
| Pneumococcal | 1% | - | 2% | 2% | 2% | 5% |
| There are no adult vaccines I am reluctant to recommend | 76% | 52% | 78% | 63% | 77% | 72% |
Q11-3 Please indicate below if there are any vaccines you are reluctant to recommend to patients, for any reason.
BASE: Professionals dealing with vaccines for adults
*Note very small base size (<50) - exercise caution in interpreting results
HCPs who indicated they are reluctant to recommend any vaccine were asked to indicate which of a list of potential reasons are the main reasons for their reluctance. HCPs could also specify a reason not listed. Top reasons are concerns about effectiveness (32% to 52%), having available alternative treatments (7% to 42%), lack of public funding (15% to 26%) safety/side effects (19% to 48%) and lack of familiarity (5% to 19%).
| Q12 Those reluctant to recommend any vaccine |
Family physicians (n=25*) |
Midwives (n=30*) |
Nurses (n=38*) |
Pharma-cists (n=50) |
OB-GYN (n=12**) |
Pedia-tricians (n=19**) |
|---|---|---|---|---|---|---|
| Concerned about vaccine effectiveness | 49% | 52% | 33% | 32% | (1) | (7) |
| Alternative treatments available | 42% | 7% | 8% | 32% | (1) | (1) |
| Not publicly funded | 26% | - | 15% | 16% | (4) | (2) |
| Concerned about safety/potential side effects | 19% | 46% | 48% | 20% | (2) | (1) |
| Not familiar with vaccine/ recommendations | 18% | 19% | 14% | 5% | (2) | - |
| Better/more effective vaccines available* | 16% | - | 4% | 12% | (1) | (1) |
| Disease it prevents is not serious | 14% | 23% | 11% | 5% | (1) | (3) |
| Too expensive | 10% | - | 26% | 14% | (4) | (1) |
| Don't know enough about effects/ long term harm* | 6% | 9% | - | 2% | (4) | - |
| Low potential for herd immunity | 3% | 6% | 9% | - | - | (1) |
| Not safe for pregnant women* | - | 3% | - | - | (1) | - |
| Patients undergoing specific therapies/treatment* | - | 8% | 7% | 4% | (4) | - |
| Disease no longer exists/is very rare | - | - | 7% | 2% | (3) | - |
| Too many doses required to complete schedule | - | - | <1% | - | - | (1) |
| Too invasive (injection vs. other) | - | - | - | 5% | - | (1) |
| Complex to store/handle | - | - | 11% | - | - | - |
| Concerns for immunocompromised patients* | - | - | <1% | 5% | - | (5) |
| Other | - | 6% | <1% | 1% | - | (6) |
| Not sure | - | 2% | 7% | 5% | (1) | (1) |
Q12 What are the main reasons why you are reluctant to recommend certain vaccines? / * Answer volunteered, not provided to respondents /Base: Those reluctant to recommend any vaccine *Note very small base size (<50) - exercise caution in interpreting results / **Note extremely small base size (<25) - actual (weighted) n's used (in brackets)
HCPs were asked to indicate, from a provided list, what they would say are the most important benefits of vaccinations; they could specify any benefits not listed. They could select up to three benefits in total. The top benefits across all occupations are protecting people from diseases/saving lives (66% to 85%), eradicating or decreasing rate of disease (57% to 74%), and protecting vulnerable people via herd immunity (62% to 77%). Half of OB-GYN also indicate that one of the most important benefits of immunizations is that it is a cost-effective health intervention (51%).
| Q13 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Protecting people from diseases/saving lives | 80% | 66% | 78% | 72% | 87% | 85% |
| Eradicating or decreasing the rate of diseases | 63% | 72% | 74% | 57% | 60% | 58% |
| Protecting immunocompromised/ vulnerable people via herd immunity | 62% | 72% | 77% | 69% | 62% | 70% |
| Cost-effective health intervention | 44% | 36% | 28% | 37% | 51% | 33% |
| Low risk compared to natural infection | 24% | 9% | 12% | 23% | 13% | 22% |
| Reducing disease severity | 21% | 16% | 22% | 26% | 27% | 26% |
| There are no benefits to vaccinations | - | - | 1% | 1% | - | - |
| Not sure | - | 2% | - | - | - | - |
Q13 What would you say are the most important benefits of vaccinations, if any?
HCPs were asked to indicate, from a provided list, what they would say are the most notable drawbacks of vaccinations; they could specify any not listed. They could select up to three drawbacks in total. Majorities of family physicians (55%), nurses (60%) and pediatricians (67%) indicate there are no notable drawbacks to vaccination. The drawbacks indicated are similar to the list of reasons for reluctance to recommend: lack of effectiveness (8% to 18%) and risk of side effects (16% to 35%) are top mentions across occupations. Lack of cost effectiveness is an issue for 13 percent of pharmacists, while lack of public funding is a drawback for 12 percent of OB-GYN. Four in ten midwives indicate vaccines contain harmful or toxic chemicals; 18 percent of midwives say there are no drawbacks to vaccinations.
| Q14 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Lack of effectiveness against disease | 18% | 27% | 8% | 16% | 14% | 9% |
| Risk of serious side effects | 16% | 35% | 17% | 19% | 25% | 16% |
| Contain harmful/toxic chemicals | 7% | 42% | 10% | 2% | 11% | 2% |
| Not publicly funded/covered by government/too expensive for patients not covered* | 7% | 4% | 1% | 7% | 12% | - |
| Not cost effective | 4% | - | 6% | 13% | - | - |
| Reactions (e.g. allergies, fever)* | 2% | - | 1% | - | 5% | 2% |
| Unnecessary/unneeded frequency of delivery* | 2% | 1% | - | - | - | - |
| Time taken away from work to get vaccinated* | 2% | 2% | - | - | - | 1% |
| They compromise the ability of the body to defend itself against disease | 1% | 8% | 1% | - | 5% | 1% |
| Pain associated with needle/sore injection site* | 1% | 5% | 1% | 1% | 2% | 4% |
| Flu strains often do not match vaccine* | - | - | 1% | 1% | - | - |
| Public perception/misconception* | - | - | <1% | 1% | 2% | 1% |
| Too many vaccines at once for infants* | - | 3% | 1% | - | - | - |
| Other | - | 6% | - | 1% | 2% | - |
| There are no drawbacks to vaccinations | 55% | 18% | 60% | 48% | 42% | 67% |
| Not sure | 3% | 8% | 6% | 5% | - | 3% |
Q14 What would you say are the most notable drawbacks of vaccinations, if any?
* Answer volunteered, not provided to respondents
Health care professionals were asked to indicate their level of agreement with two negative statements about vaccines (phrases linking the vaccines to children were randomly added to the statements shown to some respondents who work with children). Majorities of family physicians, nurses, pharmacists, OB-GYN and pediatricians disagree to some extent with both statements; pluralities of midwives disagree, but notable minorities neither agree nor disagree or are not sure.
Just over one-quarter of midwives and one in eight nurses agree to some extent that administering multiple vaccines at a single visit could overwhelm the immune system. One in ten or fewer of other occupations agree with this. One in ten or fewer of all occupations agree administering multiple vaccines at a single visit could reduce their efficacy.
Majorities of all professions except midwives disagreed with both statements, whether or not children were referenced. [2]In the case of nurses, disagreement with either statement was even higher when reference was made to children.
| Q15-16 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Administering multiple vaccines at a single visit could overwhelm the immune system [of children] | ||||||
| Net: agree | 4% | 28% | 13% | 5% | 10% | 1% |
| Strongly agree | - | 1% | 5% | 1% | 1% | - |
| Somewhat agree | 4% | 27% | 8% | 4% | 9% | 1% |
| Neither agree nor disagree | 9% | 16% | 13% | 7% | 3% | - |
| Net: disagree | 83% | 32% | 63% | 84% | 82% | 98% |
| Somewhat disagree | 16% | 18% | 17% | 33% | 19% | 11% |
| Strongly disagree | 67% | 14% | 46% | 50% | 63% | 87% |
| Not sure | 4% | 24% | 11% | 4% | 4% | 1% |
| Base: Those shown "of children" | 81 | 40 | 74 | 92 | 12** | 95 |
| Net agree | 2% | 27% | 5% | 4% | (1) | 1% |
| Base: Those not shown "of children" | 19** | 27* | 66 | 37* | 47* | 1** |
| Net agree | (2) | 29% | 19% | 6% | 11% | - |
| Administering multiple vaccines at a single visit could reduce their efficacy [in children] | ||||||
| Net: agree | 3% | 8% | 9% | 5% | 10% | - |
| Strongly agree | 1% | 2% | 1% | 2% | 1% | - |
| Somewhat agree | 2% | 6% | 7% | 3% | 9% | - |
| Neither agree nor disagree | 12% | 23% | 13% | 10% | 12% | 1% |
| Net: disagree | 80% | 38% | 67% | 81% | 71% | 98% |
| Somewhat disagree | 24% | 18% | 24% | 31% | 13% | 15% |
| Strongly disagree | 56% | 20% | 43% | 50% | 58% | 83% |
| Not sure | 5% | 30% | 11% | 4% | 7% | 1% |
| Base: Those shown "in children" | 81 | 40 | 74 | 92 | 12** | 95 |
| Net agree | 3% | 7% | 3% | 3% | (1) | - |
| Base: Those not shown "in children" | 19** | 27* | 66 | 37* | 47* | 1** |
| Net agree | - | 9% | 13% | 9% | 9% | - |
Q15-16 To what extent do you agree or disagree with the following statements
*Note very small base size (<50) - exercise caution in interpreting results / **Note extremely small base size (<25) - actual (weighted) n's used (in brackets)
The most important factors in HCP vaccine recommendation are disease severity (85% to 95% across occupations), ease of contracting the disease (75% to 88%), and likelihood of the disease returning or spreading (66% to 91%). Majorities in all occupations (54% to 65%) think vaccine-preventable diseases are becoming more common, and strong majorities believe it is very important for people in vulnerable groups to be vaccinated (proportions vary by group across occupations, from 63% to 99%)
For all occupations, the most important factors when deciding to recommend a vaccination are if the disease it covers is serious (84% to 95%), very contagious (75% to 88%), or likely to return and spread without herd immunity (66% to 91%). Smaller majorities of family physicians (58%), nurses (63%), pharmacists (57%), OB-GYN (60%) and pediatricians (54%) also feel it is very important to their decision if the disease is very common. Minorities in all occupations think it is very important to their recommendation decision if treating the disease is safer than vaccination (22% to 37%), or if there are a better means of preventing the disease (19% to 28%).
| Q17-22 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| If the disease is very serious (i.e., it is life-threatening and often requires hospitalization) | 93% | 91% | 84% | 84% | 91% | 95% |
| If the disease is very contagious/easy to contract | 88% | 75% | 83% | 75% | 82% | 83% |
| If the disease is likely to return or spread if people are not vaccinated against it | 76% | 66% | 82% | 72% | 77% | 91% |
| If the disease is very common (i.e., most unvaccinated persons will have it during their lifetime) | 58% | 30% | 63% | 57% | 60% | 54% |
| If treating the disease is safer than vaccinating against it | 24% | 37% | 31% | 22% | 19% | 23% |
| If there are better means of preventing the disease | 23% | 28% | 31% | 27% | 19% | 24% |
Q17-22 How important are the following factors to you when deciding to recommend vaccinations?
Majorities of health care professionals in all occupations feel vaccine-preventable diseases are becoming more common in Canada. This impression ranges from a low of 54 percent of pharmacists to a high of 65 percent of pediatricians and nurses. Around one-quarter each of pediatricians, family physicians and OB-GYN think these diseases are in fact becoming less common.
| Q23 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| More common | 58% | 63% | 65% | 54% | 56% | 65% |
| About the same | 10% | 15% | 13% | 19% | 11% | 8% |
| Less common | 26% | 10% | 19% | 19% | 28% | 25% |
| Not sure | 6% | 13% | 4% | 8% | 4% | 2% |
Q23 In your opinion are vaccine-preventable diseases becoming more or less common in Canada, or is the rate staying about the same?
Health care professionals were shown a list of groups of people and given a chance to indicate how important it is for each group to be vaccinated against diseases. Majorities in all occupations feel vaccination is very important for all groups except for healthy adults age 18 to 64 (proportions vary by group across occupations, from 63% to 99%), but most important for people with compromised immune systems (77% to 97%) and infants/children (80% to 99%). For healthy adults, almost two-thirds of OB-GYN, close to six in ten pediatricians and about half of family physicians and nurses think it is very important they be immunized as well.
| Q24-31 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| People with compromised immune systems | 95% | 77% | 89% | 95% | 94% | 97% |
| Infants and children | 95% | 80% | 92% | 92% | 99% | 99% |
| People with pre-existing health problems | 89% | 64% | 83% | 86% | 89% | 96% |
| Health care workers | 88% | 63% | 82% | 85% | 86% | 97% |
| Seniors age 65+ | 88% | 70% | 82% | 84% | 78% | 88% |
| New immigrants and refugees | 85% | 67% | 86% | 78% | 75% | 88% |
| Pregnant women | 84% | 56% | 82% | 76% | 86% | 89% |
| Healthy adults age 18-64 | 50% | 26% | 48% | 43% | 64% | 57% |
Q24-31 For which types of people do you believe vaccination against disease is most important?
Half or more of HCPs other than OB-GYN (49% to 73%, OB-GYN 28%) both discuss and administer vaccinations. Majorities of each occupation (51% to 84%) except pharmacists (42%) have six or more years of vaccination-related experience. Frequency of interacting with patients about vaccinations varies notably by occupation; daily vaccine intervention ranges from 6 percent of midwives to 44 percent of pediatricians. Majorities of 62 percent to 85 percent recommend newly approved vaccines to at least some eligible patients. Among those who would recommend a new vaccine to at least some patients. lack of efficacy (14% to 32%), side effects (27% to 38%) and cost to patients (11% to 36%) could prevent recommendation.
To better understand the involvement of health care professionals with vaccinations, they were asked a series of questions. The first was a screening question, as only HCPs who administer vaccines or discuss vaccinations with their patients qualified for the survey.
Majorities of the family physicians (73%), nurses (72%) and pharmacists (69%) both administer and discuss vaccines with their patients. Around half of midwives (49%) and pediatricians (49%) also do both activities while the other half (51%) discuss but do not administer vaccines. Almost three-quarters of OB-GYN discuss vaccines but do not deliver them. Nurses are the only occupation where a small minority only administer but do not discuss vaccinations (5%).
| Q3 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Both administer vaccines and discuss vaccines with patients | 73% | 49% | 72% | 69% | 28% | 49% |
| Discuss vaccines but do not administer | 27% | 51% | 22% | 31% | 72% | 51% |
| Administer vaccines but do not discuss vaccines with patients | - | - | 5% | - | - | - |
Q3 Do you administer vaccines to, or discuss vaccines with, your patients?
The types of patients for whom HCPs administer or discuss vaccinations vary by occupation. Majorities of family physicians report dealing with each of the six types of patients (79%); only one in five (20%) do not deal with children in their practice. Midwives are most likely to deal with pregnant women (76%) and infants (61%). Nurses are more likely to deal with adults (87%) than children (39%) or infants (35%). Pharmacists are most likely to deal with adults (96%) and seniors (93%), but around two thirds also deal with vaccinations for children (68%) and those in high risk groups (63%). Eight in ten (83%) OB-GYN only deal with adults when it comes to vaccinations, and the reverse is true of pediatricians, eight in ten (80%) of which only deal with infants and children.
| Q4 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Infants/young children (0-6yrs) | 73% | 61% | 35% | 11% | 2% | 94% |
| Children (7-17yrs) | 75% | - | 39% | 68% | 17% | 92% |
| Adults (18-64yrs) | 96% | 45% | 87% | 96% | 92% | 18% |
| Seniors (65yrs+) | 89% | - | 70% | 93% | 25% | 2% |
| Pregnant women | 70% | 76% | 36% | 52% | 72% | 7% |
| High-risk groups | 72% | 7% | 52% | 63% | 37% | 21% |
| Other | 3% | 1% | 1% | 1% | - | 1% |
| NET: Children only | 1% | 12% | 2% | - | - | 80% |
| NET: Adults only | 20% | 39% | 55% | 29% | 83% | 1% |
| NET: Both | 79% | 50% | 41% | 70% | 17% | 18% |
Q4 To whom do you administer/discuss vaccines?
Notable majorities of health care professionals in four occupations (family physicians - 84%, nurses - 64%, OB-GYN - 80% and pediatricians - 84%) have six or more years of vaccination-related experience. Half of midwives - 51% - have six or more years of vaccine-related experience, as do four in ten (42%) pharmacists. The results correspond with pharmacist-administered vaccines being a relatively recent professional function (Quebec pharmacists were not authorized to administer vaccines at the time of the survey).
| Q5 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| NET: Less than six | 16% | 49% | 36% | 58% | 20% | 16% |
| Less than 1 year | 1% | 5% | 6% | 2% | - | - |
| 1 to 5 years | 15% | 44% | 30% | 56% | 20% | 16% |
| NET: 6+ | 84% | 51% | 64% | 42% | 80% | 84% |
| 6 to 15 years | 19% | 36% | 36% | 34% | 47% | 24% |
| More than 15 years | 65% | 15% | 28% | 8% | 34% | 59% |
Q5 For approximately how many years have you been administering vaccines/discussing vaccines?
The frequency of interacting with patients about vaccinations varies notably by occupation. Around four in ten family physicians (42%) and pediatricians (44%) administer or discuss vaccinations with patients daily. Around half of pharmacists (48%) and OB-GYN (50%), and three in ten (30%) midwives and one-quarter of nurses (27%), do so at least weekly.
| Q32 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Daily | 42% | 6% | 19% | 7% | 33% | 44% |
| NET: At least weekly | 39% | 30% | 27% | 48% | 50% | 30% |
| A few times a week | 27% | 21% | 21% | 31% | 32% | 23% |
| About once a week | 12% | 9% | 6% | 17% | 17% | 7% |
| Less often than once a week | 4% | 30% | 13% | 14% | 9% | 12% |
| It varies | 15% | 35% | 41% | 32% | 9% | 13% |
Q32 How often do you [administer vaccines/discuss vaccines with your patients]?
Majorities of each occupation recommended newly approved vaccines to at least some eligible patients (85% family physicians, 66% midwives, 62% nurses, 65% pharmacists, 76% OB-GYN, 85% pediatricians). Recommending to all such patients happens in the case of around half of family physicians (46%), midwives (45%) and OB-GYN (51%), and six in ten (59%) pediatricians. Notable minorities of midwives (31%), nurses (25%) and OB-GYN (24%) are unable to say.
| Q33 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| NET: At least some | 85% | 66% | 62% | 65% | 76% | 85% |
| All | 46% | 45% | 35% | 22% | 51% | 59% |
| Some | 40% | 21% | 27% | 42% | 24% | 27% |
| A few | 8% | 3% | 6% | 20% | - | 3% |
| None | - | - | 7% | 2% | - | 1% |
| Not sure | 7% | 31% | 25% | 14% | 24% | 11% |
Q33 When a new vaccine is approved for use in Canada, do you typically recommend it to all, some, a few or none of your eligible patients?
HCPs were shown a list of possible considerations when recommending a newly approved vaccine, and asked to indicate up to three which are most important to them. HCPs are most likely to consider effectiveness (52% to 74%), with whether or not an expert committee has recommended it be used (28% to 68%) and patient susceptibility to the disease (28% to 46%) also being noteworthy factors. Notable proportions would also consider if the patients could afford it if it was not covered (13% to 30%), the side effects it has (16% to 35%), how extensively it was tested (18% to 44%), and how common the disease is (20% to 39%). One-quarter of midwives and one in six OB-GYN would also consider it if their colleagues were recommending the vaccine. Consideration of major side effects ranges from 16 percent of OB-GYN to 35 percent of midwives. How extensively the vaccine is tested ranges in importance from 18 to 44 percent. Nurses are not generally concerned with expert committee recommendation (28%), but just under half (46%) factor in patient susceptibility to the disease.
| Q34 Those recommending new vaccines to at least a few eligible patients |
Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=134) |
Pharma-cists (n=127) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| How effective it is | 74% | 68% | 60% | 70% | 52% | 72% |
| If an immunization expert committee has recommended it | 50% | 37% | 28% | 50% | 68% | 66% |
| The patient's susceptibility to the disease | 31% | 28% | 46% | 39% | 35% | 28% |
| If cost not covered, if the patient can afford it | 28% | 13% | 22% | 30% | 20% | 24% |
| What major side effects it has | 26% | 35% | 20% | 26% | 16% | 27% |
| How extensively it was tested | 24% | 44% | 26% | 21% | 29% | 18% |
| How common the disease is | 20% | 23% | 39% | 25% | 28% | 28% |
| If cost is covered by health insurance | 20% | 18% | 23% | 19% | 32% | 17% |
| If other professionals in my field are recommending it to their patients | 9% | 25% | 7% | 5% | 16% | 14% |
| The route of administration (e.g. injection vs. intranasal/oral) | 3% | - | 6% | 2% | 1% | - |
| What minor side effects it has | 2% | 1% | 6% | 4% | - | 3% |
| None of the above | 1% | - | 1% | 1% | 1% | - |
| Not sure | 1% | - | 2% | - | - | - |
Q34 When a new vaccine is approved for use in Canada, what are the most important factors in whether you would recommend it to eligible patients?
BASE: Those recommending new vaccines to at least a few eligible patients
Health care professionals indicating they would recommend a newly approved vaccine to at least a few eligible patients were asked what, if anything, would prevent them from going through with such a recommendation. The different occupations offer differing responses, but a top reason for all is a concern about safety and potential side effects (27% to 38%). Other reasons given by notable proportions of HCPs include if the vaccine was too expensive (11% to 36%), or if they were concerned about effectiveness (14% to 32%). Two in ten midwives would also not recommend a vaccine they felt had not been sufficiently studied, or that was not sufficiently tested; also, 11% would not recommend a vaccine based on the patient's individual choice, and 28 percent would not recommend if they thought the vaccine was not safe for pregnant women. A concern for OB-GYN would be if insufficient data were available (16%), or if it was not being recommended by vaccine expert panels (16%).
| Q35 Those recommending new vaccines to at least a few eligible patients providing a response | Family physicians (n=81) |
Midwives (n=51) |
Nurses (n=104) |
Pharma-cists (n=108) |
OB-GYN (n=43*) |
Pedia-tricians (n=73) |
|---|---|---|---|---|---|---|
| Concerned about safety/potential side effects | 38% | 27% | 32% | 27% | 32% | 36% |
| Too expensive | 36% | 11% | 23% | 28% | 13% | 25% |
| Concerned about effectiveness | 28% | 14% | 20% | 27% | 16% | 32% |
| Not publicly funded | 8% | 11% | 6% | 4% | 6% | 11% |
| How much data is available/unclear data/information | 6% | 5% | 6% | 13% | 16% | 4% |
| Disease it prevents is not serious | 6% | 1% | 3% | 4% | 10% | 10% |
| Lack of evidence to support it | 6% | 8% | 4% | 2% | 11% | 2% |
| If it hasn't been approved by Health Canada/NACI | 5% | 8% | 5% | 5% | 13% | 8% |
| If studies not strong/insufficient long-term research | 4% | 22% | 15% | 8% | 1% | - |
| If not tested enough as of yet | 4% | 20% | 2% | 2% | 1% | 5% |
| Unclear benefits | 4% | 1% | 2% | 1% | - | 4% |
| If not recommended by vaccine expert panels | 2% | 7% | 2% | 6% | 16% | 10% |
| Prefer to wait until it has been around a while | 2% | 3% | 4% | 1% | 1% | 2% |
| Alternative treatments available | 2% | - | 2% | - | - | 1% |
| Bad/allergic reaction to the vaccine | 2% | - | 1% | 5% | - | - |
| I respect individual choice for optional vaccine | 1% | 11% | 1% | 1% | - | 1% |
| If it doesn't apply to patient/ possible interactions with patient's medical treatment/history | 1% | - | 1% | 3% | - | 3% |
| Better vaccine already available | 1% | - | - | 5% | - | 2% |
| If not safe/recommended for pregnant women/newborn | 1% | 28% | - | 1% | 7% | - |
| Not familiar with the vaccine or its recommendations | - | 1% | 8% | 2% | 4% | - |
| Immunocompromised patients with live vaccine | - | - | <1% | 6% | - | 4% |
| Other | 5% | 9% | 1% | 5% | 4% | 3% |
Q35 What, if anything, would prevent you from recommending a new vaccine?
BASE: Those recommending new vaccines to at least a few eligible patients providing a response
*NOTE: very small base size (<50) - exercise caution in interpreting results
Inadequate reimbursement can be a barrier to administering vaccinations (for 24% to 64% across occupations). Majorities of nine in ten or more in all occupations agree vaccination is well-accepted by Canadians and that people should be vaccinated to ensure community protection. All occupations (99%- 100%) think it is at least somewhat important for HCPs to give patients advice and information about vaccination, but not all are equally familiar with NACI recommendations (64% to 96%). NACI (35% to 92%), government public health organizations (30% to 77%) and peer-reviewed journals (42% to 67%) are the most trusted vaccination information sources.
HCPs who administer vaccinations were asked to indicate how much of a barrier each of five situations are to delivery of vaccination in their practice. Majorities in all occupations (56% to 72%) except pediatricians (28%) indicate at least one major or moderate barrier. Inadequate reimbursement is the most noted issue for family physicians (46% say it is a moderate or major barrier) and pharmacists (64%). For midwives, storage and handling is the most noted barrier (49%), and around four in ten midwives mention each of three other barriers: inadequate reimbursement, up-front inventory costs and not giving vaccines often enough. A majority of pediatricians (62%) and a plurality of nurses (44%) say none of these pose a moderate or major barrier.
| Q36-39 Health care professionals who administer vaccines |
Family physicians (n=76) |
Midwives (n=34*) |
Nurses (n=106) |
Pharma-cists (n=93) |
OB-GYN (n=18**) |
Pedia-tricians (n=50) |
|---|---|---|---|---|---|---|
| At least one major/moderate barrier | 65% | 66% | 56% | 70% | 72% | 38% |
| Inadequate reimbursement | 46% | 37% | 33% | 64% | (8) | 24% |
| Storing/handling requirements | 37% | 49% | 8% | 7% | (9) | 17% |
| Up-front costs of ordering/maintaining inventory | 36% | 37% | 23% | 24% | (8) | 24% |
| Not giving vaccines often enough/not part of usual practice | 7% | 41% | 27% | 20% | (2) | 5% |
| None are moderate or major barriers | 35% | 34% | 44% | 30% | (5) | 62% |
Q36-39 To what extent are the following barriers to delivery of vaccination in your practice?
Base: health care professionals administering vaccines
*Note very small base size (<50) - exercise caution in interpreting results / **Note extremely small base size (<25) - actual (weighted) n's used (in brackets)
All HCPs were asked to indicate their level of agreement with four statements about vaccine acceptance. Majorities of nine in ten or more in all occupations agree to some extent people should be vaccinated to ensure community protection and that vaccination is well-accepted by Canadians. Minorities of two in ten or less agree administering vaccinations to adolescents to protect against STIs could increase likelihood of engaging in unprotected sexual activity, and this is especially low among OB-GYN and pediatricians. When it comes to agreement that people should not be required to get vaccinated, over half (55%) of midwives agree to some extent, compared to less than one in five in the other professions; this is consistent with previous research.
The table below shows strong agreement, which is a better differentiator of opinions on these statements. This table also indicates OB-GYN and pharmacists are the least likely to strongly agree vaccination is a well-accepted health practice by Canadians, even though they are about as likely as others to agree overall.
| Q40-43 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| People should be vaccinated to ensure community protection (i.e. herd immunity) | ||||||
| Strongly agree | 76% | 59% | 83% | 78% | 77% | 86% |
| Net agree (strongly and somewhat) | 94% | 90% | 97% | 96% | 95% | 98% |
| Vaccination is well-accepted as a health practice by Canadians | ||||||
| Strongly agree | 43% | 35% | 40% | 26% | 26% | 42% |
| Net agree (strongly and somewhat) | 96% | 98% | 95% | 90% | 92% | 96% |
| Administering vaccines to protect adolescents against STIs could increase their likelihood of engaging in unprotected sexual activity |
||||||
| Strongly agree | 4% | 4% | 6% | 6% | 2% | 2% |
| Net agree (strongly and somewhat) | 13% | 12% | 18% | 20% | 2% | 5% |
| People should not be required to get vaccinated | ||||||
| Strongly agree | 1% | 28% | 7% | 2% | 2% | 1% |
| Net agree (strongly and somewhat) | 10% | 55% | 17% | 10% | 18% | 11% |
Q40-43 To what extent do you agree or disagree with the following statements:
As another indication of personal opinion about vaccine acceptability, HCPs were asked if they themselves received an influenza immunization in the 2018-2019 influenza season. Results ranged from a low of six in ten midwives up to almost all (99%) OB-GYN, indicating majority participation in the program.
| Q56 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Yes | 89% | 59% | 80% | 83% | 99% | 89% |
| No | 9% | 36% | 18% | 16% | - | 9% |
| Not sure | - | 4% | - | 1% | - | - |
| Prefer not to say | 1% | 1% | 2% | 1% | 1% | 1% |
Q56 Did you personally receive an influenza immunization during the 2018-2019 flu season?
Virtually all (99% to 100%) HCPs feel it is at least a somewhat important role to give patients advice and information about vaccination, and strong majorities in all occupations think it is very important.
| Q44 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| NET: Important | 100% | 99% | 100% | 99% | 100% | 100% |
| Very important | 89% | 78% | 92% | 79% | 87% | 94% |
| Somewhat important | 11% | 20% | 8% | 20% | 13% | 6% |
| NET: Not important | - | 1% | - | 1% | - | - |
| Not very important | - | 1% | - | 1% | - | - |
| Not at all important | - | - | - | - | - | - |
Q44 To what extent do you feel giving patients advice and information on vaccination is an important role for health care professionals like you to play?
Level of self-assessed familiarity with the current National Advisory Committee on Immunization (NACI) recommendations for vaccination in Canada varies by occupation, from a low of two-thirds of midwives and nurses up to almost all pediatricians. In all cases except pediatricians, which are evenly divided, HCPs are more likely to be somewhat than very familiar.
| Q45 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| NET: Familiar | 93% | 64% | 65% | 85% | 77% | 96% |
| Very familiar | 37% | 2% | 24% | 17% | 24% | 48% |
| Somewhat familiar | 56% | 61% | 41% | 67% | 52% | 48% |
| NET: Unfamiliar | 7% | 30% | 34% | 14% | 21% | 4% |
| Somewhat unfamiliar | 4% | 13% | 20% | 11% | 17% | 3% |
| Very unfamiliar | 2% | 17% | 14% | 3% | 4% | 1% |
| Not sure | - | 7% | 1% | 1% | 2% | - |
Q45 How familiar do you feel you are with the current National Advisory Committee on Immunization (NACI) recommendations for vaccination in Canada?
HCPs were asked to indicate how confident they are in their ability to undertake four types of patient communications about vaccinations. Two-thirds or more in all professions are at least somewhat confident in their ability to undertake each type of communication. The table below shows the proportions indicating strong confidence.
Majorities of pediatricians (86%), OB-GYN (79%) and family physicians (66%) are very confident in their ability to recommend vaccinations; similarly, majorities of pediatricians (73%), OB-GYN (60%) and family physicians (57%) are very confident in their ability to effectively provide information on benefits and risks. Seven in ten pediatricians and half of family physicians are also very confident they can answer questions about vaccinations. Half of pediatricians are very confident they can address the concerns of vaccine-hesitant patients; minorities of other occupations have this level of confidence. Smaller minorities of midwives indicate they are very confident to undertake each of the four vaccine-related communications (27% recommend vaccinations, 22% effectively provide information, 8% answer patient questions, and 6% address concerns).
| Q46-49 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Recommend vaccinations to patients | 66% | 27% | 47% | 47% | 70% | 86% |
| Effectively provide information to patients about the benefits and risks of immunization | 57% | 22% | 44% | 48% | 60% | 73% |
| Answer patient questions about vaccination | 50% | 8% | 39% | 41% | 46% | 69% |
| Address the concerns of vaccine hesitant patients | 37% | 6% | 33% | 38% | 37% | 50% |
Q46-49 How confident are you in your ability to do the following:
HCPs were shown a list of sources of vaccination information and asked to indicate their level of trust in each. Majorities at least somewhat trust all sources (54% to 100%), except only one-quarter of midwives and half of OB-GYN trust pharmaceutical companies.
As the overall level of trust for most sources among most professions is very high (from 81% to 100% net trust except for pharmaceutical companies), the table below shows the level of complete trust. These data show complete trust is highest for information provided by NACI for all occupations (63% to 92%) except midwives (35%), who are marginally more likely to completely trust scientific peer-reviewed journals (42%). Government public health organizations also enjoy a high level of complete trust among pediatricians (77%), family physicians (73%), pharmacists (66%) and OB-GYN (62%), as do peer-reviewed journals (52% to 67% of those occupations). Strong trust is somewhat lower for professional organizations (25% to 71%) and colleagues (11% to 43%), but still, close to six in ten or more pharmacists, OB-GYN and pediatricians express strong trust in their respective organizations. Only small minorities completely trust pharmaceutical firms (1% to 14%) as purveyors of vaccination information.
| Q50-55 | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| The National Advisory Committee on Immunization (NACI) | 81% | 35% | 63% | 81% | 79% | 92% |
| Government public health organizations | 73% | 30% | 53% | 66% | 62% | 77% |
| Scientific peer-reviewed journals | 65% | 42% | 53% | 63% | 52% | 67% |
| Professional organizations representing health care professionals | 48% | 25% | 41% | 58% | 63% | 71% |
| My professional colleagues | 41% | 11% | 41% | 34% | 28% | 43% |
| Pharmaceutical companies | 9% | 1% | 12% | 14% | 2% | 11% |
Q50-55 How much do you trust the vaccination information provided by the following:
Environics conducted an online survey with 2,002 adult residents of Canada from June 14 to July 4, 2019. This consisted of 1,800 general population interviews, and oversamples of 100 each of two key target groups: Indigenous peoples and new Canadians (immigrated in past 10 years). Survey respondents were selected from registered members of an online panel. Since the samples used in online panel surveys are based on self-selection and are not a random probability sample, no formal estimates of sampling error can be calculated. Although opt-in panels are not random probability samples, online surveys can be used for general population surveys provided they are well designed and employ a large, well-maintained panel. Respondents were informed about privacy and anonymity.
The survey used the following sample design:
| Sample | Total | Atlantic | Quebec | Ontario | MB/SK | Alberta | BC | Territories |
|---|---|---|---|---|---|---|---|---|
| Population | 100% | 7% | 23% | 38% | 7% | 11% | 14% | <1% |
| Unweighted n | 1,800 | 200 | 395 | 475 | 200 | 250 | 275 | 5 |
| 18-29 | 20% | 39 | 78 | 94 | 39 | 49 | 54 | 1 |
| 30-44 | 25% | 50 | 99 | 118 | 50 | 62 | 69 | 1 |
| 45-54 | 18% | 36 | 70 | 85 | 36 | 44 | 49 | 1 |
| 55+ | 38% | 75 | 148 | 178 | 75 | 94 | 103 | 2 |
| Men | 49% | 99 | 195 | 234 | 99 | 123 | 135 | 3 |
| Women | 51% | 101 | 200 | 241 | 101 | 127 | 140 | 3 |
Weighting was used to ensure the final sample is representative of the general population.
The questionnaire was designed by Environics, with input from Health Canada and PHAC representatives and academic consultants to the project. The final study questionnaire is included in Appendix B.
Environics' data analysts programmed the questionnaires, then performed thorough testing to ensure accuracy in set-up and data collection. This validation ensured that the data entry process conformed to the surveys' basic logic. The data collection system handles sampling invitations, quotas and questionnaire completion (skip patterns, branching, and valid ranges).
Prior to finalizing the survey for field, a pre-test (soft launch) was conducted in English and French. The pre-test assessed the questionnaires in terms of question wording and sequencing, respondent sensitivity to specific questions and to the survey overall, and to determine the survey length; standard Government of Canada pre-testing questions were also asked. As no changes were required following the pre-test, the n=170 responses (149 English, 21 French) have been included in the final data set.
The survey was conducted by Environics using a secure, fully featured web-based survey environment. The interviews took place from June 14 (soft launch pre-test) to July 4, 2019. The average interview length was 14 minutes.
All respondents were offered the opportunity to complete the surveys in their official language of choice. All research work was conducted in accordance with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys and recognized industry standards, as well as applicable federal legislation (Personal Information Protection and Electronic Documents Act, or PIPEDA).
The completion results are presented in the following table.
| Disposition | N |
|---|---|
| Total invitations (c) | 53,304 |
| Total completes (d) | 2,002 |
| Qualified break-offs (e) | 343 |
| Disqualified (f) | 157 |
| Not responded (g) | 47,188 |
| Quota filled (h) | 3,614 |
| Contact rate = (d+e+f+h)/c | 12% |
| Participation rate = (d+f+h)/c | 11% |
Respondent profile
The following table presents the weighted distribution of participants by key demographic and other variables.
| Variable | Total sample |
|---|---|
| Age | |
| 18-29 | 19% |
| 30-44 | 26% |
| 45-54 | 17% |
| 55-64 | 18% |
| 65+ | 21% |
| Gender | |
| Female | 50% |
| Male | 48% |
| Gender fluid/non-binary/prefer not to say | 1% |
| Education | |
| High school or less | 22% |
| Apprentice/college/some university | 38% |
| University graduate/post-graduate | 39% |
| Employment status | |
| Full time/self-employed | 49% |
| Part time | 9% |
| Not employed (student, unemployed, homemaker etc.) | 14% |
| Retired | 25% |
| Other/prefer not to say | 3% |
| Total annual household income | |
| Under $40,000 | 22% |
| $40,000-<$60,000 | 17% |
| $60,000-<$80,000 | 14% |
| $80,000-<$100,000 | 13% |
| $100,000-<$150,000 | 16% |
| $150,000 or more | 8% |
| Prefer not to say | 10% |
| Children | |
| Any under 18 | 26% |
| Any under 6 years old | 11% |
| Any 7 to 12 years old | 11% |
| Any 13 to 17 years old | 10% |
| No children under 18 | 74% |
| Community size (self-reported) | |
| Rural or small (population below 30,000) | 21% |
| Medium-sized (over 30,000 but under 100,000) | 23% |
| Large urban centre (population over>100,000) | 56% |
Environics conducted an online survey with 591 Canadian health care professionals (HCPs), with responses collected from June 17 to September 9, 2019. The survey utilized both an online panel survey using targeted e-mail invitations and an open link, which PHAC provided to professional associations for the purpose of inviting their members to take part. This dual-frame approach was required because the online panel was known to contain insufficient numbers of specialist physicians and midwives to get the desired number of completions.
The majority of completed interviews were obtained using mdBriefCase, a large and diverse online opt-in panel of health care professionals. The sample was randomly drawn from this panel; however, because it is not a random probability sample, the results cannot be extrapolated to the actual HCP population and no margin of sampling error can be calculated. From this portion of the sample, we obtained 483 completed interviews. Midwives were invited to take part in the survey through the Canadian Association of Midwives (CAM), and pediatricians and OB-GYN were also invited via their respective professional associations. These professions used an open link to access the survey. The open links yielded 108 completed interviews by close of field.
Respondents were informed about privacy and anonymity. Those completing the full survey were each paid a $30 incentive for their participation.
Due to disparities in how each type of HCP provides vaccines and the regulatory/professional frameworks for doing so for different types of HCPs in different regions in Canada, no direct statistical comparisons are made between professions and no attempt is made to provide an 'overall' measure for HCPs in Canada.
The original sample plan was to capture 600 completed responses, 100 each from each of six professions. For the professions surveyed using mdBriefCase, regional quotas were also set by profession. Regional quotas were initially set but subsequently removed for the professions using open link invitations, to attempt to achieve as many completions as possible. The following table shows the completions achieved by profession and sample source (mdBriefcase or open link invitation).
| Sample | Total | mdBriefcase | Open link |
|---|---|---|---|
| Unweighted n | 591 | 483 | 108 |
| Nurses (net) | 140 | 140 | - |
| - Registered nurses | 63 | 63 | - |
| - Nurse practitioners | 56 | 56 | - |
| - RPNs | 21 | 21 | - |
| GPs/family physicians | 100 | 100 | - |
| Specialists (net) | 155 | 112 | 43 |
| - Ob/gyn | 59 | 38 | 21 |
| - Pediatricians | 96 | 74 | 22 |
| Midwives | 67 | 2 | 65 |
| Pharmacists | 129 | 129 | - |
Survey respondents were screened to ensure they practice in Canada and that they administer and/or provide advice about vaccines to patients. The eligibility rate among HCPs who started the survey was 90 percent or more for each HCP type.
Environics employed regional weighting to ensure the sample is as representative of these professions as possible. The table below shows the actual number of completed surveys by region within each health profession. In most cases, the regional distribution of respondents in each profession closely matches population statistics drawn from the 2016 CIHI Health Workforce Survey and the CAM website. As a result, minimal weighting factors were used to ensure the data matched the population distribution. Since no population estimates exist for HCPs who provide vaccines or vaccine advice, the weighting targets are based upon the overall universe of HCP types (regardless of whether they provide vaccines/advice).
| Region (Unweighted) | Family Physicians | Midwives | Nurses | Pharmacists | OB-GYN | Pediatricians |
|---|---|---|---|---|---|---|
| Total | 100 | 67 | 140 | 129 | 59 | 96 |
| Atlantic | 7 | 0 | 18 | 14 | 1 | 7 |
| Quebec | 17 | 4 | 20 | 21 | 5 | 17 |
| Ontario | 45 | 46 | 54 | 41 | 34 | 41 |
| Man/Sask | 7 | 2 | 13 | 10 | 2 | 6 |
| Alberta | 13 | 4 | 18 | 20 | 7 | 15 |
| BC/Territories | 11 | 11 | 17 | 23 | 10 | 10 |
| Region (Weighted) | Family Physicians | Midwives | Nurses | Pharmacists | OB-GYN | Pediatricians |
| Total | 100 | 67 | 140 | 129 | 59 | 96 |
| Atlantic | 7 | 0 | 12 | 10 | 4 | 7 |
| Quebec | 23 | 9 | 33 | 28 | 13 | 23 |
| Ontario | 37 | 34 | 51 | 48 | 22 | 37 |
| Man/Sask | 7 | 4 | 10 | 10 | 4 | 6 |
| Alberta | 12 | 5 | 17 | 16 | 9 | 11 |
| BC/Territories | 14 | 15 | 17 | 17 | 7 | 12 |
The questionnaire was designed by Environics with input from Health Canada and PHAC representatives and academic consultants to the project. The final study questionnaire is included in Appendix C.
Environics' data analysts programmed the questionnaires, then performed thorough testing to ensure accuracy in set-up and data collection. This validation ensured that the data entry process conformed to the surveys' basic logic. The data collection system handles sampling invitations, quotas and questionnaire completion (skip patterns, branching, and valid ranges).
Prior to finalizing the survey for field, Environics conducted a pre-test (soft launch) in English and French. Due to the limited nature of the sample, PHAC accepted a smaller number of pretest completes than is normally the case. The pre-test assessed the questionnaires in terms of question wording and sequencing, respondent sensitivity to specific questions and to the survey overall, and to determine the survey length; standard Government of Canada pre-testing questions were also asked. As no changes were required following the pre-test, the n=12 responses (7 English, 5 French) have been included in the final data set.
The survey was conducted by Environics using a secure, fully featured web-based survey environment. The interviews took place from June 17 (soft launch pre-test) to September 9, 2019. The survey was left over until the morning of September 11. The average interview length was 16 minutes.
To maintain respondent confidentiality, invitations to the survey were managed by mdBriefCase (including a unique URL survey link for each respondent) and the professional associations. All respondents were offered the opportunity to complete the surveys in their official language of choice. All research work was conducted in accordance with the Standards for the Conduct of Government of Canada Public Opinion Research - Online Surveys and recognized industry standards, as well as applicable federal legislation (Personal Information Protection and Electronic Documents Act, or PIPEDA).
The completion results for the mdBriefcase portion of the survey are presented in the following table.
| Disposition | N |
|---|---|
| Total invitations (c) | 86,565 |
| Total completes (d) | 483 |
| Qualified break-offs (e) | 259 |
| Disqualified (f) | 97 |
| Not responded (g) | 83,169 |
| Quota filled (h) | 2,557 |
| Contact rate = (d+e+f+h)/c | 4% |
| Participation rate = (d+f+h)/c | 4% |
Reminder emails were sent to attempt to reach those not yet completing the survey who were sent an initial invite via mdBriefcase (MDBC), to maximize contact rate and minimize the effects of nonresponse bias. The professional associations handled reminders to their membership; Information on the number of invitations or reminders sent by the professional associations has not been provided.
The disposition of those clicking through to the survey is as follows.
| Disposition by invitation type | Total | MDBC list | Open link: Pediatricians | Open link: OB/Gyn | Open link: Midwives |
|---|---|---|---|---|---|
| Click-through A | 3,714 | 3,396 | 115 | 65 | 138 |
| - Partial completes B | 398 | 259 | 54 | 26 | 59 |
| - Terminates C | 110 | 97 | 1 | 3 | 9 |
| - Overquota D | 2,615 | 2,557 | 39 | 14 | 5 |
| Qualified completes E | 591 | 483 | 21 | 22 | 65 |
| Participation rate (C+D+E)/A | 89% | 92% | 53% | 60% | 57% |
| Incidence (E+D)/(A-B) | 97% | 97% | 98% | 92% | 89% |
Limitations of the methodological approach
The mdBriefCase panel contains more than 100,000 HCPs. In most cases the panel also appears to be regionally representative of each health care profession. We believe this research provides a broad and solid understanding of the attitudes and opinions of HCPs. However, there are some limitations to be taken into consideration when interpreting the results.
Respondent profile
This table presents the weighted distribution of survey participants by key demographic and other variables.
| Variable | Family physicians (n=100) |
Midwives (n=67) |
Nurses (n=140) |
Pharma-cists (n=129) |
OB-GYN (n=59) |
Pedia-tricians (n=96) |
|---|---|---|---|---|---|---|
| Primary place of practice - setting | ||||||
| Paediatric hospital setting | - | 1% | 3% | 1% | 5% | 28% |
| Other hospital setting | 5% | 8% | 22% | 12% | 59% | 12% |
| Family medicine clinic | 88% | 12% | 13% | 2% | 14% | 14% |
| Public Health clinic/setting | 1% | 9% | 31% | - | 3% | 2% |
| Long term care residence | 2% | - | 10% | 2% | - | - |
| Homecare setting | - | 2% | 4% | - | - | - |
| Pharmacy | - | 1% | 3% | 83% | - | - |
| School setting | 2% | - | 4% | - | - | - |
| Other | 1% | 67% | 10% | - | 20% | 43% |
| Primary place of practice - community size | ||||||
| Large (>100k) | 68% | 74% | 62% | 64% | 73% | 77% |
| Medium (30k to 100) | 15% | 9% | 23% | 21% | 23% | 19% |
| Small (1k to <30k) | 11% | 15% | 9% | 14% | 3% | 5% |
| Rural (under 1k) | 5% | 1% | 2% | 1% | - | - |
| First Nations (on-reserve) | 1% | - | 4% | - | - | - |
| Age | ||||||
| NET: <40 | 20% | 50% | 46% | 54% | 22% | 16% |
| <30 | 4% | 19% | 19% | 14% | 2% | 4% |
| 30-39 | 15% | 31% | 28% | 39% | 20% | 12% |
| NET: 40+ | 80% | 50% | 54% | 46% | 78% | 84% |
| 40-49 | 32% | 33% | 23% | 20% | 37% | 29% |
| 50-59 | 24% | 11% | 25% | 17% | 21% | 24% |
| 60+ | 24% | 6% | 5% | 10% | 20% | 31% |
Gender |
||||||
| Female | 51% | 89% | 95% | 59% | 68% | 65% |
| Male | 46% | 5% | 5% | 37% | 31% | 35% |
| Gender fluid/diverse/non-binary | 1% | 4% | - | - | - | - |
| Prefer not to answer | 1% | 2% | 0% | 5% | 1% | - |
Environics Research Group
June 10th 2019
Public Health Agency of Canada / Agence de la santé publique du Canada
Vaccine Acceptability Survey - General population
Online survey conducted with n=2,000 adult residents of Canada:
1800 gen pop plus oversample of 100 Indigenous peoples and 100 New Canadians;
15-minute average length
Please select your preferred language for completing the survey / Veuillez choisissez votre langue préféree pour remplir le sondage
01 - English / Anglais
02 - Français / French
Welcome to this survey about vaccinations. The survey is being conducted by Environics Research, an independent research company, on behalf of the Public Health Agency of Canada. The survey will take about 15 minutes of your time.
If you have any questions about the survey, please contact Environics at Brenda.sharpe@environics.ca.
< PROGRAMMING NOTE: All questions are mandatory unless otherwise indicated.>
[IF Q1=99] Would you be willing to indicate in which of the following age categories you belong?
Select one only
SEE QUOTAS
In what province or territory do you live?
Select one only
DROP DOWN LIST - SEE QUOTAS
How do you identify yourself?
Select one only - SEE QUOTAS
In what country were you born?
When did you come to Canada?
[IF Q5=01] Are you an Indigenous person, that is, First Nations, Inuk or Métis?
Select one only
Do you have children in any of the following age groups?
Select all that apply
This survey is about vaccinations (sometimes referred to as "shots") given to protect against disease.
In this next section, please imagine that you are in a doctor's office or clinic. The doctor or nurse offers you a vaccine that can be given immediately and doesn't cost you anything.
The next page will present information about two different vaccines and ask which option you would choose to receive for yourself.
These vaccines are like others available today. The name of the vaccine and the disease are not mentioned so that you can focus on other aspects of the vaccine when you make your choice.
If you wouldn't choose either of the vaccines, you can indicate that by choosing "Neither of these".
This exercise will be repeated several times with different vaccines.
It is important that you answer in the way you would if you were actually choosing which vaccine to receive. There are no right or wrong answers, so please answer according to how you feel.
Please click >> to continue
[insert page break]
If you are offered a vaccine, and these are the only options available, which ONE would you choose for yourself?
[ADD SCREEN COUNTER: '# of 10']
| Factors in Matrix | Attributes | Levels |
|---|---|---|
| Vaccine (perceptions of) | Vaccine effectiveness |
|
| Vaccine (perceptions of) | Vaccine safety |
|
| Disease (perceptions of) | Burden of disease |
|
| Disease (perceptions of) | Susceptibility to the disease |
|
(e.g. efficacy, number of injections, route of administration, safety concerns, perceived benefits)
Please indicate how much you disagree or agree with the following statements:
Randomize order 10-12
In general, vaccines are safe (5C)
In general, vaccines are an effective way to reduce the risk of disease (5C)
When everyone is vaccinated, I don't have to get vaccinated too (5C)
NO CHILDREN (Q8=04) In your lifetime, how often have you been reluctant to receive a vaccine recommended by a healthcare professional?
HAVE CHILDREN (Q8=01-03) In their lifetime, how often have you been reluctant for your child/children to receive a vaccine recommended by a healthcare professional?
Please indicate below if there are any vaccines [IF Q8=04: you are reluctant to receive]
[IF Q8=01-03: you are reluctant for your child/children to receive], for any reason.
Select all that apply
| IF Q8= 01: Vaccines for infants |
| 01 Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (DTaP-IPV-Hib) |
| 02 Diphtheria, tetanus, pertussis, hepatitis B, polio, haemophilus influenzae type B (DTaP-HB-IPV-Hib) |
| 03 Hepatitis A (HA) |
| 04 Hepatitis B (HB) |
| 05 Hepatitis A & B (HAHB) |
| 06 Measles, Mumps, Rubella (MMR) |
| 07 Measles, Mumps, Rubella, Varicella (MMRV) |
| 08 Varicella (chickenpox) |
| 09 Meningococcal |
| 10 Pneumococcal |
| 11 Rotavirus |
| 75 There are no infant vaccines I am reluctant for my child/children to receive |
| IF Q8=01-03: Vaccines for children and adolescents |
| 21 Diphtheria, tetanus, pertussis, polio (DTaP-IPV) / Tetanus, diphtheria, pertussis, polio (Tdap-IPV) |
| 22 Tetanus, diphtheria, pertussis (Tdap) |
| 23 Hepatitis A (HA) |
| 24 Hepatitis B (HB) |
| 25 Hepatitis A & B (HAHB) |
| 26 Measles, Mumps, Rubella (MMR) |
| 27 Measles, Mumps, Rubella, Varicella, (MMRV) |
| 28 Varicella (chickenpox) |
| 29 Meningococcal |
| 30 Human papillomavirus (HPV) |
| 76 There are no child/adolescent vaccines I am reluctant for my child/children to receive |
Select all that apply
| IF Q8=04: Vaccines for adults |
| 31 Tetanus, diphtheria (Td) |
| 32 Tetanus, diphtheria, pertussis (Tdap) |
| 33 Hepatitis A (HA) |
| 34 Hepatitis B (HB) |
| 35 Hepatitis A & B (HAHB) |
| 36 Shingles zoster vaccine live (Zostavax) |
| 37 Shingle recombinant zoster vaccine (Shingrix) |
| 38 Meningococcal |
| 39 Pneumococcal |
| 40 Human papillomavirus (HPV) |
| 41 Inactivated influenza |
| 42 Live attenuated influenza (LAIV) |
| 77 There are no adult vaccines I am reluctant to receive |
IF ANY vaccine at 14: What is the main reason why you are reluctant [IF Q8=01-03: for your children] to receive certain vaccines?
randomize order of 01-13
Please select only one
What would you say is the most important reason why you get vaccinated?
RANDOMIZE ORDER OF 01-05
Select only one
Are there any risks you are concerned about related to vaccination?
RANDOMIZE ORDER OF 01-04
Select up to three
(e.g. burden of illness, groups at risk, personal risk, severity)
Please indicate how much you disagree or agree with the following statements:
Randomize order 18-21
Vaccination is unnecessary because vaccine-preventable diseases are not common anymore (5C)
I get vaccinated because I can help protect people with weaker immune systems
I need to get vaccinated to protect others at home or in my workplace from getting sick
I am confident public authorities make vaccine recommendations that are in the best interests of the community
For which types of people do you believe vaccination against disease is most important?
RANDOMIZE 01-08
Select all that apply
(e.g. access to vaccine (opportunity), cost, past vaccine experience)
Personally, have you ever had a negative experience or reaction after a vaccination?
RANDOMIZE 01-03
Select all that apply
To what extent do you agree or disagree that everyday stress prevents you from getting [IF Q8=01-03: your child/children] vaccinated? (5C)
Do any of the following make it difficult or inconvenient for you to receive vaccinations?
RANDOMIZE 01-06
Select all that apply
How comfortable are you with the healthcare professional (e.g., doctor, nurse, pharmacist) who would provide vaccinations for you and your family?
How much priority do you place on protecting against vaccine-preventable diseases compared to other health issues facing you and your family?
(e.g. belief system, self-efficacy (belief in ability to get vaccinated), past vaccination behaviours, (perceived) personal health, social norms and pressures, trust in/recommendation from health care providers/experts/ industry/system)
[Q8=04] To the best of your knowledge, have you received all the vaccines required for someone your age?
[Q8=01-03] To the best of your knowledge, has your child/children received all the vaccines required for someone their age?
When a healthcare provider recommends that [IF Q8=04: you / Q8=01-03: your child/children] receive a vaccine that is newly approved for use in Canada, how likely are you to get [Q8=01-03: your child/children] vaccinated?
Is vaccination an accepted healthcare practice in your household?
[IF Q30=02] What are the main reasons why vaccination is not an accepted healthcare practice in your household?
OPEN-ENDED
To what extent do you agree or disagree with the following statements:
RANDOMIZE 32-36
People should be vaccinated to prevent the spread of disease in the community
People should not be required to get vaccinated
[IF Q8=01-03] I do not believe in vaccinating teenagers to protect against sexually transmitted infections
When I think about getting vaccinated, I weigh benefits and risks to make the best decision possible. (5C)
In general, I find medical procedures or injections [Q8=01-03: for my child/children] to be very stressful
Do you feel that you know enough about vaccination?
How much do you trust the vaccination information provided by the following:
RANDOMIZE 38-43
SHOW AS GRID, NOT CAROUSEL
Mainstream health care providers (e.g., doctors, nurses, pharmacists)
Alternative health care providers (e.g. naturopaths, homeopaths, acupuncturists, chiropractors)
Government public health organizations
Pharmaceutical companies
My family and friends
Leaders of cultural or religious groups
The following are a few questions about you, for statistical purposes only. Please be assured all of your answers will remain completely anonymous.
To the best of your knowledge, do you or does someone else living in your household, currently have or ever been diagnosed with any of the following conditions?
Select all that apply
What is the highest level of formal education that you have completed?
Which of the following categories best describes your current employment status?
Which of the following categories best describes your total household income? That is, the total income of all persons in your household combined, before taxes?
Which of the following best describes the area where you live?
Select one only
SHOW ALL: This completes the survey. On behalf of the Public Health Agency of Canada, thank you for your valuable input. In the coming months, the results of this survey will be available on the Library and Archives Canada website.
LANDING END PAGE LINK TO
ENGLISH: Canada.ca/vaccines
FRENCH: Canada.ca/vaccins
Environics Research Group
June 6, 2019
Public Heath Agency of Canada / Agence de la santé publique du Canada
Vaccine Acceptability Survey - Heath Care Professionals
Online survey conducted with n=600 health care providers:
100 each with GPs, pediatricians, OBGYNs, nurses, pharmacists and midwives;
15-minute average length
Subject line: The Public Health Agency of Canada wants to hear from you about vaccination.
Dear [CONTACT],
You are invited to participate in an online survey about vaccination, an important issue facing healthcare professionals. The survey is being conducted by Environics Research, an independent research company, on behalf of the Public Health Agency of Canada.
Participants who qualify and complete the survey will receive a $30 (CAD) Virtual Visa electronic Gift card!
The survey will take about 15 minutes to complete. You will be asked about your experiences with and opinions about vaccine practices. The survey is voluntary and your responses will be kept entirely confidential and anonymous. Your decision on whether or not to participate will not affect any dealings you may have with the Government of Canada. Please do NOT include personal information or information about specific cases in your answers to the survey questions.
If you don't have time to complete the survey in one sitting, you can return to it by clicking on the link below again. Once the survey period closes on [DATE], if you decide not to complete the entire survey, your answers will not be retained.
Please click on the following link to complete the survey:
INSERT LINK
If you have any questions about the survey, please contact Brenda Sharpe of Environics Research by phone 613-699-6886) or email (brenda.sharpe@environics.ca).
Welcome and thank you for your interest in our survey / Bienvenue et merci de l'intérêt que vous portez à ce sondage.
Please select your preferred language for completing the survey / Veuillez choisissez votre langue préféree pour remplir le sondage
01-English / Anglais
02 - Français / French
PAGE BREAK
PUT IN BOX
About this survey
If you have any questions about the survey, please contact Environics at Brenda.sharpe@environics.ca
< PROGRAMMING NOTE: All questions are mandatory unless otherwise indicated.>
In what province or territory do you practice?
Select one only
DROP DOWN LIST - SEE QUOTAS
What is your primaryprofession?
Select one only
TERMINATE IF N=100 ACHIEVED IN PROFESSION
Do you administer vaccines to, or discuss vaccines with, your patients?
For the purposes of this survey, the term "patients" means your patients or clients. If a patient is a child, please think about their parents or caregivers.
Select one only
To whom do you (IF 01 OR 03 AT Q3: administer/IF 02 AT Q3 discuss) vaccines?
Select all that apply
For approximately how many years have you been (IF 01 OR 03 AT Q3: administering vaccines?/IF O2 AT Q3: discussing vaccines with your patients?)
Select one only
(e.g. efficacy, number of injections, route of administration, safety concerns, perceived benefits)
Please indicate how much you disagree or agree with the following statements:
Randomize order
In general, vaccines are safe
In general, vaccines are an effective way to reduce the risk of disease
In general, vaccines have benefits that outweigh their risks
Canadian children are receiving too many vaccines
In your career, how often have you been reluctant to recommend a vaccine to a patient for whom it was indicated?
Please indicate below if there are any vaccines you are reluctant to recommend to patients, for any reason.
RECORD RESPONSE FOR EACH AGE GROUP ASKED ABOUT
Select all that apply
| IF Q4= 01: Vaccines for infants |
| 01 Diphtheria, tetanus, pertussis, polio, haemophilus influenzae type B (DTaP-IPV-Hib) |
| 02 Diphtheria, tetanus, pertussis, hepatitis B, polio, haemophilus influenzae type (DTaP-HB-IPV-Hib) |
| 03 Hepatitis A (HA) |
| 04 Hepatitis B (HB) |
| 05 Hepatitis A & B (HAHB) |
| 06 Measles, Mumps, Rubella (MMR) |
| 07 Measles, Mumps, Rubella, Varicella (MMRV) |
| 08 Varicella (chickenpox) |
| 09 Meningococcal |
| 10 Pneumococcal |
| 11 Rotavirus |
| 75 There are no infant vaccines I am reluctant to recommend [EXCLUSIVE] |
| IF Q4=02: Vaccines for children and adolescents |
| 21 Diphtheria, tetanus, pertussis, polio (DTaP-IPV) / Tetanus, diphtheria, pertussis, polio (Tdap-IPV) |
| 22 Tetanus, diphtheria, pertussis (Tdap) |
| 23 Hepatitis A (HA) |
| 24 Hepatitis B (HB) |
| 25 Hepatitis A & B (HAHB) |
| 26 Measles, Mumps, Rubella (MMR) |
| 27 Measles, Mumps, Rubella, Varicella, (MMRV) |
| 28 Varicella (chickenpox) |
| 29 Meningococcal |
| 30 Human papillomavirus (HPV) |
| 76 There are no child/adolescent vaccines I am reluctant to recommend [EXCLUSIVE] |
Select all that apply
| IF Q4=03/04/05/06: Vaccines for adults |
| 31 Tetanus, diphtheria (Td) |
| 32 Tetanus, diphtheria, pertussis (Tdap) |
| 33 Hepatitis A (HA) |
| 34 Hepatitis B (HB) |
| 35 Hepatitis A & B (HAHB) |
| 36 Shingles zoster vaccine live (Zostavax) |
| 37 Shingle recombinant zoster vaccine (Shingrix) |
| 38 Meningococcal |
| 39 Pneumococcal |
| 40 Human papillomavirus (HPV) |
| 41 Inactivated influenza |
| 42 Live attenuated influenza (LAIV) |
| 77 There are no adult vaccines I am reluctant to recommend [EXCLUSIVE] |
IF ANY vaccine at q11, ASK q12 ONCE: What are the main reasons why you are reluctant to recommend certain vaccines?
randomize order of 01-12
Select all that apply
What would you say are the most important benefits of vaccinations, if any?
RANDOMIZE ORDER OF 01-06
Select up to three
What would you say are the most notable drawbacks of vaccinations, if any?
RANDOMIZE ORDER OF 01-05
Select up to three
To what extent do you agree or disagree with the following statements:
RANDOMIZE ORDER OF 15-16
Administering multiple vaccines at a single visit could reduce their efficacy (RANDOMLY ADD IF Q4=01 OR 02: in children)
Administering multiple vaccines at a single visit could overwhelm the immune system (RANDOMLY ADD IF Q4=01 OR 02: of children)
Select one for each
(e.g. burden of illness, groups at risk, personal risk, severity)
How important are the following factors to you when deciding to recommend vaccinations?
RANDOMIZE ORDER OF FACTORS
If the disease is very common (i.e., most unvaccinated persons will have it during their lifetime)
If the disease is very serious (i.e., it is life-threatening and often requires hospitalization)
If the disease is very contagious/easy to contract
If the disease is likely to return or spread if people are not vaccinated against it
If there are better means of preventing the disease
If treating the disease is safer than vaccinating against it
Select one for each
In your opinion are vaccine-preventable diseases becoming more or less common in Canada, or is the rate staying about the same?
Select one
For which types of people do you believe vaccination against disease is most important?
RANDOMIZE ORDER
People with pre-existing health problems
People with compromised immune systems
Seniors age 65+
Infants and children
Pregnant women
Health care workers
Healthy adults age 18-64
New immigrants and refugees
Select one for each
(e.g. access to vaccine (opportunity), cost, past vaccine experience)
How often do you (IF Q3=01 OR 03: administer vaccines) (IF Q3=-02: discuss vaccines with your patients)?
Select one
When a new vaccine is approved for use in Canada, do you typically recommend it to all, some, a few or none of your eligible patients?
[IF Q31=01-03 OR 99] When a new vaccine is approved for use in Canada, what are the most important factors in whether you would recommend it to eligible patients?
RANDOMIZE ORDER 01-11
Select up to three
What, if anything, would prevent you from recommending a new vaccine?
Open text box - Non Mandatory
(ASK Q36-39 IF Q3=01 OR 03) To what extent are the following barriers to delivery of vaccination in your practice?
RANDOMIZE ORDER
Storing/handling requirements
Up-front costs of ordering/maintaining inventory
Inadequate reimbursement
Not giving vaccines often enough/not part of usual practice
Select one for each
(e.g. belief system, self-efficacy (belief in ability to get vaccinated), past vaccination behaviours, (perceived) personal health, social norms and pressures, trust in/recommendation from health care providers/experts/ industry/system)
To what extent do you agree or disagree with the following statements:
RANDOMIZE ORDER
Vaccination is well-accepted as a health practice by Canadians
People should be vaccinated to ensure community protection (i.e. herd immunity)
People should not be required to get vaccinated
Administering vaccines to protect adolescents against STIs could increase their likelihood of engaging in unprotected sexual activity
To what extent do you feel giving patients advice and information on vaccination is an important role for health care professionals like you to play?
How familiar do you feel you are with the current National Advisory Committee on Immunization (NACI) recommendations for vaccination in Canada?
How confident are you in your ability to do the following:
RANDOMIZE ORDER
Effectively provide information to patients about the benefits and risks of immunization
Answer patient questions about vaccination
Address the concerns of vaccine hesitant patients
Recommend vaccinations to patients
How much do you trust the vaccination information provided by the following:
RANDOMIZE ORDER
The National Advisory Committee on Immunization (NACI)
Government public health organizations
Professional organizations representing health care professionals
Pharmaceutical companies
Scientific peer-reviewed journals
My professional colleagues
Did you personally receive an influenza immunization during the 2018-2019 flu season?
The following are a few questions about you, for statistical purposes only. Please be assured all of your answers will remain completely anonymous.
What type of setting best describes your primary place of practice?
Select one only
Which of the following best describes the area where your primary place of practice is located?
Select one only
In what year were you born?
DROP DOWN LIST - 18 YEARS TO 100 YEARS AS OF 2018
How do you identify yourself?
Select one only
What are the first three digits of the postal code of your primary place of practice?
___ ___ ___
999 999 - Prefer not to answer
IF OPEN LINK COMPLETION (NON-MDBRIEFCASE):
To receive your $30 thank-you gift, please provide your name and mailing address. This information will only be used to provide you with your incentive and will not be linked to your survey responses. If you do not wish to receive a cheque, please indicate that below.
First name:
Last name:
Address Line 1:
Address Line 2:
City:
Province/territory:
Postal Code: [6 DIGITS]
X - do not want to receive an incentive
SHOW ALL: This completes the survey. On behalf of the Public Health Agency of Canada, thank you for your valuable input. In the coming months, the results of this survey will be available on the Library and Archives Canada website.
LANDING END PAGE LINK TO
ENGLISH: Canada.ca/vaccines
FRENCH: Canada.ca/vaccins
Environics Research Group. Survey of healthcare providers' views and experiences with vaccine hesitancy: final report. Public Health Agency of Canada, 2018, POR 118-16. http://epe.lac-bac.gc.ca/100/200/301/pwgsc-tpsgc/por-ef/public_health_agency_canada/2018/118-16-e/index.html
Due to an issue in the randomization programming, most HCPs saw the version with reference to children.