In a recent article published in The Lancet Regional Health – Americas, CITF-funded researcher Dr. Prabhat Jha and his Action to beat Coronavirus (Ab-C Study) team estimated 9% of Canadians would refuse a COVID-19 vaccine and the authors identified key populations to work with to improve vaccine acceptance.

Between January and March 2021, the Ab-C study team recruited a nationally representative sample of 14,621 Canadians to complete an online survey conducted by Angus Reid, an established online public opinion community. The respondents were deemed demographically comparable to the Canadian population in terms of age, gender, and household size, with the exception of the proportion of the Indigenous group (8.9% in the Ab-C study and 5% in Canada) and education level (43% bachelor’s degree or higher in Ab-C compared to 23% in Canada). Education levels were adjusted for in analyses to achieve the same distribution as captured in the most recent Canadian census.

The study captured the percentage of the study group who reported they would refuse a COVID-19 vaccine. The results do not include the percentage of Canadians who may be undecided: vaccine hesitant respondents were defined as choosing “No” to the survey question “when a vaccine against the coronavirus becomes available to you, will you get vaccinated or not?”. It is important to note that the survey was conducted prior to the widespread availability of vaccines.

Key findings:

  • 9% of Canadians in this sample would refuse a COVID-19 vaccine, which translates to the equivalent of 3 million people, suggesting millions of Canadians would remain vulnerable to ongoing outbreaks of COVID-19.
  • Identified factors related to greater vaccination refusal among study participants included living in Alberta, being aged 40-59, self-identifying as a visible minority, having some college level education or lower, or living in a household of at least five people.

Vaccine hesitancy is recognized as one of the biggest threats to controlling the spread of SARS-CoV-2 in Canada and globally. The spectrum of vaccine hesitancy refers to a delay in vaccine acceptance or an outright refusal of vaccines. Previous research has indicated that vaccine hesitancy is complex and can be influenced by an array of factors. In the context of the COVID-19 pandemic, vaccine hesitancy is detrimental in the ability of communities to reach high vaccine coverage, thus postponing the end of the ongoing crisis. The authors suggest that in partnership with the vaccination rollout, policymakers should engage with the groups identified as high risk for vaccine hesitancy to provide education, support, and resources.


Tang, X., Gelband, H., Nagelkerke, N., Bogoch, I.I., Brown, P., Morawski, E., Tam, T., 2021. COVID-19 vaccination intention during early vaccine rollout in Canada: a nationwide online survey. The Lancet Regional Health – Americas 100055. doi: 10.1016/j.lana.2021.100055