Seasonal Influenza Vaccination Coverage in Canada, 2019-2020

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Organization: Public Health Agency of Canada

Published: November 2020

Table of contents

This report summarizes the results from the national 2019–2020 Seasonal Influenza Vaccination Coverage Survey. Respondents were questioned regarding their influenza vaccine uptake for the 2019–2020 season, reasons for vaccination or non-vaccination, knowledge, attitudes, and beliefs (KAB) regarding vaccination, sources of information on influenza vaccine, and select demographic information. Results are described for all adults and for two sub-groups at increased risk for complications from influenza: adults aged 18–64 years with a chronic medical condition (CMC) and seniors aged 65 years and older.

Key findings

  • Overall, influenza vaccination coverage among adults (42%) was similar to the previous season (42%).
  • More females (46%) than males (37%) received the vaccine.
  • Among high-risk groups, vaccination coverage for seniors aged 65 years and older (70%) and adults aged 18–64 years with CMC (44%) remained below the national coverage goals of 80%.
  • The majority of adults received their influenza vaccine in October or November (81%).
  • The main vaccination places were pharmacies (40%) and doctor’s offices (28%).
  • The most commonly reported reason for receiving the vaccine was to prevent infection or to avoid getting sick (47%), whereas the most common reason for non-vaccination was the perception that the vaccine was not needed or not necessary (22%).
  • The most commonly reported sources of information on influenza vaccination were family physicians, Internet such as Google, health websites or blogs, and health professionals such as doctors, nurses or pharmacists.
  • The most trusted sources of information about the influenza vaccine were health professionals (nurses, doctors, and pharmacists), family physicians and Health Canada or the Public Health Agency of Canada.
  • Among the 25% of respondents who reported having seen or read information related to the influenza vaccine on the Internet or social media lately, the majority of them (78%) stated that their opinion about the influenza vaccine has not changed as a result.

Introduction

Influenza, also known as the flu, is an infection of the upper airway caused primarily by the influenza A and B viruses. Symptoms can include fever, cough, muscles aches and pains, headache, sore throat, etc.Footnote 1. It is ranked among the top 10 leading causes of death in Canada. Each year, it is estimated that influenza causes on average 12,200 hospitalizations and 3,500 deaths in CanadaFootnote 1. Though influenza viruses circulate in Canada year-round, most cases within the northern hemisphere occur between November and April.

The best way to prevent influenza and its potentially serious complications is to get vaccinated against it early in each flu season. Vaccination against influenza protects oneself and others by reducing the severity of the disease and likelihood of transmissionFootnote 2Footnote 3. It is important to get the influenza vaccine every year because the influenza virus is constantly changing, and a new vaccine is developed for each influenza season based on the circulating virus strain expected to be dominant during the flu seasonFootnote 4. It is best to receive the influenza vaccine earlier in the flu season before the virus begins spreading in the community, usually between October and December.

The National Advisory Committee on Immunization (NACI) recommends that all individuals aged six months and older receive the annual seasonal influenza vaccine, especially for populations at higher risk of influenza-related complications including:

  • Children aged 6–59 months;
  • People with certain chronic medical conditions (CMC);
  • Seniors aged 65 years and older; and
  • Pregnant womenFootnote 5.

Slightly higher than the World Health Organization (WHO) coverage goals of 75%, the Canadian national influenza vaccination coverage goals for seniors aged 65 and older and adults aged 18–64 years with CMC were set at 80% in 2017 to be reached by 2025Footnote 6Footnote 7. Measuring influenza vaccination coverage is necessary to track Canada’s progress towards its coverage goals as well as to identify under-vaccinated subpopulations and evaluate vaccination programs.

In addition to measuring influenza vaccination coverage, it is important to understand people’s KAB regarding influenza vaccination. Any element of KAB regarding influenza vaccination could serve as a barrier or facilitator to vaccinationFootnote 8. Understanding these elements can inform and improve vaccination promotion efforts in order to increase uptake within the Canadian population to achieve the coverage goals.

This year, new questions related to source of information on influenza vaccination were added to the survey in order to identify where and how Canadian adults obtained information about the influenza vaccine and which sources they trusted the most. While Internet use for information seeking is now ubiquitous, it is important to identify the actual information delivered on the Internet and social media regarding the influenza vaccine and how the information could influence their views about the vaccine.

This report summarizes results from the 2019–2020 Seasonal Influenza Vaccination Coverage Survey to estimate seasonal influenza vaccination coverage, describe KAB regarding the influenza vaccine, identify sources of information about influenza vaccine and determine factors associated with influenza vaccine uptake within the total Canadian population and risk groups.

Methodology

Survey sampling

The survey was conducted by Léger Marketing. A comprehensive description of the quantitative methodology is available elsewhereFootnote 9. Briefly, a stratified regional sampling approach was used, with survey respondents from every province and territory selected using random digit dialling of landlines and known cellphone-only household numbers.

In order to appropriately reflect the total Canadian population, sample weights were provided by Léger to adjust for region, sex, age, language (mother tongue), education, presence of minor children in the household, and whether the respondent lives in a cellphone-only household.

Data collection

Interviews were conducted between January 10 and February 18, 2020, using computer-assisted telephone interviewing (CATI) system. A total of 3,026 adults were interviewed regarding their influenza vaccine uptake for the 2019–2020 season, reasons for vaccination or non-vaccination, KAB regarding vaccination, sources of information about influenza vaccine and select demographic information. Respondents who were unsure about their influenza vaccination status (n=3) were excluded from subsequent analyses, resulting in a final analytical data set of 3,023 respondents.

Statistical analysis

Vaccination coverage was estimated as the number of survey respondents who reported they received the influenza vaccine in the 2019–2020 season, expressed as a weighted proportion of the survey respondents who provided a definitive response (i.e. reported did or did not receive the vaccine). Simple weighted proportions and 95% confidence intervals were calculated for categorical variables. Chi-squared tests with a p-value <0.05 were used to determine significant differences in vaccination coverage between genders within each age or risk group. Logistic regression was used to assess the associations between sources of information and influenza vaccine uptake. Unadjusted (OR) and adjusted (aOR) odds ratios with 95% confidence intervals were estimated.

The precision of the estimate was determined by the coefficient of variation. Estimates with a coefficient of variation from 16% to 33% indicated higher sampling error and are to be interpreted with caution. Estimates with a coefficient of variation greater than 33.3% or based on a count less than 10 were considered unreliable and therefore are not reported.

All estimates presented in this report are weighted.

Results

1. Vaccination coverage

A total of 3,026 eligible adult respondents completed the telephone interview in the 2019–2020 Seasonal Influenza Vaccination Coverage Survey. The overall response rate calculated using the Marketing Research Intelligence Association’s standard calculation method for the response rate regarding a telephone survey was 17%Footnote 9.

Overall, approximately four in ten (42%) adults aged 18 years and older reported receiving the 2019-2020 influenza vaccine. In general, influenza vaccine uptake was significantly higher in females (46%) than in males (37%, p<0.001). (Table 1.1)

Vaccination coverage was 44% among adults aged 18-64 years with CMC and 30% among adults 18-64 years of age without any CMC. The vaccination rate was highest among seniors 65 years of age and older (70%). (Table 1.1)

For adults aged 18-64 years with or without CMC, a significant difference in influenza vaccine uptake between females and males was also observed. However, this difference was not significant among seniors aged 65 years and older, which is consistent with previous studiesFootnote 10Footnote 11. (Table 1.1).

Although the national influenza vaccination coverage goal for those at high risk of influenza-related complications or hospitalization (80%) has not been achieved, vaccine uptake among seniors 65 years of age and older is approaching this goal (70%).

Table 1.1. Influenza vaccination coverage by gender and risk group
Age group (years) All Male Female p
n Vaccination Coverage,
% (95% CI)
n Vaccination Coverage,
% (95% CI)
n Vaccination Coverage,
% (95% CI)
All adults ≥18 3023 41.8 (39.7-43.9) 1320 37.2 (34.1-40.2) 1691 46.1 (43.2-49.0) <0.001Footnote *
18-64 2234 34.1 (31.8-36.5) 1005 29.8 (26.5-33.1) 1218 38.4 (35.1-41.7) <0.001Footnote * 
18-64 with CMC 668 43.6 (39.0-48.1) 268 38.3 (31.5-45.2) 397 47.9 (41.7-54.0)  0.043Footnote *
18-64 without CMC 1558 30.0 (27.3-32.7) 732 26.7 (22.9-30.5) 818 33.5 (29.6-37.3) 0.015Footnote *
≥65 789 70.3 (66.7-73.8) 315 67.2 (61.5-72.9) 473 72.7 (68.3-77.1) 0.134
n = number of respondents (unweighted).
CMC – Chronic medical condition(s).
CI – Confidence interval.
Footnote *

Significant difference between males and females (p<0.05).

Return to footnote * referrer

Note: totals do not add up to 3023 because of missing gender or CMC information.

Overall, coverage among all adults aged 18 years of age and older for the 2019–2020 flu season has not changed significantly from previous cycles of the surveyFootnote 12Footnote 13. (Figure 1.1)

Figure 1.1. Seasonal influenza vaccination coverage, by risk group and influenza season, Seasonal Influenza Vaccination Coverage Survey, Canada, 2017-2018 to 2019-2020.

Figure 1. Text equivalent follows.

Figure 1.1: Text description
Seasonal flu vaccination coverage for all adults (18+)
Flu season Percent vaccinated (%)
2017-2018 38.3
2018-2019 41.8
2019-2020 41.8
Seasonal flu vaccination coverage for age 18-64 without chronic medical conditions
Flu season Percent vaccinated (%)
2017-2018 26.5
2018-2019 30.8
2019-2020 30
Seasonal flu vaccination coverage for age 18-64 with chronic medical conditions
Flu season Percent vaccinated (%)
2017-2018 39.4
2018-2019 42.8
2019-2020 43.6
Seasonal flu vaccination coverage for seniors (65+)
Flu season Percent vaccinated (%)
2017-2018 70.7
2018-2019 69.9
2019-2020 70.3

Consistent with the previous two seasons, the proportion of vaccinated respondents was highest among seniors aged 65 years and older (70%). In contrast, vaccine uptake was lower among those aged 18–64 years with CMC (44%) and lowest in those without CMC (30%).

2. Month and place of vaccination

Seasonal influenza activity in Canada is usually low in the late spring and summer, begins to increase over the fall, and peaks in the winter. Depending on the year, the peak can occur as early as fallFootnote 5. Vaccination early in the influenza season allows time for the development of antibodies against the influenza virus. During the 2019-2020 influenza campaign, among respondents who recalled the month they received their influenza vaccination (n=1310), the majority (81%) received the vaccine in October or November 2019. (Table 2.1)

Table 2.1. Month of influenza vaccination among vaccinated respondents
Month Proportion vaccinated in this month,
% (95% CI)
September 2019 4.3 (2.9-5.6)
October 2019 38.5 (35.4-41.6)
November 2019 42.4 (39.2-45.5)
December 2019 11.4(9.3-13.5)
January 2020 3.0 (1.9-4.1)Footnote **
February 2020 0.5 (0.0-1.0)Footnote **
A total of 1310 respondents recalled the month of influenza vaccination.
CI – Confidence interval.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

Consistent with previous years, the most commonly reported places of vaccination among adults were pharmacies (40%) and doctor’s offices (28%) (Table 2.2). The proportion of respondents vaccinated in pharmacies in 2019-2020 was significantly higher than the 2016-2017 season (28%)Footnote 14. This may be due in part to the increasing number of jurisdictions allowing pharmacists to administer the influenza vaccine. It should be noted, however, that a proportion of the vaccines administered in pharmacies are given by nurses not pharmacists.

Table 2.2. Place of influenza vaccination among vaccinated respondents
Place of vaccination Proportion vaccinated by place,
% (95% CI)
Pharmacy 40.0 (36.9-43.1)
Doctor’s office 28.2 (25.3-31.1)
Workplace 8.4 (6.5-10.2)
CLSC/Community Health Centre 5.9 (4.5-7.3)
Hospital 5.2 (3.6-6.9)
Temporary vaccine clinic (i.e. at the mall) 4.2 (3.1-5.4)
Retirement residence 1.2 (0.7-1.8)Footnote **
Other 6.8 (5.2-8.5)
A total of 1,338 respondents recalled their place of influenza vaccination.
CI – Confidence interval.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

3. Reasons for vaccination

Among respondents who provided a reason for receiving the vaccine, the most commonly reported reason across all adults was that they wanted to prevent infection or avoid getting sick (47%). It was also the most common reason for having received the influenza vaccine among high-risk groups, including those aged 18–64 years with CMC (45%) and seniors (48%). (Table 3.1)

Table 3.1. Top three reasons for influenza vaccination among vaccinated respondents, by risk group
Age group (years) Reason % (95%% CI)    
All adults ≥18
(n=1338)
1. To prevent infection/don't want to get sick 46.9 (43.7-50.0)
2. Receive it yearly (no specific reason) 18.6 (16.2-20.9)
3. If I don’t, I can transmit to at-risk people (children, elderly or sick people/patients) 10.6 (8.6-12.6)
18-64 without CMC
(n=484)
1. To prevent infection/don't want to get sick 47.0 (41.6-52.3)
2. If I don’t, I can transmit to at-risk people (children, elderly or sick people/patients) 14.3 (10.5-18.1)
3. It is required in my workplace 12.3 (9.0-15.7)
18-64 with CMC
(n=312)
1. To prevent infection/don't want to get sick 44.7 (38.1-51.3)
2. At risk because of health condition 17.4 (12.5-22.3)
3. If I don’t, I can transmit to at-risk people (children, elderly or sick people/patients) 12.7 (8.1-17.2)
≥65
(n=542)
1. To prevent infection/don't want to get sick 47.9 (43.2-52.6)
2. Receive it yearly (no specific reason) 31.6 (27.2-35.9)
3. At risk because of age 11.1 (8.1-14.1)
n = number of respondents (unweighted).
CMC – Chronic medical condition(s).
CI – Confidence interval.
Note: Respondents could provide more than one reason.

Among adults aged 18-64 years with CMC, being at higher risk because of a chronic health condition was also a commonly reported reason for receiving the vaccine (17%), whereas for adults aged 18-64 years without CMC, avoid transmitting the disease to at-risk people (14%) and vaccination is required in workplace (12%) were frequently reported.

Additionally, the non-specific reason of receiving it yearly (32%) and being at risk because of age (11%) were also commonly stated for having received the influenza vaccine among seniors aged 65 years and older. This suggested that these vaccinated respondents have adopted yearly influenza vaccination as a preventive health practice, potentially recognizing their increased risk for influenza-related complicationsFootnote 15.

4. Reasons for non-vaccination

Among all survey respondents who provided a reason for not receiving the influenza vaccine this year, the most common answer among all adults was that they were healthy and/or never had the flu (21%). However, among those aged 18–64 years with CMC, not getting around to the vaccine was the most commonly provided response for not receiving the influenza vaccine (26%). Among seniors, concerns about vaccine safety was one of the common reasons for not receiving the influenza vaccine (13%). Some studies demonstrating lower effectiveness with increased safety concerns regarding influenza and other vaccines in the elderly, due to diminution in immune response, may have contributed towards this beliefFootnote 16Footnote 17. (Table 4.1)

Table 4.1. Top three reasons for not getting vaccinated for influenza
Age group (years) Reason % (95% CI)
All adults ≥18
(n=1672)
1. I am healthy, and/or never get the flu 21.3 (18.9-23.7)
2. I did not get around to it 15.0 (12.8-17.2)
3. No specific reason, just didn’t get it 14.7 (12.6-16.7)
18-64 without CMC
(n=1070)
1. I am healthy, and/or never get the flu 25.1 (21.9-28.3)
2. No specific reason, just didn’t get it 15.0 (12.4-17.6)
3. I did not get around to it 11.9 (9.7-14.2)
18-64 with CMC
(n=356)
1. I did not get around to it 25.5 (19.3-31.8)
2. No specific reason, just didn’t get it 13.6 (9.2-17.9)
3. I am healthy, and/or never get the flu 13.3 (9.0-17.5)
≥65
(n=246)
1. I am healthy, and/or never get the flu 15.6 (10.7-20.6)
2. No specific reason, just didn’t get it 14.4 (9.5-19.3) 
3. I have concerns about the flu vaccine, and/or its side effects 13.2 (8.4-18.1)Footnote **
n = number of respondents (unweighted).
CMC – Chronic medical condition(s).
CI – Confidence interval.
Note: Respondents could provide more than one reason.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

5. Knowledge, attitudes and beliefs (KAB) regarding vaccination

The 2019-2020 Seasonal Influenza Vaccination Coverage Survey included several questions collecting information about adults’ KAB regarding all vaccines in general and influenza vaccine only. The large majority of respondents (92%) strongly or somewhat agreed that vaccines are important for their health and about the same proportion thought that they know enough about vaccines to make a decision about getting vaccinated (91% strongly or somewhat agreed). (Table 5.1)

Table 5.1. Knowledge, attitudes and beliefs (KAB) regarding vaccinations
Statements n Strongly agree
% (95% CI)
Somewhat agree
% (95% CI)
Somewhat disagree
% (95% CI)
Strongly disagree
% (95% CI)
All vaccines in general:
In general, I consider vaccines to be important for my health. 3016 70.5 (68.6-72.5) 21.2 (19.4-22.9) 4.7 (3.8-5.7) 3.5 (2.7-4.3)
I know enough about vaccines to make an informed decision about getting vaccinated. 3005 61.5 (59.4-63.6) 29.3 (27.4-31.3) 6.2 (5.2-7.3) 3.0 (2.2-3.7)
Influenza vaccine:
The flu vaccine does not protect you against the flu. 2938 16.4 (14.8-18.1) 25.2 (23.3-27.1) 26.9 (25.0-28.8) 31.4 (29.4-33.5)
Sometimes you can get the flu from the flu vaccine. 2885 17.5 (15.8-19.3) 24.9 (23.0-26.8) 21.4 (19.6-23.3) 36.2 (34.1-38.2)
The flu vaccine is safe. 2940 58.7 (56.6-60.9) 29.8 (27.8-31.9) 6.5 (5.5-7.6) 4.9 (4.0-5.9)
I understand why the flu vaccine is recommended annually 2984 67.3 (65.3-69.3) 23.9 (22.0-25.8) 5.4 (4.5-6.4) 3.4 (2.6-4.1)
The opinion of my family doctor, general practitioner, or nurse practitioner is an important part of my decision when it comes to getting the flu vaccine. 2951 42.1 (40.0-44.3) 27.3 (25.3-29.3) 15.3 (13.8-16.9) 15.2 (13.7-16.8)
n = number of respondents (unweighted).
CI – Confidence interval.

Regarding influenza vaccination only, a majority (89%) of respondents strongly or somewhat believed that the flu vaccine is safe; and 91% strongly or somewhat agreed that they understand why the flu vaccine is recommended annually. However, 16% of respondents strongly believed that the flu vaccine does not protect them against the flu. About the same proportion of respondents (18%) strongly believed that they might get the flu from the flu vaccine – which is not possible for any influenza vaccine licenced in Canada. (Table 5.1)

About seven in ten respondents (69%) strongly or somewhat agreed that the opinion of their family doctor, general practitioner or nurse practitioner is an important part of their decision for getting the flu vaccine. This outcome shows that there is public trust in health care professionals and suggests that the advice provided by a health care provider, and the frequency of interaction with the health care system, may play a large role in influencing influenza vaccine uptake.

6. Sources of information on influenza vaccination

The most common source of information that the respondents would consult to keep up to date about the influenza vaccine was their own family physician. About four in ten respondents aged 18-64 years with (38%) or without CMC (42%) would seek information on the Internet such as Google and health websites or blogs. Whereas for seniors aged 65 years and older, 25% of respondents would refer to a health professional such as doctor, nurse or pharmacist, and about one in five (21%) would seek vaccine information on the Internet. The least frequently reported source of information on the influenza vaccine was newspapers or magazines (2%). (Table 6.1)

Table 6.1. Sources of information that respondents would consult to keep up to date about the influenza vaccine, by risk group
Response 18-64 years without CMC 18-64 years with CMC 65 years and older
n % (95% CI)            n % (95% CI)            n % (95% CI)           
Visiting your own family physician 758 50.6 (47.6-53.5) 350 53.0 (48.3-57.6) 489 64.6 (61.0-68.3)
On the Internet - Google, websites or blogs about health 675 42.2 (39.2-45.1) 252 37.7 (33.1-42.2) 175 20.7 (17.6-23.7)
Consult a health professional (doctor, nurse, pharmacist, etc.) 362 22.8 (20.3-25.3) 163 23.6 (19.6-27.5) 214 25.4 (22.0-28.7)
Consulting brochures or pamphlets offered by Health Canada, Public Health Agency of Canada or the provincial/territorial ministry of health on the subject 130 8.3 (6.6-10.1) 48 6.1 (4.1-8.1)Footnote ** 27 2.7 (1.6-3.9)Footnote **
A CLSC/Community Health Centre 95 6.4 (4.8-7.9) 32 5.3 (3.0-7.6)Footnote ** 36 3.8 (2.4-5.2)Footnote **
A local pharmacy 88 5.3 (3.9-6.6) 46 6.3 (4.2-8.5)Footnote ** 56 7.3 (5.2-9.3)
By consulting your family, friends or colleagues 70 4.7 (3.4-6.0) 22 3.3 (1.5-5.2)Footnote ** 28 3.1 (1.8-4.3)Footnote **
Through Info-Santé or Telehealth telephone lines, 811 74 4.2 (3.0-5.4) 29 4.0 (2.2-5.8)Footnote ** 11 1.0 (0.3-1.6)Footnote **
The media (television, radio, etc.) 64 4.2 (3.0-5.3) 32 4.8 (2.8-6.8)Footnote ** 61 7.1 (5.2-9.0)
Health Canada / Government websites 70 4.1 (3.0-5.2) 31 3.7 (2.0-5.3)Footnote ** 6 Footnote ***
On social media (Facebook, Twitter or other) 49 3.3 (2.2-4.4)Footnote ** 17 2.4 (1.0-3.9)Footnote ** 18 2.2 (1.1-3.2)Footnote **
Directly at the hospital - at the emergency 33 2.3 (1.3-3.2)Footnote ** 12 2.0 (0.4-3.5)Footnote ** 4 Footnote ***
Newspapers / magazines 26 1.5 (0.8-2.2)Footnote ** 12 1.9 (0.6-3.2)Footnote ** 36 4.6 (3.0-6.2)Footnote **
Another source 174 11.4 (9.5-13.3) 74 11.0 (7.9-14.1) 59 6.4 (4.6-8.1)
n = number of respondents (unweighted).
CMC – Chronic medical condition(s).
CI – Confidence interval.
Note: Respondents could provide more than one source of information.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

Footnote ***

Coefficient of variation >33%; the estimate is too unreliable to be published.

Return to footnote *** referrer

Whether adults get vaccinated against influenza due to consulting these sources of information is important for identifying potential effective communication strategies to promote influenza vaccination. Among adults who would consult their family physician (n=752) or other health professional (n=358), 45% of them received the influenza vaccine. After adjusting the age, gender and the level of education, seeking information on the influenza vaccine by visiting their family physician or other health professional was significantly associated with vaccine uptake. Moreover, respondents seeking information on government websites had twice the odds of reporting being vaccinated against influenza, compared with those that did not consult this source of information (aOR 2.0; 95% CI 1.3–3.0). However, the odds of receiving the influenza vaccine for respondents who would consult their friends or seek information through Telehealth were 0.5 times the odds of those who did not consult these sources of information (aOR 0.5; 95% Cl 0.3–0.8). (Table 6.2)

Table 6.2. Association between each source of information that respondents would consult and influenza vaccine uptake among all adults
Sources of information n Proportion of vaccinated adults
% (95% CI)                
Unadjusted OR
% (95% CI)
AdjustedFootnote OR
% (95% CI)    
Health Canada / Government websites. 56 51.1 (39.3-62.8) 1.6 (1.0-2.4) 2.0 (1.3-3.0)
Visiting your own family physician. 752 45.0 (42.1-47.9) 1.4 (1.2-1.6) 1.2 (1.1-1.5)
Consult a health professional (doctor, nurse, pharmacist, etc.). 358 45.0 (40.7-49.3) 1.3 (1.1-1.6) 1.3 (1.1-1.5)
On the Internet - Google, websites or blogs about health. 438 36.0 (32.6-39.4) 0.8 (0.6-0.9) 0.9 (0.8-1.1)
Newspapers / magazines. 38 48.7 (35.6-61.8) 1.3 (0.8-2.2) 1.0 (0.6-1.6)
A local pharmacy. 88 44.2 (35.8-52.6) 1.5 (1.0-2.0) 1.3 (0.9-1.8)
The media (television, radio, etc.). 84 47.1 (38.0-56.3) 1.3 (0.9-1.8) 1.2 (0.8-1.7)
Consulting brochures or pamphlets offered by Health Canada, Public Health Agency of Canada or the provincial/territorial ministry of health on the subject. 92 39.2 (31.1-47.2) 1.1 (0.8-1.5) 1.3 (1.0-1.8)
On social media (Facebook, Twitter or other). 31 36.7 (24.3-49.1)Footnote ** 1.1 (0.7-1.8) 1.2 (0.8-2.0)
A CLSC/Community Health Centre. 67 33.1 (24.5-41.6) 0.9 (0.6-1.3) 0.9 (0.6-1.3)
Directly at the hospital - at the emergency. 17 32.9 (16.9-48.9)Footnote ** 1.1 (0.6-2.0) 1.3 (0.7-2.5)
By consulting your family, friends or colleagues. 38 25.1 (16.3-33.9)Footnote ** 0.5 (0.3-0.8) 0.5 (0.3-0.8)
Through Info-Santé or Telehealth telephone lines, 811. 29 22.2 (12.5-31.9)Footnote ** 0.4 (0.2-0.7) 0.5 (0.3-0.8)
Another source. 140 41.0 (34.2-47.8) 1.0 (0.8-1.2) 1.1 (0.8-1.4)
n = number of vaccinated respondents (unweighted) who would consult each source of information on influenza vaccine.
CI – Confidence interval.
Footnote †

Adjusted for age, gender and level of education.

Return to footnote referrer

Note: Respondents could provide more than one source of information.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

The majority of respondents trusted the sources of information provided by health professionals such as nurses, doctors and pharmacists, their own family physician, and Health Canada or the Public Health Agency of Canada. Moreover, 73% of adults aged 18-64 years with or without CMC trusted vaccine information from telephone lines such as Telehealth, 811 and Info-santé; whereas 48% of senior respondents (aged 65 years and older) believed the information provided on these telephone lines. Less than half of the respondents believed the information read on the Internet (48% among adults 18-64 years without CMC, 44% among adults 18-64 years with CMC and 32% among seniors 65 years and older). Personal testimonies read on the web or social media was the least trusted source across all risk groups (16% among adults 18-64 years without CMC, 15% among adults 18-64 years with CMC and 11% among seniors 65 years and older). (Table 6.3)

Table 6.3. Sources of information about the influenza vaccine that respondents would trust, by risk group
Response 18-64 years without CMC 18-64 years with CMC 65 years and older
n % (95% CI)          n % (95% CI)          n % (95% CI)         
Health professionals (nurses, doctors, pharmacists) 1466 94.5 (93.1-95.9) 638 94.7 (92.3-97.1) 738 93.7 (91.7-95.7)
Your own family physician 1438 94.1 (92.8-95.4) 625 95.0 (92.9-97.1) 744 96.7 (95.3-98.0)
Health Canada or Public Health Agency of Canada 1412 91.2 (89.5-92.9) 595 90.2 (87.3-93.0) 623 80.1 (76.8-83.3)
Info-Santé telephone lines, Telehealth, 811 1067 72.8 (69.9-75.6) 461 72.7 (68.2-77.2) 337 47.6 (43.4-51.9)
Your family, friends or colleagues 807 54.5 (51.5-57.4) 302 48.7 (44.0-53.5) 306 41.2 (37.2-45.1)
Internet (Google, websites or blogs about health) 702 47.9 (44.9-51.0) 286 44.3 (39.5-49.0) 240 31.8 (28.0-35.5)
Alternative health practitioners such as chiropractors, naturopath and homeopath 664 46.6 (43.6-49.7) 243 40.0 (35.2-44.7) 191 26.4 (22.8-29.9)
Personal testimonies read on the web or social media 225 15.7 (13.4-17.9) 87 14.5 (11.1-17.9) 81 11.0 (8.5-13.5)
n = number of respondents (unweighted).
CMC – Chronic medical condition(s).
CI – Confidence interval.
Note: Respondents could provide more than one source of information.

In total, about one quarter of respondents (25%) reported that they had seen or read something regarding the influenza vaccine on the Internet or social media lately. Furthermore, 19% of them stated that they had encountered the information on the reason to get vaccinated against influenza. 17% of respondents had seen or read about the benefits of getting vaccinated as well as the risks associated with vaccination. About 14% of respondents had read about the reasons for not getting vaccinated against influenza. About the same proportion of respondents had read information related to vaccination advertising campaigns (13%) and only 5% had seen information related to places to get vaccination. (Table 6.4)

Table 6.4. Information that respondents have seen or read about the influenza vaccine on the Internet or social media lately
Response % (95% CI)
Reasons to get vaccinated 19.2 (16.1-22.4)
The benefits of getting vaccinated 16.7 (13.6-19.8)
Risks associated with vaccination 16.6 (13.2-20.0)
Reasons for not getting vaccinated 13.6 (10.6-16.5)
Advertising campaigns on vaccination 13.1 (10.1-16.1)
Places to get vaccinated 5.4 (3.3-7.5)Footnote **
Other 45.7 (41.4-50.1)
A total of 730 respondents reported having seen or read information about the influenza vaccine on the Internet or social media lately.
CI – Confidence interval.
Note: Respondents could provide more than one type of information read on the Internet or social media.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

The majority of respondents (78%) stated that their opinion about the influenza vaccine has not changed after reading the information on the Internet or on social media. Only about 12% of respondents trusted the vaccine much more or somewhat more than before, and 9% were more or much more concerned about getting the flu vaccine. (Table 6.5)

Table 6.5. The influence of information read on the Internet or social media on respondents’ views about the influenza vaccine
Response % (95% CI)
You trust the flu vaccine much more than before 6.7 (4.2-9.2)Footnote **
You trust the flu vaccine somewhat more than before. 5.5 (3.6-7.5)Footnote **
Your opinion of the flu vaccine has not changed 78.4 (74.7-82.2)
You are more concerned about the flu vaccine than before 4.0 (2.3-5.7)Footnote **
You are much more concerned about the flu vaccine than before 5.3 (3.2-7.4)Footnote **
A total of 730 respondents reported having seen or read information about the influenza vaccine on the Internet or social media lately.
CI – Confidence interval.
Footnote **

Coefficient of variation >16%; therefore, estimates should be interpreted with caution due to a higher level of error.

Return to footnote ** referrer

According to the results shown in table 6.5, it seems that the influenza vaccine related messages on social media has slight impact on respondents’ views about the influenza vaccine. This finding is consistent with a recent survey conducted in the United States where they found that only consulting social media may not influence individual vaccination behavioursFootnote 18. Another study has also shown that the general population might chose sites that generally agree with their views. As a result, attitudes and beliefs towards influenza vaccination were not greatly influenced by social mediaFootnote 19.

Strengths and limitations

The major strength of this survey was the timely reporting of seasonal influenza vaccination coverage across Canada. The timeliness of this survey allows Canada to meet its international reporting obligations and help identify priorities for future vaccination program planning and promotion campaigns.

Additionally, the Seasonal Influenza Vaccination Coverage Survey is flexible in allowing question modules to be added or removed on an annual basis in light of changing priorities.

Though consistent with previous iterations of the surveyFootnote 12Footnote 13, limitations of the present survey included the relatively low response rate of 17%, below the 45% achieved by similar surveys in the USAFootnote 20. This response rate can potentially increase the risk of non-response bias and limits the representativeness of the sample, as respondents included in the survey may differ from those who chose not to complete the survey.

Furthermore, participants were interviewed within six months of the beginning of the seasonal influenza vaccination campaign, which limits the potential for recall bias and may lead to an under or over-estimation of vaccine uptake. However, some studies have shown that self-reported influenza vaccination status is a valid measure of vaccine exposure when medical records or registry data are not availableFootnote 21Footnote 22.

It is also important to consider that respondents could interpret the provided choices of sources of information on influenza vaccine differently. For instance, of two respondents browsing the Twitter feed of one organization, one may list Twitter as a source of information whereas the other one may list the name of the organization. Moreover, for those who consulted information on the Internet and social media, the information could had been shared from other sources such as government websites, electronic brochures, etc.

Conclusion

Adult influenza vaccination coverage estimated from the 2019-2020 Seasonal Influenza Vaccination Coverage Survey has remained similar to previous influenza seasons. Moreover, the national vaccination coverage goals (80%) for those who are at increased risk for influenza-related complications, namely seniors and adults 18–64 years of age with CMC, remain unmet. According to the results of this survey, vaccine uptake was well below the national goal among adults 18–64 years with CMC (44%). However, vaccine uptake among seniors 65 years of age and older (70%) is approaching the coverage goal of 80%. The most common reported reasons for vaccination was to prevent infection or to avoid getting sick, whereas the most common reason for non-vaccination was the perception that they were healthy or never had flu.

According to the findings of the survey, the most commonly reported sources of information about influenza vaccine were family physicians and health professionals such as doctors, nurses or pharmacists. Previous studies have found that receiving a recommendation from a health care provider to get the influenza vaccine to be a significant factor associated with vaccine uptake in adultsFootnote 23Footnote 24. Thus, primary health care providers play a key role in driving vaccine acceptance, dispelling the vaccine-related myths and encouraging vaccination uptake.

Overall, this report highlighted the need for increasing influenza vaccine uptake in Canada as a whole, and among its high-risk populations. Promotional messaging on the Internet or social media for the influenza vaccine remains an important strategy in increasing knowledge regarding the benefits of influenza vaccination in addition to encouraging greater vaccination uptake.

References

Footnote 1

Public Health Agency of Canada. Flu (influenza): For health professionals. 2019; Available at: https://www.canada.ca/en/public-health/services/diseases/flu-influenza/health-professionals.html#a8.

Return to footnote 1 referrer

Footnote 2

Arriola C, Garg S, Anderson EJ, Ryan PA, George A, Zansky SM, Bennett N, Reingold A, Bargsten M, Miller L, Yousey-Hindes K. Influenza vaccination modifies disease severity among community-dwelling adults hospitalized with influenza. Clinical Infectious Diseases. 2017.15;65(8):1289-97.

Return to footnote 2 referrer

Footnote 3

Castilla J, Godoy P, Domínguez Á, Martínez-Baz I, Astray J, Martín V, Delgado-Rodríguez M, Baricot M, Soldevila N, Mayoral JM, Quintana JM. Influenza vaccine effectiveness in preventing outpatient, inpatient, and severe cases of laboratory-confirmed influenza. Clinical infectious diseases. 2013. 15;57(2):167-75.

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Footnote 4

Petrova VN RC. The evolution of seasonal influenza viruses. Nature Reviews Microbiology 2017.16:47.

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Footnote 5

National Advisory Committee on Immunization (NACI). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2019–2020. An Advisory Committee Statement (ACS) National Advisory Committee on Immunization (NACI). 2019; Available at: https://www.canada.ca/en/public-health/services/publications/vaccines-immunization/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2019-2020.html.

Return to footnote 5 referrer

Footnote 6

World Health Organization. WHA56.19: Prevention and control of influenza pandemics and annual epidemics. 2003; Available at: https://www.who.int/immunization/sage/1_WHA56_19_Prevention_and_control_of_influenza_pandemics.pdf.

Return to footnote 6 referrer

Footnote 7

Public Health Agency of Canada. Vaccination Coverage Goals and Vaccine Preventable Disease Reduction Targets by 2025. 2019; Available at: https://www.canada.ca/en/public-health/services/immunization-vaccine-priorities/national-immunization-strategy/vaccination-coverage-goals-vaccine-preventable-diseases-reduction-targets-2025.html.

Return to footnote 7 referrer

Footnote 8

Nowak GJ, Sheedy K, Bursey K, Smith TM, Basket M. Promoting influenza vaccination: Insights from a qualitative meta-analysis of 14 years of influenza-related communications research by U.S. Centers for Disease Control and Prevention (CDC). Vaccine. 2015. 33(24):2741–2756.

Return to footnote 8 referrer

Footnote 9

Léger. Seasonal Influenza Vaccination Coverage Survey, 2019–2020. 2020.

Return to footnote 9 referrer

Footnote 10

Roy M, Sherrard L, Dubé È, Gilbert NL. Determinants of non-vaccination against seasonal influenza. Health Reports. 2018;29:13–23.

Return to footnote 10 referrer

Footnote 11

Farmanara N, Sherrard L, Dubé È, Gilbert NL. Determinants of non-vaccination against seasonal influenza in Canadian adults: findings from the 2015–2016 Influenza Immunization Coverage Survey. Canadian Journal of Public Health. 2018;109(3):369-78.

Return to footnote 11 referrer

Footnote 12

Public Health Agency of Canada. Vaccine uptake in Canadian Adults 2019. 2019; Available at: https://www.canada.ca/en/public-health/services/publications/healthy-living/2018-2019-influenza-flu-vaccine-coverage-survey-results.html.

Return to footnote 12 referrer

Footnote 13

Public Health Agency of Canada. 2017/18 Seasonal Influenza Vaccine Coverage in Canada. 2019; Available at: http://publications.gc.ca/collections/collection_2019/aspc-phac/HP40-198-2018-eng.pdf.

Return to footnote 13 referrer

Footnote 14

Public Health Agency of Canada. 2016/17 Seasonal Influenza Vaccine Coverage in Canada. 2018; Available at: http://publications.gc.ca/collections/collection_2018/aspc-phac/HP40-198-2017-eng.pdf.

Return to footnote 14 referrer

Footnote 15

World Health Organization. Barriers of influenza vaccination intention and behavior—A systematic review of influenza vaccine hesitancy 2005–2016. 2016:10.

Return to footnote 15 referrer

Footnote 16

Schmid P, Rauber D, Betsch C, Lidolt G, Denker M. Barriers of influenza vaccination intention and behavior—A systematic review of influenza vaccine hesitancy, 2005–2016. PloS one 2017; 12(1):e0170550.

Return to footnote 16 referrer

Footnote 17

Amanna IJ. Balancing the Efficacy and Safety of Vaccines in the Elderly. Open Longevity Science. 2012;6(2012):64.

Return to footnote 17 referrer

Footnote 18

Ahmed N, Quinn SC, Hancock GR, Freimuth VS, Jamison A. Social media use and influenza vaccine uptake among White and African American adults. Vaccine. 2018 Nov 26;36(49):7556-61.

Return to footnote 18 referrer

Footnote 19

Giese H, Neth H, Moussaïd M, Betsch C, Gaissmaier W. The echo in flu-vaccination echo chambers: Selective attention trumps social influence. Vaccine. 2020;38(8):2070-6.

Return to footnote 19 referrer

Footnote 20

Centers for Disease Control and Prevention. The Behavioral Risk Factor Surveillance System 2017: Summary Data Quality Report. 2018; Available at: https://www.cdc.gov/brfss/annual_data/2017/pdf/2017-sdqr-508.pdf.

Return to footnote 20 referrer

Footnote 21

King JP, McLean HQ, Belongia EA. Validation of self-reported influenza vaccination in the current and prior season. Influenza Other Respi Viruses 2018 07/20; 2018/08;0(0).

Return to footnote 21 referrer

Footnote 22

Laurence A, Lewis P, Gately C, Dixon A. Influenza and pneumococcal vaccination: do older people know if they have been vaccinated?. Aust N Z J Public Health 2016;40(3):279-280.

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Footnote 23

Jasek JP. Having a primary care provider and receipt of recommended preventive care among men in New York City. American journal of men’s health, 2011; 5(3), 225-235.

Return to footnote 23 referrer

Footnote 24

Nichol, K. L., Mac Donald, R., & Hauge, M. Factors associated with influenza and pneumococcal vaccination behavior among high-risk adults. Journal of General Internal Medicine, 1996;11(11), 673-677.

Return to footnote 24 referrer

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