Childhood COVID-19 Immunization Coverage Survey (CCICS): 2022 results

On this page

• Introduction
• Key results
• Summary
• Considerations and limitations

Introduction

The Childhood COVID-19 Immunization Coverage Survey (CCICS) is a new annual survey conducted by the Public Health Agency of Canada to measure the proportion of children in Canada who have received a COVID-19 vaccine and/or a seasonal influenza vaccine during the 2021–2022 influenza season (September to March). The survey is given to parents or guardians of children younger than 18 years of age.

In Canada, the COVID-19 vaccine is recommended for children and youth 6 months to 17 years. Canada authorized the use of COVID-19 vaccines at varying times, for different age groups, as more data became available. At the time of data collection for this survey, COVID-19 vaccines for children 6 months to 4 years were not yet authorized, but vaccine coverage in this age group will be measured in future survey cycles.

The influenza vaccine is recommended to every Canadian 6 months of age and older. Children 6 months to 9 years of age who have never had the influenza vaccine should receive two doses of the vaccine, given at least four weeks apart. Those who have had one or more doses of the influenza vaccine in the past or children 9 years of age or older should only receive one dose per year.

Children and youth with underlying medical conditions or those who are immunocompromised are at an increased risk for severe disease or complications due to COVID-19 or influenza; therefore, monitoring vaccine coverage is important to ensure adequate protection and vaccine access for children.

CCICS provides key information about COVID-19 and seasonal influenza (flu) vaccine coverage among children, and the circumstances around vaccination. The aim of the CCICS is to:

• Measure COVID-19 and seasonal influenza vaccine coverage among children in Canada younger than 18 years of age who are eligible for vaccination
• Determine parental knowledge, attitudes, and beliefs towards their children's COVID-19 and influenza vaccination status including vaccine hesitancy and refusal
• Determine parental intentions to vaccinate children who were not eligible for vaccination at the time of data collection or who were eligible but had not yet been vaccinated
• Determine barriers to vaccination
• Determine parental vaccine coverage for COVID-19 and the seasonal Influenza (flu) vaccines

COVID-19 vaccine coverage estimates were collected for children 5 to 17 years of age since they were eligible for vaccination when data collection for this survey started (April 2022). Influenza vaccination coverage estimates were collected for children 6 months and older at the time of data collection; this was shortly after the influenza season ended.

Detailed results tables and the methodological report are published on the Library and Archives Canada website. The following summary presents survey findings from the first cycle of data collection, which started on April 20th, 2022 and ended on July 21st, 2022. All differences noted are significant at the 5% level.

Key results

COVID-19 vaccine coverage among children

The 2022 Childhood COVID-19 Immunization Coverage Survey (CCICS) found that among children 5–17 years of age:

• 81% had received at least one dose of a COVID-19 vaccine approved for use in Canada (Table 1).
• Of these, 8% had received only one dose, 75% received two doses, and 17% received three or more doses. 74% of children 5–11 years and 90% of children 12–17 years received at least one dose of a COVID-19 vaccine.
• No major differences were seen between females and males who received at least one dose of a COVID-19 vaccine (82% and 81%, respectively).
• Provincial/territorial coverage estimates for at least one dose of a COVID-19 vaccine among children 5–17 years ranged from 75% in Alberta to 93% in Newfoundland and Labrador and Nunavut.
• Ethnicity and Indigenous identity: Vaccine coverage among children 5–17 years of age across various ethnicities was 74% or above for at least one dose of COVID-19 vaccine. It was highest among those identifying as East/Southeast Asian (89%), followed by South Asian descent (88%), Latin American (86%), white European descent (83%), Middle Eastern and North African (76%), and Black (African, Afro-Caribbean, and African descent (76%). Vaccine coverage was 74% among those identifying as Indigenous (First Nations, Métis or Inuit), while 69% of those identifying as First Nations, 78% identifying as Métis and 97% identifying as Inuit received at least one dose of a COVID-19 vaccine.
• Rural/urban: More children 5–17 years of age living in an urban area received at least one dose of a COVID-19 vaccine (83%) compared to those living in a rural area (72%).
• Routine immunization coverage: Parents/guardians who reported that their 5 to 17 year old child had received all recommended routine childhood vaccinations were more likely to report their child received at least one dose of a COVID-19 vaccine (84%), compared to those who received some routine vaccinations (55%) and those who did not receive any routine vaccinations (45%).
• Medical conditions/disability: No major differences were seen among children 5–17 years of age that had a pre-existing medical condition (83%) compared to those that did not have a medical condition (81%) for receiving at least one dose of a COVID-19 vaccine. Similarly, no major differences were seen between children that had a disability (82%) compared to those who did not have a disability (81%).

Table 1. Percent of children in Canada who have received a COVID-19 vaccine by sex, age group and number of doses

Demographic	At least 1 dose	1 dose	2 doses	3 or more doses
Females	82%	8%	74%	18%
Males	81%	8%	77%	15%
5–11 years	74%	14%	85%	1%
12–17 years	90%	2%	66%	32%

• Intent to vaccinate: Parents/guardians of children 5 to 17 years, who had not yet received a COVID-19 vaccine and parents of children less than 5 years who were not yet eligible for COVID-19 vaccination at time of data collection, were asked about their level of intent to vaccinate their child in the future. Overall, 30% reported they definitely will vaccinate their child against COVID-19 in the future and 13% said they probably will (Figure 1).
• The younger the child, the higher was parental intention to vaccinate their child in future; 60% of parents of children less than 5 years of age indicated that they intend to vaccinate their child once the child becomes eligible for vaccination compared to parents of 5–11 and 12–17 year olds whose child did not receive a COVID-19 vaccine (11% and 5%, respectively).
• More specifically, 43% of parents/guardians of children less than 5 years of age indicated they definitely will vaccinate their child once the child becomes eligible for a COVID-19 vaccine, while 22% indicated they definitely won't.
• 56% of parents/guardians of 5–11 year olds and 79% of parents/guardians of 12–17 year olds who had not received a COVID-19 vaccine indicated they definitely won't get a COVID-19 vaccine.
• Parents/guardians' level of intention to vaccinate their child, 0–17 years of age, in the future ranged across the provinces and territories; 45% of parents/guardians in Newfoundland and Labrador indicated they will definitely vaccinate their child, compared to 24% in Quebec.

Figure 1: Text description

Parents/guardians' intention to vaccinate child, 0–17 years of age, against COVID-19 in the future

Level of intention to vaccinate against COVID-19	Overall (%)	Parents of 0–4 years (%)	Parents of 5–11 years (%)	Parents of 12–17 years (%)
Definitely willFootnote a	30	43	5	Not reportableFootnote b
Probably willFootnote a	13	17	7	Not reportableFootnote b
Probably won'tFootnote a	14	11	24	13
Definitely won'tFootnote a	36	22	56	79
Don't knowFootnote a	7	7	9	4
Footnote a Significant differences by age group (p<0.05). Return to footnote a referrer Footnote b Not reportable due to high sampling variability or small sample size. Estimates may not sum to 100% due to rounding. Return to footnote b referrer

Parental reasons for COVID-19 vaccination or non-vaccination of their child

• According to parents/guardians of children 5–17 years of age the most common reason for getting their child a COVID-19 vaccine was to protect the child and/or household members against COVID-19 infection (76%), followed by preventing the spread of COVID-19 in the community (60%), to help restore a more normal life (59%) and based on public health recommendations (59%).
• The most common reason for not getting a COVID-19 vaccine was vaccine refusal^{Footnote 1} (72%; 60% of parents/guardians decided not to vaccinate their child and 12% indicated their child decided not to get a vaccine) followed by vaccine hesitancy^{Footnote 2} (22%; 19% of parents/guardians were hesitant to vaccinate their child and 3% indicated their child was hesitant to get vaccinated).
• More parents/guardians of females decided not to vaccinate their child (62%) compared to parents/guardians of males (58%).
• Vaccine refusal was higher among parents/guardians of children belonging to younger age groups; more parents/guardians of children 5–11 years of age decided not to vaccinate their child against COVID-19 (62%) compared to 54% of parents of 12–17 year olds.
• Obstacles to COVID-19 vaccination: The majority (88%) of parents/guardians of unvaccinated 5 to 17 year olds indicated they did not face any obstacles. Among those who reported facing an obstacle, 30% reported their child fears needles and 16% reported it was difficult to book time off work/school for the appointment.

COVID-19 vaccine hesitancy^{Footnote 2} and refusal^{Footnote 1}

Parents/guardians of children younger than 18 years of age were asked if they were ever hesitant about the COVID-19 vaccine for their child, regardless of whether the child got a COVID-19 vaccine or not.

Overall, 43% of parents/guardians of all children below 18 years of age indicated they were hesitant about the COVID-19 vaccines, regardless of their child's vaccination status. There were some differences between groups:

• Hesitancy ranged in the provinces/territories from 14% in Nunavut to 48% in Alberta;
• In general, there were no major differences among parents/guardians of males (44%) compared to parents/guardians of females (42%);
• More parents/guardians of children 0–4 years of age (48%) were hesitant regarding the COVID-19 vaccine compared to parents/guardians of children 5–11 (45%) or 12–17 years of age (36%).

The most common reason for hesitancy reported by parents/guardians was that not enough research on the vaccine has been done in children (65%), followed by concerns about the safety of COVID-19 vaccines and/or side effects (62%) and concerns about the effectiveness (39%).

As previously noted, 60% of parents/guardians indicated they decided not to vaccinate their child against COVID-19, and there were some differences by sex and age group:

• More parents/guardians of females (62%) decided not to vaccinate their child against COVID-19 compared to parents/guardians of males (58%);
• More parents/guardians of children 5–11 years (62%) decided not to vaccinate their child against COVID-19 compared to parents/guardians of children 12–17 (54%);
• Provincial/territorial differences in parents/guardians deciding not to vaccinate their child ranged from 57% in Ontario to 69% in Alberta and New Brunswick.

The most common reason for refusal reported by parents/guardians was concerns about the safety of COVID-19 vaccines and/or side effects (66%), followed by concerns that not enough research on the vaccines has been done in children (55%) and concerns about the effectiveness (50%).

Source of information

• Parents/guardians of children younger than 18 years of age were asked what their most trusted source of information related to COVID-19 vaccines was. The most trusted source of information reported was health care providers (42%), followed by Public Health Agency of Canada/Health Canada (27%), international sources such as the World Health Organization (6%), and local public health units/clinics (6%).

Seasonal influenza vaccine coverage among children

• Overall, 30% of children 6 months to 17 years received the influenza vaccine during the 2021–2022 influenza season (Figure 2).
• There were no differences by sex. But in terms of age group, more children 6 months–4 years (40%) received their influenza vaccine in the 2021–22 influenza season compared to 5–11 (29%) or 12–17 year olds (24%).
• Provincial/territorial coverage estimates among children 6 months–17 years ranged from 13% in Quebec to 50% in Northwest Territories and Nunavut.
• In 2021–2022, most provinces and territories, with the exception of Quebec, had publicly funded influenza vaccines for all children 6 months and older. Only children with certain chronic medical conditions as well as children on long-term acetylsalicylic acid (ASA) were eligible for publicly funded influenza vaccine in Quebec.^{Footnote 3} This may help explain some of the variations seen across jurisdictions. More recently, in November 2022, Quebec announced publicly funded influenza vaccines for everyone 6 months and older.^{Footnote 4}
• Rural/urban: More children 5–17 years of age living in an urban area received the influenza vaccine in the 2021–22 influenza season (31%) compared to those living in a rural area (22%).
• Ethnicity: Influenza vaccine coverage among children 6 months to 17 years of age across various ethnicities was highest among East/Southeast Asians (37%), followed by those of South Asian descent (34%), Indigenous people (33%), white European descent (31%), Middle Eastern and North African (29%), Latin American (27%), and Black (African, Afro-Caribbean, and African descent) (15%). Among those that identified as Indigenous, 28% of those identifying as First Nations, 35% identifying as Métis and 43% identifying as Inuit received their influenza vaccine this season.
• Medical conditions/disability: Overall, more children 6 months–17 years of age who had a pre-existing medical condition received their influenza vaccine this season (36%) compared to those who did not have a medical condition (29%). Contrary, no major differences were seen between children who had a disability (28%) compared to those who did not have a disability (30%).

Figure 2: Text description

Seasonal influenza vaccine coverage among children 6 months–17 years of age, by sex and age group

Demographic	Overall (%)	Males (%)	Females (%)	6 months–4 years (%)	5–11 years (%)	12–17 years (%)
Percent vaccinatedFootnote a	30	30	30	40	29	24
Footnote a Significant differences by age group (p<0.05). Return to footnote a referrer

• Frequency: Prior to the COVID-19 pandemic, 24% of children received the influenza vaccine every influenza season, 14% received it most influenza seasons, 19% received it some influenza seasons and 43% never received it.
• Reason for influenza vaccination: The most common reason for a child getting the influenza vaccine was to protect themselves and/or household members from influenza (85%), followed by preventing the spread of influenza in their community (49%), and that the child receives the influenza vaccine every year (48%). Participants could select multiple options, thus percentages do not add to 100%.
• Obstacles to influenza vaccination: The majority (81%) of parents/guardians of unvaccinated 6 months to 17 year olds indicated they did not face any obstacles. Among parents/guardians that faced an obstacle, the most common obstacle that prevented them from vaccinating their child against influenza was difficulty in booking time off work/school for an appointment (34%) followed by their child fears needles (24%). While 3% of parents reported that the cost of the vaccine prevented them from getting it, 2% lived in remote area with limited access to transportation and approximately 1% had language barriers or concerns about racism.
• Hesitancy: About 24% of parents/guardians were hesitant to vaccinate their child against influenza; no major differences were reported between males (24%) and females (23%). More parents/guardians of older children (24% of 5–11 year olds; 25% of 12–17 year olds) reported influenza vaccine hesitancy compared to parents/guardians of children 6 months–4 years (22%). The most common reason for vaccine hesitancy was that parents believed their child was not at risk of getting influenza or at risk of severe infection (43%).
• Refusal: Overall, 44% of parents/guardians refused to vaccinate their child against influenza. Similar to hesitancy, the most common reason for parental refusal to vaccinate their child against influenza was that parents believed their child was not at risk of getting influenza or at risk of severe infection (50%).
• Impact of the COVID-19 pandemic on decision to receive the influenza vaccine in 2021–22: Parents/guardians were asked whether the COVID-19 pandemic affected their decision to vaccinate their child against influenza; the majority said it did not impact their decision (80%), while 11% of parents indicated it motivated them to get their child vaccinated and 10% indicated it made them not want to get their child vaccinated against influenza.
• Intent to receive the influenza vaccine next season: The younger the child, the higher was parental intention to vaccinate their child in the next influenza season (2022–2023); 59% of parents of children younger than 5 years of age indicated that they intend to vaccinate their child in the next influenza season (2022–2023) compared to parents of 5 to 11 and 12 to 17 year olds (51% and 44%, respectively). Overall, 27% of parents/guardians indicated they definitely will get their child the influenza vaccine during the next influenza season (2022–2023), 24% probably will, while 19% indicated they definitely won't.

Figure 3: Text description

Parents/guardians' intention to vaccinate child, 6 months–17 years of age, against seasonal influenza during the next influenza season (2022–2023)

Level of intention to vaccinate against seasonal influenza	Overall (%)	Parents of 6 months–4 years (%)	Parents of 5–11 years (%)	Parents of 12–17 years (%)
Definitely willFootnote a	27	36	26	21
Probably willFootnote a	24	23	25	23
Probably won'tFootnote a	23	18	23	26
Definitely won'tFootnote a	19	18	18	20
Don't knowFootnote a	8	6	8	9
Footnote 1 Significant differences by age group (p<0.05). Return to footnote a referrer

COVID-19 vaccine coverage among parents/guardians

• COVID-19 coverage: Overall, 91% of parents/guardians received at least one dose of a COVID-19 vaccine.
• Intent to vaccinate: Among parents/guardians who were not vaccinated, 1% indicated they definitely will get the vaccine in the future, while 84% reported they definitely won't.
• Reasons for not getting vaccinated: Among parents/guardians that did not get vaccinated, the most commonly reported reason for not receiving a COVID-19 vaccine was vaccine refusal (88%) followed by vaccine hesitancy (9%).
• Hesitancy: Approximately, 34% of all parents/guardians (regardless of their vaccination status) were hesitant to vaccinate themselves with a COVID-19 vaccine, with the most common reason for hesitancy being related to concerns about COVID-19 vaccine safety and/or side effects (66%).
• Refusal: Among parents/guardians that did not get vaccinated, 88% of parents/guardians decided they did not want a COVID-19 vaccine; concern about COVID-19 vaccine safety and/or side effects (73%) was the most commonly reported reason.

Seasonal influenza vaccine coverage among parents/guardians

• Influenza vaccine coverage: More than a third (37%) of parents/guardians received their influenza vaccine during the 2021–2022 influenza season.
• Provincial and territorial vaccine coverage ranged from 21% in Quebec to 53% in the Northwest Territories.
• In 2021–2022, all provinces and territories, with the exception of Quebec, had a publicly funded universal influenza vaccination program for all adults. Quebec publicly funded influenza programs for select high-risk groups which may help explain some of the variations seen across jurisdictions.^{Footnote 3} As of November 2022, Quebec announced the influenza vaccine is free for everyone 6 months and older.^{Footnote 4}
• Hesitancy and refusal: Approximately, 20% of parents were hesitant to receive the influenza vaccine and 50% refused to get the influenza vaccine during the 2021–2022 influenza season. The most common reason why parents/guardians of children below 18 years of age were hesitant to get the influenza vaccine was concerns related to the effectiveness (42%), and the most commonly reported reason to refuse the influenza vaccine was believing they were not at risk of getting influenza or at risk of severe infection (49%).
• Intent to vaccinate: About 29% of parents of children younger than 18 years reported they definitely will get the influenza vaccine in the 2022–2023 influenza season, while 21% reported they definitely won't.

Knowledge, attitudes and beliefs

To better understand factors influencing decisions on COVID-19 and influenza vaccinations, additional questions were asked of parents/guardians. These questions were designed to determine their knowledge, attitudes and beliefs around vaccines (Table 2) and to understand if there is any relation to their child's vaccination status.

Parents were asked their level of agreement with a series of statements about childhood vaccines.

• Most parents/guardians of children younger than 18 years agree that COVID-19 vaccines are safe (76%) and effective (73%). While 86% agree that the influenza vaccine is safe and 71% agree it is effective.
• 68% agree that COVID-19 vaccines are a safer way to build immunity against the virus rather than getting infected.
• Most parents/guardians of children younger than 18 years agree that additional doses are important to protect themselves against COVID-19 (60%), while 31% disagree that additional doses are needed.
• A majority of parents/guardians agree that public health measures are important to prevent and/or reduce the spread of COVID-19 (77%).
• Most parents/guardians of children younger than 18 years agreed they have access to enough trustworthy information to make an informed decision about COVID-19 vaccines (89%).

Table 2. Perceptions about vaccines among parents/guardians of children 0–17 years of age

Statement	Parental level of agreement (%)Footnote a
	Strongly or somewhat agree	Strongly or somewhat disagree	Don't know
In general, vaccines are safe	91	7	2
In general, vaccines are effective	92	6	2
In general, COVID-19 vaccines are safe	76	17	7
In general, COVID-19 vaccines are effective	73	23	5
Additional COVID-19 doses are important to continue to protect myself from the virus	60	31	8
Vaccination is a safer way to build immunity against COVID-19 than getting infected	68	25	7
My child needs to be vaccinated against COVID-19 even after infection	62	31	8
Public health measures are important to prevent and/or reduce the spread of COVID-19	77	21	1
I have access to enough trustworthy information about COVID-19 vaccines to make an informed decision	89	10	2
In general, the flu vaccine is safe	86	9	6
In general, the flu vaccine is effective	71	22	7
Footnote a Estimates may not sum to 100% due to rounding. Return to footnote a referrer

Summary

COVID-19 vaccine coverage

To summarize, 81% of children 5–17 years of age have been vaccinated with at least one dose of a COVID-19 vaccine and the majority of those (75%) have received 2 doses. There were gaps by age group, with 5–11 year olds having a lower coverage (74%) compared to the 12–17 year olds (90%).

The most common reason for parents/guardians to get their child vaccinated was to protect themselves and/or household members against COVID-19 infection (76%); while the most common reason for not getting their child vaccinated was vaccine refusal (72%) followed by hesitancy (22%). Parents/guardians of children younger than 18 years of age reported the same top reasons for not receiving the COVID-19 vaccine for themselves. Overall, among unvaccinated children, 60% of parents/guardians intended to vaccinate their child.

Parents/guardians of children younger than 18 years old were more hesitant to vaccinate their child (43%) than they were to vaccinate themselves (34%). The main reason for hesitancy reported by parents/guardians was that not enough research on the vaccine has been done in children (65%), while the main reason for refusal to vaccinate themselves was concern around COVID-19 vaccine safety and/or side effects (66%).

Parents/guardians who reported their 5 to 17 year old child got all recommended routine childhood vaccinations were more likely to report their child received at least one dose of a COVID-19 vaccine (84%), compared to those who received some routine vaccinations (55%) and who did not receive any routine vaccinations (45%).

Seasonal influenza vaccine coverage

Overall, 30% of children 6 months–17 years have received their influenza vaccine during the 2021–2022 influenza season. Similar to results reported by parents/guardians for COVID-19, the most common reason to get their child the influenza vaccine was to protect themselves and/or household members from influenza (85%).

CCICS also investigated the impact of the pandemic on influenza vaccine coverage. Prior to the COVID-19 pandemic, 24% of children received influenza vaccine every influenza season while the majority of parents/guardians reported that the pandemic did not impact their decision to get their child vaccinated in the 2021–22 influenza season (80%). Parents were also asked about intentions to vaccinate their child in the next influenza season; 51% of parents intend to vaccinate their child against influenza in the 2022–23 influenza season.

Again, parents/guardians were more hesitant to vaccinate their child against influenza (24%) than they were to vaccinate themselves (20%). 44% of parents/guardians refused to get their child the influenza vaccine while 50% of parents/guardians refused to get the influenza vaccine for themselves. The most commonly reported reason for influenza vaccine hesitancy and refusal was that the child was not at risk of getting influenza or at risk of severe infection.

Socio-demographic characteristics

Among reported ethnicities, COVID-19 and influenza vaccine coverage were highest among children identifying as East/Southeast Asian and South Asian descent. COVID-19 vaccine coverage was lower among children identifying as Black (African, Afro-Caribbean, and African descent), Middle Eastern and North African and Indigenous, while Black (African, Afro-Caribbean, and African descent) children had the lowest influenza vaccine coverage estimates. Among those that identified as Indigenous, Inuit children the highest COVID-19 and influenza vaccine coverage estimates, followed by Métis children and First Nations children. Children living in urban areas had higher COVID-19 and influenza vaccine coverage estimates compared to children living in rural areas. More children with a pre-existing medical condition received the influenza vaccine compared to those who do not have a medical condition while no major differences were reported for COVID-19 vaccine coverage. No major differences were reported by presence of a disability for both influenza and COVID-19 vaccine coverage.

Knowledge, attitudes and beliefs

The majority of parents agree that vaccines in general, COVID-19 and influenza vaccines are safe and effective. However, 25% of parent do not agree that vaccination is a safer way to build immunity against COVID-19 than getting infected and almost one third of parents (31%) disagree that their child needs to be vaccinated against COVID-19 even after infection or that additional COVID-19 doses are important to continue to protect themselves from the virus.

The most trusted source of information reported was health care providers (42%), followed by Public Health Agency of Canada/Health Canada (27%), international sources such as the World Health Organization (6%), and local public health units/clinics (6%).

Considerations and limitations

Due to the collection methodology and the nature of the survey, CCICS estimates of COVID-19 vaccine coverage in children below 18 years of age may be higher than results reported by the Canadian COVID-19 Vaccination Coverage Surveillance System (CCVCSS). In particular, participants were aware the survey was about COVID-19 which may have increased participation among people interested in COVID-19, or who feel strongly about it. At the time of data collection, children younger than 5 years old were not eligible for COVID-19 vaccination. Information on COVID-19 vaccine coverage for this age group will be available in future iterations of CCICS. Children living in the North were oversampled to obtain information and estimates that were more reliable. Institutionalised children and youth were not included in the survey.

For more information about the Childhood COVID-19 Immunization Coverage Survey (CCICS), please contact us at ccics-ecvec@phac-aspc.gc.ca.

Related links

• Vaccines for COVID-19: How to get vaccinated
• Approved COVID-19 vaccines
• Vaccines for children: COVID-19
• Guidance on the use of influenza vaccine in the presence of COVID-19
• Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022–2023