Childhood COVID-19 Immunization Coverage Survey (CCICS): 2023 results

On this page

• Key highlights
• Introduction
• Results
• Summary
• Considerations and limitations
• Related links

Key highlights

• The Childhood COVID-19 Immunization Coverage Survey (CCICS) results provided context to vaccine coverage by identifying socio-demographic gaps. Overall, COVID-19 vaccine coverage estimates for 6 months to 17 year olds was 67%. Similar to trends seen in 2022, among reported ethnicities, COVID-19 vaccine coverage was highest among those identifying as East/Southeast Asian (73%) and lowest among those identifying as Middle Eastern and North African (56%) and Black (56%).
• New in 2023: Among those who were eligible, approximately half (49%) of children 5 to 17 years received a COVID-19 additional dose. About 32% of parents/guardians of eligible children who had not received an additional dose indicate they may get it for their child in the future.
• Similar to trends seen in 2022, children living in urban areas had higher COVID-19 and seasonal influenza vaccine coverage estimates (69% and 36%, respectively) than children living in rural areas (59% and 25%, respectively).
• Similar to trends seen in 2022, COVID-19 vaccine coverage was higher among children who reported having received all recommended routine childhood vaccines (71%), compared to those who received some routine vaccines (51%) or did not receive any (5%).
• New in 2023: Overall, 64% of children 6 months to 17 years whose parents/guardians had seen a COVID-19 awareness campaign received at least one dose of a COVID-19 vaccine.
• New in 2023: More children who had received a recommendation to get a COVID-19 vaccine from a health care provider reported receiving at least one dose of a COVID-19 vaccine (83%), compared to those who did not receive a recommendation (61%). While a similar notable difference was observed for the seasonal influenza vaccine, where more children who had received a recommendation to get an influenza vaccine from a health care provider reported receiving it (70%), compared to those who did not receive a recommendation (24%).
• Similar to trends seen in 2022, the most common reason for COVID-19 vaccine reluctancy or hesitancy was concerns that not enough research on the vaccine has been done in children (72%), while the most common reason for seasonal influenza vaccine reluctancy or hesitancy was concerns about the effectiveness of flu vaccines (41%).
• This survey allowed Canada to report on seasonal influenza vaccine coverage in children to the WHO for the first time last year. Canada will continue reporting on this. Overall, 34% of children 6 months to 17 years and 43% of children with a pre-existing medical condition received the seasonal influenza vaccine during the 2022 to 2023 influenza season, both an increase from last year 30% and 36%, respectively.
• Similar to trends seen in 2022, the most trusted source of information related to COVID-19 vaccines was health care providers (42%, no change from 2022) followed by PHAC and HC (19%, a decrease from 27% from 2022).
• Most parents/guardians of children younger than 18 years agree that COVID-19 vaccines are safe (70%, a decrease from 76% in 2022) and effective (68%, also a decrease from 73% in 2022). While 83% agree that the influenza vaccine is safe (a decrease from 86% in 2022) and 70% agree it is effective (no change from 71% in 2022).

Introduction

The Childhood COVID-19 Immunization Coverage Survey (CCICS) is an 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 2022 to 2023 influenza season (September to March). The survey is given to parents or guardians who have children younger than 18 years of age. In Canada, both the COVID-19 and seasonal influenza vaccines are recommended for children and youth 6 months and older, and especially for populations at risk, such as immunocompromised individuals.

CCICS provides key information about COVID-19 and seasonal influenza (flu) vaccine coverage among children, parental knowledge, attitudes and beliefs (KABs) regarding these vaccines, intention to vaccinate, hesitancy and barriers to vaccination, along with select demographic information. In addition, the 2023 CCICS also asks about COVID-19 diagnosis, COVID-19 additional doses, exposure to awareness campaigns related to children and recommendations from healthcare providers.

COVID-19 and seasonal influenza vaccine coverage estimates were collected for children 6 months to 17 years of age. It must be noted, that COVID-19 vaccine coverage estimates from the 2022 CCICS only included children 5 to 17 years of age, as children below 5 years were not eligible for vaccination when data collection started. Therefore, when making comparisons between the 2023 and 2022 cycles of CCICS, ensure that the age groups are the same. Influenza vaccination coverage estimates were collected shortly after the 2022 to 2023 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 second cycle of data collection, which started on April 11, 2023, and ended on July 26, 2023. All differences noted are significant at the 95% confidence interval.

Results

COVID-19 vaccine coverage among children

The 2023 Childhood COVID-19 Immunization Coverage Survey (CCICS) found that among children 6 months to 17 years of age:

• 67% had received at least one dose of a COVID-19 vaccine approved for use in Canada (Table 1).
  • Overall, 7% had received only one dose, 37% received two doses, 19% received three doses, and 4% received four or more doses. 31% of children 6 months to 4 years, 71% of children 5 to 11 years received at least one dose of a COVID-19 vaccine, a decrease from 74% in 2022, while 89% of children 12 to 17 years received at least one dose of a COVID-19 vaccine, similar to 90% in 2022.
  • During the CCICS 2022 cycle, children younger than 5 years were not eligible for COVID-19 vaccination whereas this year they were included in coverage estimates, thus the larger difference between 2022 and 2023. When limiting the age group to 5 to 17 year olds, to better compare estimates over the two cycles, there were no major differences between COVID-19 vaccine coverage in CCICS 2022 (81%) and CCICS 2023 (79%).  
  • Among children 6 months to 17 years, slightly more females than males had received at least one dose of a COVID-19 vaccine (68% and 66%, respectively). When looking at 5 to 17 year olds this cycle, no major differences were seen between females and males who received at least one dose of a COVID-19 vaccine (80% and 79%, respectively), similar to 2022.
• Vaccine recommendation from a health care provider: Overall, 30% of children 6 months to 17 years were recommended by a health care provider to receive a COVID-19 vaccine. More children 6 months to 17 years who had received a recommendation to get a COVID-19 vaccine from a health care provider reported receiving at least one dose of a COVID-19 vaccine (83%), compared to those who did not receive a recommendation (61%).
• Provincial/territorial coverage estimates for at least one dose of a COVID-19 vaccine among children 6 months to 17 years ranged from 76% in Northwest Territories to 60% in Alberta. Compared to 2022, among 5 to 17 year olds, Newfoundland and Labrador and Prince Edward Island had the largest decreases in COVID-19 vaccine coverage (86% from 93%; 80% from 88%, respectively).
• Ethnicity and Indigenous identity: Vaccine coverage among children 6 months to 17 years of age across various ethnicities ranged from 56% to 73%. Similar to trends seen in 2022, coverage was highest among those identifying as East/Southeast Asian (73%), followed by South Asian descent (70%), white European descent (69%), Latin American (68%), Middle Eastern and North African (56%), and Black (African, Afro-Caribbean, and African) descent (56%). Vaccine coverage was 62% among those identifying as Indigenous (First Nations, Métis or Inuit), while 60% of those identifying as First Nations, 61% identifying as Métis and 75% identifying as Inuit received at least one dose of a COVID-19 vaccine. Compared to 2022, COVID-19 vaccine coverage in Indigenous children 5 to 17 years of age increased among First Nations (71%, 69% in 2022) while it decreased among Métis (72%, 78% in 2022) and Inuit children (84%, 97% in 2022).
• Rural/urban: More children 6 months to 17 years of age living in an urban area received at least one dose of a COVID-19 vaccine (69%) compared to those living in a rural area (59%).
• Routine immunization coverage: Parents/guardians who reported their 6 months 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 (71%), compared to those who received some routine vaccinations (51%) and those who did not receive any routine vaccinations (5%).
• Medical conditions/disability: Among children 6 months to 17 years of age, more children who had a pre-existing medical condition reported receiving at least one dose of a COVID-19 vaccine (76%) compared to those that did not have a medical condition (66%). Similarly, there were significant differences in vaccine coverage among children that had a disability (78%) compared to children who did not have a disability (67%). These differences may largely be driven by those younger than 5 years of age, where COVID-19 immunization coverage was significantly higher among children within that age group who had a medical condition (42%) or disability (37%) compared to those who did not have a medical condition (31%) or a disability (31%). There were also some differences reported among 5 to 17 year olds (no medical condition: 79%, pre-existing medical condition: 83%; no disability: 79%, presence of a disability: 83%).  
• Additional doses: New to this cycle, parents were asked whether their child received an additional COVID-19 dose and their intentions to vaccinate their children with an additional dose in the future. COVID-19 additional doses had not been authorised for children aged 6 months to 4 years of age at time of data collection. 
  • Almost half (49%) of children 5 to 17 years of age received a COVID-19 additional dose; 43% of children 5 to 11 years of age and 54% of children 12 to 17 years of age.
  • Parents/guardians of children 5 to 17 years, who had not yet received a COVID-19 additional dose indicated their intent to vaccinate their child in the future. Overall, 8% reported they definitely will vaccinate their child with a COVID-19 additional dose in the future and 24% said they probably will, 18% of parents/guardians indicated that they definitely won’t vaccinate their child with a COVID-19 additional dose.
  • Twenty percent (20%) of parents/guardians of children 0 to 4 years reported that when their child becomes eligible for a COVID-19 additional dose that they definitely will vaccinate their child, while 25% indicated that they definitely won’t. There was a small difference between males (20%) and females (21%).

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 doses	4 or more doses
All children	67%	7%	37%	19%	4%
Females	68%	7%	36%	20%	4%
Males	66%	7%	37%	18%	4%
6 months to 4 years	31%	9%	19%	3%	<1%
5 to 11 years	71%	10%	40%	18%	2%
12 to 17 years	89%	3%	46%	32%	8%

• Intent to vaccinate: Parents/guardians of children 0 to 17 years, who had not yet received a COVID-19 vaccine or who were not eligible (younger than 6 months) were asked about their level of intent to vaccinate their child in the future. Overall, 5% reported they definitely will vaccinate their child against COVID-19 in the future and 11% said they probably will (Figure 1), a decrease from 30% and 13%, respectively in 2022.
  • Similar to 2022, the younger the child, the higher parental intention was to vaccinate their child in future; 24% of parents of children less than 5 years of age indicated that they intend to vaccinate their child in the future (a decrease from 60% in 2022) compared to parents of 5 to 11 and 12 to 17 year olds whose child did not receive a COVID-19 vaccine (9% and 3%, respectively, a slight decrease from 11% and 5% in 2022).
  • The decrease in intention to vaccinate children against COVID-19 may partly be due to the fact that a high percentage of parents/guardians in this group were hesitant (77%) or refusing (49%) of the COVID-19 vaccine for their child and thus could have contributed to the lower intention to vaccinate.
  • Parents/guardians’ level of intention to vaccinate their child, 0 to 17 years of age, in the future ranged across the provinces and territories; 13% of parents/guardians in Prince Edward Island and Northwest Territories indicated they will definitely vaccinate their child, while only 3% in Quebec indicated they definitely will.

Figure 1: Text description

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

Level of intention to vaccinate against COVID-19	Overall (%)	Parents of 0 to 4 years (%)	Parents of 5 to 11 years (%)	Parents of 12 to 17 years (%)
Definitely willFootnote a	5	8	2	1
Probably willFootnote a	11	16	7	2
Probably won'tFootnote a	25	27	24	16
Definitely won'tFootnote a	49	37	58	75
Don't knowFootnote a	10	12	8	6
Footnote a Significant differences by age group (p<0.05). Estimates may not sum to 100% due to rounding. Return to footnote a referrer

Parental reasons for COVID-19 vaccination or obstacles that prevented vaccination

• Reasons for vaccination: According to parents/guardians of children 6 months to 17 years of age the most common reason for getting their child a COVID-19 vaccine was based on public health recommendations (71%), followed by to protect themselves and/or household members against COVID-19 infection (65%), and preventing the spread of COVID-19 in the community (58%), these were also the most commonly reported reasons in 2022.
• Obstacles to COVID-19 vaccination: Sixty-three percent (63%) of parents/guardians of unvaccinated 6 months to 17 year old children indicated they did not face any obstacles. Among parents/guardians of children 5 to17 years of age, 61% did not face an obstacle, a decrease from 88% in 2022. Among those who reported facing an obstacle, 59% reported that at least one parent opposed it; 10% reported their child fears needles and 9% reported that their child had an adverse reaction to a previous vaccine, similar to some of the more commonly reported obstacles to vaccination in 2022.

COVID-19 vaccine reluctancy or hesitancy^{Footnote 1}

Parents/guardians of children younger than 18 years of age were asked if they were reluctant or hesitant to get a COVID-19 vaccine for their child, regardless of whether the child got a COVID-19 vaccine or not. Overall, hesitancy has remained somewhat similar, 44% of parents/guardians of children below 18 years of age indicated they were reluctant or hesitant to vaccinate their child against COVID-19, compared to 43% in 2022, regardless of child’s vaccination status. There were some differences between specific groups, though the trends across groups remained similar compared to 2022:

• Reluctancy or hesitancy ranged in the provinces/territories from 14% in Nunavut to 51% in Alberta;
• In general, there were no major differences among parents/guardians of males (45%) compared to parents/guardians of females (43%);
• More parents/guardians of children 0 to 4 years of age (53%) were reluctant or hesitant regarding the COVID-19 vaccine compared to parents/guardians of children 5 to 11 (45%) or 12 to 17 years of age (36%).

Similar to 2022, the most common reason for reluctancy or hesitancy was concern that not enough research on the vaccine has been done in children (72%), followed by concerns about the safety of COVID-19 vaccines and/or side effects (50%) and concerns about the effectiveness (40%).

COVID-19 vaccine refusal^{Footnote 2}

In this cycle, parents/guardians were asked whether they refused to vaccinate their children aged 6 months to 17 years against COVID-19. Results indicated that 49% of parents/guardians refused to vaccinate their child against COVID-19; there were some differences by sex and age group:

• Slightly more parents/guardians of females (50%) refused to vaccinate their child against COVID-19 compared to parents/guardians of males (48%);
• The older the child, the higher the refusal, more parents/guardians of children 12 to 17 years (70%) refused to vaccinate their child against COVID-19 compared to parents/guardians of children 5 to 11 years (61%) and children 6 months to 4 years (36%);
• Provincial/territorial differences in parents/guardians refusing to vaccinate their child ranged from 33% in Quebec to 61% in Alberta.

Similar to 2022, the most common reason for refusal was concerns about the safety of COVID-19 vaccines and/or side effects (73%, increasing from 63% in 2022). This was followed by considering the vaccine was unnecessary for their child (64%) and lack of trust in the government and/or pharmaceutical companies (57%). When examining refusal among parents/guardians of 5 to 17 year olds, 63% refused to vaccinate their child compared to 60% who decided not to vaccinate their child in 2022, although, direct comparisons cannot be made due to changes in question terminology.

Source of information and awareness campaigns

• Similar to 2022, the most trusted source of information related to COVID-19 vaccines reported by parents/guardians of children younger than 18 years of age was health care providers (42%, no change from 2022), followed by Public Health Agency of Canada/Health Canada (19%, a decrease from 27% in 2022). Trust in other sources such as scientific publications or journals increased from 1% in 2022 to 18% in 2023, while trust in family/friends (1% in 2023, 2% in 2022) and international organizations (3% in 2023, 6% in 2022) decreased in 2023.
• New to this cycle, parents/guardians of children younger than 18 years of age were asked if they had seen any COVID-19 awareness campaigns for children and adolescents.  Sixty-two percent (62%) of parents/guardians reported seeing COVID-19 awareness campaigns. More parents/guardians of children 5 to 11 years (65%) and 12 to 17 years (64%) reported seeing COVID-19 awareness campaigns compared to parents/guardians of children 0 to 4 years (56%). Overall, 64% of children 6 months to 17 years whose parents/guardians had seen a COVID-19 awareness campaign received at least one dose of a COVID-19 vaccine.

Seasonal influenza vaccine coverage among children

• Overall, 34% of children 6 months to 17 years received the influenza vaccine during the 2022 to 2023 influenza season (Figure 2), an increase from 30% in the previous influenza season.
  • Slightly higher influenza vaccine coverage estimates were noted between this cycle and the previous cycle by sex and age group. 34% of males and 35% of females received their flu vaccine compared to 30% (for both males and females) in the previous influenza season.
  • In terms of age group, slightly more children 6 months to 4 years (41%) received their influenza vaccine in the 2022 to 2023 influenza season compared to 40% in the 2021 to 2022 influenza season; similarly coverage for children 5 to 11 years (35%) and 12 to 17 years (28%) were higher compared to the previous season (29% and 24%, respectively).
• Provincial/territorial coverage estimates among children 6 months to 17 years ranged from 16% in Quebec to 55% in Northwest Territories. A similar trend was noticed in the previous influenza season.
  • In 2022 to 2023, all provinces and territories had publicly funded influenza vaccines for all children 6 months and older. In November 2022, Quebec publicly funded influenza vaccines for everyone 6 months and older. Since this was the first season that Quebec implemented this, uptake although increased, may not have been ideal.
• Rural/urban: Similar to the previous influenza season, more children 6 months to 17 years of age living in an urban area received the influenza vaccine in the 2022 to 2023 influenza season (36%, an increase from 31% in the previous season) compared to those living in a rural area (25% an increase from 22% in the previous season).
• Ethnicity and Indigenous identity: Influenza vaccine coverage among children 6 months to 17 years of age, increased from the previous influenza season across various ethnicities. Influenza vaccine coverage was highest among East/Southeast Asian (46%), followed by South Asian descent (40%), white European descent (35%), Latin American (34%), Indigenous people (32%), Middle Eastern and North African (32%), and Black (African, Afro-Caribbean, and African) descent (25%). Compared to the previous influenza season, vaccine coverage in Indigenous children increased among First Nations (33%, compared to 28% in the previous season), remained unchanged among Métis (35%) and decreased among Inuit children (25%, compared to 43% in the previous season). These differences, especially among Inuit children must be interpreted with caution as they may be due to small sample sizes.
• Medical conditions/disability: Similar to the previous influenza season, more children 6 months to 17 years of age who had a pre-existing medical condition received their influenza vaccine in the 2022 to 2023 influenza season (43%; an increase from 36% in the previous season) compared to those who did not have a medical condition (34%; an increase from 29% in the previous season). Similarly, slightly more children that had a disability (36%; an increase from 28% in the previous season) compared to those who did not have a disability (34%; an increase from 30% in the 2021 to 2022 season) received their influenza vaccine.

Figure 2: Text description

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

Demographic	Overall (%)	Males (%)	Females (%)	6 months to 4 years (%)	5 to 11 years (%)	12 to 17 years (%)
2021 to 2022 seasonal influenza seasonFootnote a	30	30	30	40	29	24
2022 to 2023 seasonal influenza seasonFootnote a	34	34	35	41	35	28
Footnote a Significant differences by age group (p<0.05). Return to footnote a referrer

• Frequency: Prior to the 2022 to 2023 influenza season, 25% of children received the influenza vaccine every influenza season, 14% received it most influenza seasons, 19% received it some influenza seasons and 41% never received it.
• Reason for influenza vaccination: Similar to trends in the previous influenza season, the most common reasons for a child getting the influenza vaccine in the 2022 to 2023 influenza season was to protect themselves and/or household members from influenza (72%), followed by preventing the spread of influenza in their community (55%), and that the child receives the influenza vaccine every year (52%). These were the most commonly reported reasons for influenza vaccination in the previous season as well.
• Obstacles to influenza vaccination: Similar to the previous influenza season, the majority (77%) 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 to vaccinating their child against influenza, the most common obstacle they faced was difficulty in booking time off work/school for an appointment (36%) followed by at least one parent opposed it (26%) and their child fears needles (25%). While 9% of parents reported that their child or themselves had an adverse reaction to a previous vaccine, 5% were sick at appointment time or before and 2% lived in remote area with limited access to transportation.
• Reluctancy or hesitancy: : About 29% of parents/guardians were reluctant or hesitant to vaccinate their child against influenza, an increase from 24% in the previous influenza season. Consistent with the previous influenza season, no major differences were reported between males (30%, an increase from 24%) and females (28%, an increase from 23%). More parents/guardians of older children (30%, 5 to 11 year olds; 29%, 12 to 17 year olds) reported influenza vaccine hesitancy compared to parents/guardians of children 6 months to 4 years (27%). The most common reasons for vaccine reluctancy or hesitancy was that parents were concerned about the effectiveness of the flu vaccine (41%) and 39% believed their child was not at risk of getting influenza or at risk of severe infection.
• Refusal: Overall, 38% of parents/guardians refused to vaccinate their child against influenza, a decrease from 44% during the 2021 to 2022 flu season. The most common reason for parental refusal to vaccinate their child against influenza was believing it was not necessary to vaccinate their child (70%) and 31% had concerns about the safety/side effects of the flu vaccine.
• Impact of the COVID-19 pandemic on decision to receive the influenza vaccine in 2022 to 2023: Parents/guardians were asked whether the COVID-19 pandemic affected their decision to vaccinate their child against influenza; similar to trends in the previous influenza season, the majority said it did not impact their decision (80%, unchanged from the previous cycle), while 12% of parents indicated it motivated them to get their child vaccinated against influenza (representing a slight increase from 11% in the previous cycle) and 8% indicated it made them not want to get their child vaccinated against influenza (representing a slight decrease from 10% in the previous cycle).
• Intent to receive the influenza vaccine next season: Overall, 50% of parents/guardians indicated they definitely will or probably will get their child the influenza vaccine during the 2023 to 2024 influenza season (unchanged from the previous cycle). Similar to trends in the last cycle, the younger the child, the higher was parental intention to vaccinate their child; 58% of parents of children younger than 5 years of age indicated that they intend to vaccinate their child in the next influenza season compared to parents of 5 to 11 and 12 to 17 year olds (51% and 44%, respectively).
• Vaccine recommendation from a health care provider: Overall, 22% of parents reported that it was recommended for their child to receive the flu vaccine. Recommendations were more often made to parents/guardians of children younger than 5 years (34%) compared to parents/guardians of children 5 to 11 (20%) or 12 to 17 years (15%). More children who had received a recommendation to get an influenza vaccine from a health care provider reported receiving it (70%), compared to those who did not receive a recommendation (24%).

Figure 3: Text description

Parents/guardians’ intention to vaccinate child, 6 months to 17 years of age, against seasonal influenza during the next influenza season (2023 to 2024)

Level of intention to vaccinate against seasonal influenza	Overall (%)	Parents of 6 months to 4 years (%)	Parents of 5 to 11 years (%)	Parents of 12 to 17 years (%)
Definitely willFootnote a	25	31	25	20
Probably willFootnote a	25	27	26	24
Probably won'tFootnote a	24	19	24	28
Definitely won'tFootnote a	18	17	17	19
Don't knowFootnote a	8	7	7	9
Footnote a Significant differences by age group (p<0.05). Return to footnote a referrer

COVID-19 vaccine coverage among parents/guardians

• Overall, no major changes were noticed compared to 2022.
• COVID-19 coverage: Overall, 92% of parents/guardians received at least one dose of a COVID-19 vaccine.
• Intent to vaccinate: Among parents/guardians who were not vaccinated, 2% indicated they definitely will or probably will get the vaccine in the future, while 87% reported they definitely won’t.
• Reluctancy or hesitancy: Approximately, 37% of all parents/guardians (regardless of their vaccination status) were reluctant or hesitant about the COVID-19 vaccine.
• Refusal: Among parents/guardians that did not get vaccinated, 86% of parents/guardians refused a COVID-19 vaccine.

Seasonal influenza vaccine coverage among parents/guardians

• Influenza vaccine coverage: About 41% of parents/guardians received their influenza vaccine during the 2022 to 2023 influenza season, an increase from 37% in the 2021 to 2022 season.
• Provincial and territorial influenza vaccine coverage ranged from 27% in Quebec to 56% in the Northwest Territories. A similar trend was noticed in the previous influenza season.
  • In 2022 to 2023, all provinces and territories had a publicly funded universal influenza vaccination program for all adults. In November 2022, Quebec publicly funded influenza vaccines for everyone, regardless of whether they were high-risk or not.
• Reluctancy or hesitancy and refusal: Approximately, 26% of parents were reluctant or hesitant to receive the influenza vaccine, an increase from 20% last cycle, and 50% refused to get the influenza vaccine during the 2022 to 2023 influenza season, unchanged from the previous influenza season.
• Intent to vaccinate: About 28% of parents of children younger than 18 years reported they definitely will get the influenza vaccine in the 2023 to 2024 influenza season, while 20% reported they definitely won’t, both figures unchanged from the previous influenza season

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 (70%, a decrease from 76% in 2022) and effective (68%, also a decrease from 73% in 2022). While 83% agree that the influenza vaccine is safe (a decrease from 86% in 2022) and 70% agree it is effective (no change from 71% in 2022 ).
• 66% agree that COVID-19 vaccines are a safer way to build immunity against the virus rather than getting infected, unchanged from 2022.
• Approximately half of parents/guardians of children younger than 18 years agree that additional doses are important to protect themselves against COVID-19 (52%, a decrease from 60% in 2022), while 39% disagree that additional doses are needed (an increase from 31%).
• New to the 2023 cycle; a majority of parents/guardians agreed that they know where to obtain a COVID-19 vaccine for their child (91%) while, 45% agree that close family and friends want them to get their child vaccinated against COVID-19.
• 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 (85%, a decrease from 89% in 2022).

Table 2. Perceptions about vaccines among parents/guardians of children 0 to 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	89	9	2
In general, vaccines are effective	92	7	2
In general, COVID-19 vaccines are safe	70	22	8
In general, COVID-19 vaccines are effective	68	25	6
Additional COVID-19 doses are important to continue to protect myself from the virus	52	39	9
Vaccination is a safer way to build immunity against COVID-19 than getting infected	66	26	8
My child needs to be vaccinated against COVID-19 even after infection	54	38	8
I know where to get a COVID-19 vaccine for my child	91	6	3
I have access to enough trustworthy information about COVID-19 vaccines to make an informed decision	85	13	3
Close family and friends want me to get my child vaccinated against COVID-19	45	37	18
In general, the flu vaccine is safe	83	10	6
In general, the flu vaccine is effective	70	23	7
Footnote a Estimates may not sum to 100% due to rounding. Return to footnote a referrer

Summary

COVID-19 vaccine coverage

To summarize, 67% of children 6 months to 17 years of age have been vaccinated with at least one dose of a COVID-19 vaccine. The results revealed significant age differences in COVID-19 vaccination coverage; among those that received at least one dose of a COVID-19 vaccine, children 6 months to 5 years have the lowest coverage (31%) compared to 5 to 11 year olds (71%) and 12 to 17 year olds (89%). When limiting the age group to 5 to 17 year olds, to better compare estimates to CCICS 2022, there were no major differences between COVID-19 vaccine coverage in CCICS 2022 (81%) and CCICS 2023 (79%). Almost half (49%) of parents/guardians of children 5 to 17 years of age received a COVID-19 additional dose. Monitoring uptake of the latest formulations of vaccines will help inform public health actions to prevent adverse outcomes related to COVID-19 infection and protect against new lineages.

Overall, 30% of children 6 months to 17 years were recommended by a health care provider to receive a COVID-19 vaccine. Vaccine coverage was higher in those that were recommended to get a COVID-19 vaccine (83%) compared to those who did not receive a recommendation (61%), indicating that parents/guardians value health care providers advice. 

The most common reason for parents/guardians to get their child vaccinated was based on public health recommendations (71%). Overall, among children that have not been vaccinated yet, 16% of parents/guardians intend to vaccinate their child, while 49% definitely won’t vaccinate.

Parents/guardians of children younger than 18 years old were more reluctant or hesitant to vaccinate their child (44%) than they were to vaccinate themselves (37%). The main reason for reluctancy/hesitancy reported by parents/guardians was concern that not enough research on the vaccine has been done in children (72%).The main reason for refusal to vaccinate their children was concern around COVID-19 vaccine safety and/or side effects (73%). Among parents/guardians that had not received a COVID-19 vaccine (8%), 86% refused to get the vaccine for themselves.

Similar trends to last cycle, parents/guardians who reported their children got all recommended routine childhood vaccinations were more likely to report their child received at least one dose of a COVID-19 vaccine (71%), compared to those who received some routine vaccinations (51%) and who did not receive any routine vaccinations (5%).

Seasonal influenza vaccine coverage

Overall, 34% of children 6 months to 17 years have received their influenza vaccine during the 2022 to 2023 influenza season. The most common reason to get their child the influenza vaccine was to protect themselves and/or household members from influenza (72%).

Parents were also asked about intentions to vaccinate their child in the next influenza season; 50% of parents intend to vaccinate their child against influenza in the 2023 to 2024 influenza season.

There were no major differences between parental/guardian hesitancy to vaccinate their child against influenza (29%) than they were to vaccinate themselves (26%). Thirty-eight percent (38%) of parents/guardians refused to get their child the influenza vaccine while 49% of parents/guardians refused to get the influenza vaccine for themselves. The most commonly reported reason for influenza vaccine reluctancy/hesitancy was the child was not at risk of getting influenza or at risk of severe infection; while the most common reason for refusal was that they did not consider it necessary for their child (70%).

Socio-demographic characteristics

Among reported ethnicities, COVID-19 and influenza vaccine coverage were highest among children identifying as East/Southeast Asian (73%, 46%, respectively) and South Asian (70%, 40%, respectively) descent. COVID-19 vaccine and influenza vaccine coverage was lower among children identifying as Middle Eastern and North African (56%, 32%, respectively) and Black (56%, 25% respectively). Children living in urban areas had higher COVID-19 and influenza vaccine coverage estimates (69% and 36%, respectively) compared to children living in rural areas (59% and 25%, respectively). More children with a pre-existing medical condition or a disability received the COVID-19 and influenza vaccine compared to those who do not have a medical condition or disability.

Knowledge, attitudes and beliefs

The majority of parents agree that vaccines in general, COVID-19 and influenza vaccines are safe and effective. However, 26% of parents do not agree that vaccination is a safer way to build immunity against COVID-19 than getting infected and more than one third of parents (38%) 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 (39%), indicating a need to improve vaccine confidence.

The most trusted source of information reported was health care providers (42%), followed by Public Health Agency of Canada/Health Canada (19%), and scientific publications or journals (18%). Parents/guardians of children younger than 18 years of age reported seeing COVID-19 awareness campaigns (62%).

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 and seasonal influenza which may have increased participation among people interested in these topics, or who feel strongly about it. Children living in the North were oversampled to gain more information on Indigenous people while institutionalised children and youth are not included. Furthermore, caution must be taken when making comparisons to the previous cycle of CCICS in terms of COVID-19 vaccine coverage, in the previous cycle of CCICS, children below 5 years were not included in coverage estimates as they were not eligible at the time of data collection, while this cycle they were included.

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
• Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2022 to 2023
• Vaccination Coverage in Canada