Vaccine uptake in Canadian adults: Highlights from the 2020-2021 Seasonal Influenza Vaccination Coverage Survey
The Seasonal Influenza Vaccination Coverage Survey collects information every year about the uptake of the flu shot in Canada. Each flu season, it estimates how many people get vaccinated as well as knowledge, attitudes, and beliefs about the flu shot. Every two years, the survey also collects information about other recommended vaccines for adults: pertussis (whooping cough), tetanus, pneumococcal and shingles. The 2020-2021 Seasonal Influenza Vaccination Coverage Survey took place between January 6 and February 11, 2021. With the current pandemic context, questions about the COVID-19 vaccine were also added to the survey this year.
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Purpose of this survey
Results from the survey provide information about how well Canadian adults are protected against vaccine preventable diseases as well as what they know and think about vaccines.
Survey results are used to:
- measure progress towards achieving Canada's national vaccination coverage goals
- determine reasons for non-vaccination
- identify potential impacts of the COVID-19 pandemic on seasonal influenza vaccine uptake
- assess how well vaccination programs are working, and how they could be improved
- report Canada's vaccination coverage to the World Health Organization (WHO)
Key results
Influenza vaccine
The flu season in Canada normally runs from November to April. Anyone can get the flu, which can sometimes lead to severe complications or death. Some people are at higher risk of complications due to the flu, including:
- people with certain chronic health conditions
- people 65 years and older
- people who live in nursing homes or other long-term care facilities
- children under 5 years of age
- pregnant people or those planning to get pregnant
- people who experience barriers in accessing health care
- people who are at an increased risk of disease because of living conditions, such as overcrowding
The influenza vaccine, also known as the flu shot, is the best way to prevent the disease. Every Canadian 6 months of age and older should get the flu shot every year.
Figure 1 - Text description
| Flu season | Percent vaccinated (%) | ||||
|---|---|---|---|---|---|
| for all adults (18+) |
for age 18-64 without chronic medical conditions |
for age 18-64 with chronic medical conditions |
for seniors (65+) |
||
| 2018-2019 | 41.8 | 30.8 | 42.8 | 69.9 | |
| 2019-2020 | 41.8 | 30 | 43.6 | 70.3 | |
| 2020-2021 | 40.4 | 29.2 | 40.5 | 70.4 | |
Overall, influenza vaccination coverage among all adults (40%) was similar to the previous season (42%).
Canada's goal is to have 80% of those at higher risk of complications from the flu vaccinated. This includes seniors (65 years of age and older) and adults aged 18-64 years with chronic medical conditions.
In the 2020/21 flu season:
- only 4 in 10 Canadian adults aged 18-64 years with chronic medical conditions (41%) received the flu shot
- Vaccination coverage among seniors (70%) is closer to the target of 80%; however, no improvement has been observed in the last 3 years
Timing and place of vaccination
- Most respondents were vaccinated in October (42%) or November 2020 (38%).
- Getting the flu shot early in the flu season (by the end of October) helps protect from infection before the flu begins to spread.
- Most respondents were vaccinated at pharmacies (49%), followed by doctor's offices (23%).
Reasons to get, or not get the flu shot
- The most common reason for getting the flu shot was to prevent infection or avoid getting sick (37%).
- The most common reason for not getting the flu shot was they are healthy and/or they never get the flu (29%).
Impact of COVID-19 on getting the flu shot
- Overall, 47% of Canadian adults stated that they had encountered difficulties in scheduling an appointment for getting the flu shot this year due to the preventive measures in place to reduce the spread of COVID-19. The difficulties encountered include:
- limited appointment availability (23%)
- concern about being exposed to COVID-19 (17%)
- lack of walk-in options (9%)
Other vaccines
Tetanus and pertussis (whooping cough) vaccines
In Canada, adults can be vaccinated against tetanus (lockjaw) with either the tetanus-diphtheria (Td) or the tetanus-diphtheria-pertussis (Tdap) vaccines. All adults should receive 1 dose of Tdap in adulthood to be protected from pertussis and tetanus, and all pregnant individuals should receive 1 dose of Tdap to protect their babies until they can be vaccinated themselves. In addition, all adults should receive a booster dose of tetanus vaccine (Td) every 10 years to be protected from tetanus.
- Only 34% of adults reported having been vaccinated against pertussis after 18 years of age.
- 67% of Canadian adults reported having been vaccinated against tetanus in the previous 10 years.
- More females (37%) than males (30%) had been vaccinated against pertussis. There was no difference between females and males for tetanus.
- The most common reason for not getting vaccinated against pertussis or tetanus in adulthood was the perception that these vaccines are not necessary.
Pneumococcal vaccine
The bacterium Streptococcus pneumoniae, also known as pneumococci, is a common cause of pneumonia and can also cause blood infections referred to as invasive pneumococcal disease (IPD). People with some underlying medical conditions and seniors (65 years of age and older) are at higher risk of IPD and should receive the pneumococcal vaccine if not previously vaccinated.
Among seniors
- The results showed that 55% of seniors reported having received a pneumococcal vaccine in adulthood. The number remains below the national vaccination coverage goals for pneumococcal vaccine, which is 80% among this age group.
- Pneumococcal vaccination rate was higher for females (60%) compared to males (48%).
- The most common reason among seniors for not getting a pneumococcal vaccine was the perception that the vaccine is not necessary.
Among adults
- Only 26% of adults between 18-64 years of age with underlying medical conditions were vaccinated against pneumococci.
- The most common reason for non-vaccination among younger adults with underlying medical conditions was that they had never heard of the vaccine.
Shingles vaccine
Shingles is a painful skin rash with blisters, usually on part of one side of the body. It is triggered by the same virus that causes varicella (chicken pox). Any person who has had varicella can get shingles, but most people who get the disease are older than 50 or have a weakened immune system. One dose of the shingles vaccine is recommended for adults 50 years of age and older.
- Among adults 50 years of age and older, 27% reported receiving their shingles vaccine.
- The most common reason among adults 50 years of age and older for not getting a shingles vaccine was the perception that the vaccine is not necessary.
COVID-19 vaccines
At the time of the data collection between January 6 and February 11, 2021, two COVID-19 vaccines (Pfizer-BioNTech and Moderna) were authorized for use in Canada. At that time:
- most Canadian adults (72%) intended to get the COVID-19 vaccine, while 17% had not decided yet and 10% did not intend to get the COVID-19 vaccine
- the main reasons for Canadian adults to receive a COVID-19 vaccine were to protect themselves (32%) or their family members (18%) from the disease
- the main reason for being hesitant to get vaccinated against COVID-19 among adults aged 18-64 with underlying medical conditions was concerns about the safety and/or side effects of the vaccine, while the most common reason stated among seniors was not enough testing or research on the vaccine has been done
- overall, the common reasons stated for not intending to get a COVID-19 vaccine were:
- I do not trust vaccines in general (20%)
- I am afraid because it is a new vaccine (17%)
- I am afraid of potential adverse effects (15%)
- the proportion of those who intended to get vaccinated against COVID-19 was higher among people who had received their flu shot (89%) than those who had not (60%)
Knowledge, attitudes and beliefs
Most adults (90%) reported that they knew enough about vaccines to make a decision about getting vaccinated and considered vaccines to be important for their health (92%).
While most of the respondents believed that the flu shot is safe (91%), there were still 40% of respondents who believed they might get the flu from the flu vaccine—which is not true for any flu shot in Canada. Moreover, 34% felt that the flu vaccine does not protect them against getting the flu.
About three quarters of respondents (74%) agreed that the opinion of their family doctor, general practitioner or nurse practitioner is an important part of their decision to get the flu shot.
To summarize
Overall, coverage among all adults aged 18 years and older for the 2020/21 flu season has not changed significantly from previous years. Although the national flu vaccination coverage goal of 80% for those at higher risk remain unmet, flu shot uptake among seniors is close to this goal (70%), although little improvement has been achieved in recent years.
While almost half of the Canadian adults surveyed stated that they had encountered difficulties in scheduling an appointment for getting the flu shot this year due to the preventive measures to reduce the spread of COVID-19 (47%), it did not seem to have a significant impact on flu vaccination coverage.
The most common reason for getting the flu shot was to prevent infection or avoid getting sick, whereas the most common reason for non-vaccination was the perception of being healthy/never getting the flu.
While a greater proportion of seniors reported having received a pneumococcal vaccine in adulthood compared to younger adults, the number still fell short of the national goal of 80%.
The most commonly stated reason for not getting other adult vaccines (tetanus, pertussis, pneumococcal and shingles) was the perception that the vaccines are not necessary.
A full report of the survey results is available. For more information about the Seasonal Influenza Coverage Survey, please contact us at coverage-couvertures@phac-aspc.gc.ca.
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