People and COVID-19 booster doses


Volume 48-7/8, July/August 2022: Healthcare-Associated Infections & Antimicrobial Resistance


What do people think about COVID-19 booster doses?

Source: Emerging Sciences Group of the Public Health Agency of Canada. Evidence Brief on attitudes and acceptance of COVID-19 booster doses. April 2022. Full report available from:

Background: Attitudes towards the coronavirus disease 2019 (COVID-19) vaccines in the “Five Eye” countries—Canada, United States (US), United Kingdom (UK), New Zealand and Australia—have been followed throughout the pandemic. After tracking relatively high rates of acceptance for the first two doses of COVID-19 vaccine (89% in Canada), the focus has now turned to boosters. In late 2021, booster doses were authorized for those aged 18 years and older in all five countries. In March 2022, second boosters were initially recommended only for individuals who were immunocompromised or living in long-term care and congregate settings, but this varied by age from older than 50 years in the US, to older than 70 years in Canada and older than 75 years in the UK. In Canada, the National Advisory Committee on Immunization also strongly recommended the second booster for all people older than 80 years of age. Some jurisdictions have expanded these recommendations to include eligibility of all adolescents for the first booster and all adults older than 60 years of age for the second booster. The National Advisory Committee on Immunization noted the primary vaccine series and booster recommendations also apply to those who were previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has indicated that a second booster may be needed for the broader population in the future, depending on COVID-19 activity. A review was conducted to examine the evidence on the facilitators, barriers and hesitancy to accept or refuse COVID-19 booster doses among both vaccinated and unvaccinated populations.

Methods: Seven databases and targeted websites were searched for relevant articles up to April 1, 2022. Data from these articles were extracted into evidence tables and the key findings summarized.

Results: Twenty articles were identified including those from Canada (n=6), US (n=6), UK (n=5), New Zealand (n=1) and Australia (n=1) and globally (13 countries including Canada, US, UK and Australia, n=1). Fourteen of the articles were conducted since the approval of the COVID-19 booster dose in their respective countries, and the remaining six were conducted prior to the approvals in early to mid-2021.

Intention to receive COVID-19 booster doses

  • The most recent Canadian articles from February to March 2022 report that among those with two doses, 69% of those in British Columbia and 23% of those in Québec intended to receive a COVID-19 vaccine booster dose. In Québec, this decreased from 43% in January. Intention to accept a booster was highest in Atlantic Canada and lowest in the Prairies.
  • A longitudinal study in the UK showed that intention to receive a COVID-19 vaccine booster was steady from 88% to 95% between August and December 2021, but decreased to 72% in January 2022 and 53% in March 2022.

Factors associated with the intention to accept or reject booster doses

Overall, factors associated with intention to accept or reject a COVID-19 booster were similar to accepting/rejecting the first and second doses of the vaccine.

  • Intention to accept a booster dose was most commonly associated with older age, higher education, having long-term health conditions, being a past voter for the Liberal/Democrat parties, living in a larger more populated area and having trust in science and COVID-19 information. Asian or Caucasian people reported a higher intention to receive a booster than Black people.
  • Hesitancy about initial COVID-19 vaccination may be a strong predictor for hesitancy about booster doses of the vaccine. The main reasons reported for rejecting a booster were concerns about short and long-term side-effects and beliefs that a booster dose would not offer extra protection and/or that they were protected if they had already had COVID-19.
  • Overall support for vaccine donations to low-income countries before rolling out booster doses was high in both Canada and the UK.

Conclusion: Intentions to receive COVID-19 booster doses decreased between late 2021 and early 2022 in Canada and other countries. None of the previously published articles explored why this occurred. This review is based on self-reported results from surveys, so findings may be limited by response and social desirability bias. Additional public opinion studies are warranted as the course of COVID-19 and the booster recommendations evolve.

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