Post-COVID-19 pandemic inequities in routine childhood immunization in Canada: racial disparities in uptake of polio, meningococcal conjugate, and varicella vaccines.
BACKGROUND Decline in routine childhood vaccination coverage in Canada has accelerated following the COVID-19 pandemic, increasing risks of vaccine-preventable diseases. Yet, little is known about how this affects different racial groups. This study examines racial disparities in uptake of childhood polio, meningococcal, and varicella vaccines, and the roles of health literacy and conspiracy beliefs. METHODS We conducted a national survey that included 2,528 Canadian parents of children aged 0-12 years. Parents reported their child's vaccination status and completed measures of health literacy and COVID-19 conspiracy beliefs. Associations between parental racial category, sociodemographic characteristics and vaccine uptake were assessed using Chi-square tests and multivariable logistic regression models. RESULTS Overall vaccine uptake rates were 76.8% for polio, 73.1% for meningococcal conjugate, and 76.7% for varicella. Children of racialized parents had consistently lower vaccination coverage compared with children of White parents. Lower odds of polio and meningococcal vaccination were reported among children of Arab (aOR: 0.47-0.58), Asian (aOR: 0.36-0.45), Black (aOR: 0.63-0.69), and Indigenous parents (aOR: 0.54-0.60) compared to their White counterparts. Regarding varicella vaccination, uptake was significantly lower among children of Arab (aOR: 0.54, p < 0.001) and Asian parents (aOR: 0.61, p = 0.006), but not among children of Black and indigenous parents. Higher health literacy was associated with greater vaccine uptake, whereas stronger conspiracy beliefs were associated with lower uptake across all vaccines. CONCLUSIONS Racial inequities in routine childhood vaccination exist in Canada in the post-COVID-19 pandemic period. Strategies aimed at culturally tailored interventions, improved health literacy, and addressing mistrust and structural inequities are needed to support equitable vaccine coverage.