Factors associated with childhood non-vaccination against COVID-19 in Canada: A national survey analysis.

Background: COVID-19 vaccination efforts are critical in mitigating the impact of the virus, but despite proven safety and efficacy, vaccination rates among children in Canada are lower than in adults, prompting a need to explore determinants of childhood COVID-19 non-vaccination to improve uptake. Method: This study analyzed data from the Canadian COVID-19 Immunization Coverage Survey 2022. Using multivariable logistic regression, it examined the association between COVID-19 non-vaccination among children aged 5-17 and factors such as parental sociodemographic characteristics, vaccine knowledge, attitudes, and beliefs (KAB), and vaccination history. Results: The analysis revealed that negative KAB towards vaccines, reflected in higher KAB composite scores, significantly increased the likelihood of non-vaccination. Additionally, factors such as lower household incomes, rural residence, employment in sectors not at risk for vaccine-preventable diseases, and younger parental age were associated with higher non-vaccination. The study also highlighted ethnic disparities in vaccination odds and found that children with incomplete routine vaccinations or inconsistent flu vaccination histories were more likely to be unvaccinated against COVID-19. Surprisingly, children of parents who consistently received flu vaccinations were more likely to be unvaccinated against COVID-19. Furthermore, parental education levels showed a complex relationship with children's COVID-19 vaccination status, indicating nuanced influences on vaccination decisions. Conclusion: The findings offer vital insights into the factors influencing COVID-19 vaccination uptake among children in Canada, suggesting avenues for targeted strategies to improve vaccine coverage.