Navigating vaccine access, trust, coercion and regret: post-pandemic lessons on COVID-19 vaccination among newcomer communities in Alberta, Canada

Since the COVID-19 pandemic routine vaccination rates have dropped in Canada. Many newcomers and refugees experience significant vaccine inequities despite wide vaccine availability and COVID-19 pandemic vaccination campaigns. We aimed to investigate post-pandemic vaccine hesitancy, acceptance, and vaccine outreach strategies among newcomers’ communities. We conducted a community-based-participatory research (CBPR) qualitative study with self-identified newcomers in Alberta between July 2022 - January 2023. Community Scholars, leaders representing various ethnocultural communities trained in community-engaged research conducted semi-structured interviews and focus groups in English and first languages. Scholars collected and translated detailed qualitative notes which were thematically analyzed and coded using a consensus-based approach. We conducted two focus groups and five semi-structured interviews with 12 participants, originating from the Philippines, Ethiopia, Eritrea, Mexico, Africa and Egypt. Using WHO 3Cs (confidence, convenience, complacency) model of vaccine hesitancy, we identified three main themes, each with two subthemes: (1) vaccine hesitancy due to lack of reliable information and religious and cultural beliefs, (2) access to COVID-19 vaccines and information, and (3) vaccine acceptance as voluntary or coerced. Employer mandated vaccination emerged as a critical issue with potential long-term negative public health implications, leading to vaccine regret and loss of trust of public health authorities and healthcare systems. During population-wide COVID-19 vaccination campaigns newcomers perceived their communities’ circumstances were overlooked, potentially increasing vaccine hesitancy. Perceived coercive vaccination policies had unintended negative public health consequences. These findings may help inform future emergency and routine public health vaccination policies.