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. 2025 Dec;21(1):2458353.
doi: 10.1080/21645515.2025.2458353. Epub 2025 Feb 3.

Acceptance and attitudes towards COVID-19 vaccination during pregnancy in Canada

Suraya Bondy  1 , Elisabeth McClymont  1 , Gal Av-Gay  1 , Arianne Albert  2 , Janice Andrade  1 , Sandra Blitz  1 , Ianna Folkes  1 , Lucia Forward  1 , Erin Fraser  1 , Sela Grays  1 , Jon Barrett  3 , Julie Bettinger  4 , Tali Bogler  5 , Isabelle Boucoiran  6 , Eliana Castillo  7 , Rohan D'Souza  8 , Darine El-Chaâr  9 , Shaza Fadel  10 , Verena Kuret  7 , Gina S Ogilvie  2 , Vanessa Poliquin  11 , Manish Sadarangani  4 , Heather Scott  12 , John W Snelgrove  13 , Modupe Tunde-Byass  13 , Deborah Money  1   2 ; COVERED Team; COVERED Team:
Collaborators, Affiliations

Acceptance and attitudes towards COVID-19 vaccination during pregnancy in Canada

Suraya Bondy et al. Hum Vaccin Immunother. 2025 Dec.

Abstract

The COVID-19 pandemic posed a unique set of risks to pregnant women and pregnant people. SARS-CoV-2 infection in pregnancy is associated with increased risk of severe illness and adverse perinatal outcomes. However, evidence regarding the use of COVID-19 vaccines in pregnancy shows safety and efficacy. Despite eligibility and recommendations for COVID-19 vaccination among pregnant women and pregnant people in Canada, uptake remains lower compared to the general population, warranting exploration of influencing factors. The COVERED study, a national prospective cohort, utilized web-based surveys to collect data from pregnant women and pregnant people across Canada on COVID-19 vaccine attitudes, uptake, and hesitancy factors from July 2021 to December 2023. Survey questions were informed by validated tools including the WHO Vaccine Hesitancy Scale (VHS) and the Theory of Planned Behavior (TPB). Of 1093 respondents who were pregnant at the time of the survey, 87.7% received or intended to receive a COVID-19 vaccine during pregnancy. TPB variables such as positive attitudes toward COVID-19 vaccines (OR = 1.11, 95% CI = 1.08-1.14), direct social norms, and indirect social norms were significantly associated with vaccine acceptance. Perceived vaccine risks, assessed by the WHO VHS, were greater in those not accepting of the vaccine. Our study identified several key factors that play a role in vaccine uptake: perceived vaccine risks and safety and social norms. These findings may guide public health recommendations and prenatal vaccine counseling strategies.

Keywords: COVID-19; acceptance; attitudes; immunization; pregnancy; uptake; vaccines.

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Conflict of interest statement

EM has received salary support in the form of postdoctoral fellowships from Michael Smith Health Research BC and the Canadian HIV Trials Network/CANFAR. J Barrett has received funding and honoraria from Ferring Pharmaceuticals and is a medical advisor for a technical company (MYANT), which manufactures and sells textile-based smart technology. IB is funded by a “Fond de Recherche du Québec – Santé” salary award. RD is supported by a Tier-II Canada Research Chair in Maternal Health (CRC-2021-00337). DE–C is an investigator on projects funded by Moderna, funds are paid to the research institution. A donation from Merck to the The Centre for Vaccine Preventable Diseases, at the Dalla Lana School of Public Health, supported the salary of SF from April 2020 to February 2023. SF does not receive funding directly from Merck or any personal payment or direct funds from vaccine manufacturers to support her research. VP was a lecturer for a talk sponsored by Sanofi-Pasteur in June 2022. MS is supported via salary awards from BC Children’s Hospital Foundation and Michael Smith Foundation for Health Research. MS has been an investigator on projects funded by GlaxoSmithKline, Merck, Moderna, Pfizer, Sanofi-Pasteur, Seqirus, Symvivo, and VBI Vaccines. All funds were paid to his institute, and he has not received any personal payments. MT-B has received speaking honoraria not related to this work as well as education and research grants from Ferring Pharmaceuticals. DM has received past funding from Merck (outside the submitted work). All other authors report there are no competing interests to declare. Study authors SB, EM, AA, JA, IF, JB, TB, EC, RD, DE-C, SF, VK, GO, VP, MS, HS, JS, MBT, and DM previously submitted an abstract outlining preliminary findings of this study to the 2023 Canadian Immunization Conference.

Figures

Figure 1.
Figure 1.
Flow diagram of COVERED participants included in this analysis.
Figure 2.
Figure 2.
Number of respondents in each category of the WHO vaccine hesitancy scale – perceived vaccine risks.
Figure 3.
Figure 3.
Number of respondents in each category of the theory of planned behavior – attitudes toward COVID-19 vaccines.
Figure 4.
Figure 4.
Number of respondents in each category of the perceived reliability of healthcare information sources.
See this image and copyright information in PMC

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