A qualitative investigation of facilitators and barriers to accessing COVID-19 vaccines among Racialized and Indigenous Peoples in Canada

Figures & data

Table 1. Participant characteristics (N = 27).

	Indigenous participants (N=10), n (%)	Racialized participants (N=17), n (%)	Total (N=27), n (%)
Indigenous Identity			10 (37)
First Nation	2 (20)
Métis	6 (60)
Not specified	2 (20)
Racialized Identity			17 (63)
Arab		1 (6)
Black		2 (12)
East Asian		2 (12)
Latin American		3 (18)
South Asian		7 (41)
West Asian		1 (6)
Ethnicity missing		1 (6)
Migration status
Born in Canada (referred to as Turtle Island by Canadian Indigenous communities)	10 (100)	6 (35)	16 (59)
Migrated more than 5 years ago	0 (0)	3 (18)	3 (11)
Newcomers to Canada (migrated less than 5 years ago)	0 (0)	8 (47)	8 (30)
Gender
Man	3 (30)	7 (41)	10 (37)
Woman	6 (60)	10 (59)	16 (59)
Man and gender nonconforming	1 (10)	0 (0)	1 (4)
Language of interview
English	7 (70)	16 (94)	23 (85)
French	3 (30)	1 (6)	4 (15)
Age
<20	0 (0)	2 (12)	2 (7)
20-29	0 (0)	3 (18)	3 (11)
30-39	4 (40)	5 (29)	9 (33)
40-49	2 (20)	6 (35)	8 (30)
50-59	1 (10)	1 (6)	2 (7)
60-69	1 (10)	0 (0)	1 (4)
≥70	2 (20)	0 (0)	2 (7)
Province
Alberta	0 (0)	3 (18)	3 (11)
British Columbia	2 (20)	4 (24)	6 (22)
Manitoba	2 (20)	2 (12)	4 (16)
Ontario	3 (30)	5 (29)	8 (30)
Quebec	2 (20)	3 (18)	5 (19)
Saskatchewan	1 (10)	0 (0)	1 (4)
Geographic location
Rural	3 (30)	0 (0)	3 (11)
Urban	7 (70)	17 (100)	24 (89)
Education
More than a bachelor’s degree	1 (10)	4 (24)	5 (19)
University certificate or diploma	3 (30)	2 (12)	5 (19)
Non-university certificate or diploma	4 (40)	4 (24)	8 (30)
High school or less	2 (20)	4 (24)	6 (22)
Missing	0 (0)	3 (18)	3 (11)

Table 2. Categories and quotes arising from interviews with Racialized and Indigenous Peoples regarding strategies to reduce barriers to COVID-19 vaccine access.

Theme	Representative Quotes from participants (using pseudonyms)
Information about COVID-19 disease and vaccination	“[Y]our language, lack of familiarity you know with the whole system here, with all these websites, and those – not everyone is computer literate or reads the news. I still think that when it comes to this very like critical topic, going beyond internet is a better choice. Like really old school hardcopy documents” (Adam, West Asian, ON)
	“[A] lot of their information is like “visit our website,” but like we’re missing a huge population that can’t visit our website. Like, it’s something I take for granted. I can Google anything, so can my kids, but like a lot of people I work with [as a social service provider] or a lot of people in the community, they don’t have that privilege and I think that’s forgotten” (Susan, Métis, MB)
	“Literacy is another big issue […] to simplify complicated scientific and medical terminology into something that could be translated and understood was very, very difficult and there aren’t necessarily words in [Indigenous] language[s] to describe some of the concepts that we were talking about” (Tanya, First Nations, ON)
COVID-19 vaccination booking procedures	“I mean, if they have a phone or Internet, it’s a little bit easier. But getting to some people who may be vulnerable and only use mail […] I assume more out of the elderly population, who […] may not be engaged in the Internet or social media, and may not answer their phone so much. They might be hard to get a hold of” (Keith, Métis, BC)
	“Well, first of all, the vaccine is not open for everyone. You need your health card, that’s the complication for a lot of people I know. A lot of people [are] working without a work permit, so they cannot apply for a health card. And that’s just crazy to me, like everybody should be able to register” (Tomás, Latin American, BC, newcomer)
	“Sometimes I just go and check it, [and] they’re all booked up […] So, either I have to wait, basically until everybody above me is done, or every day, you know, I go to refresh this page, internet page, to be able to get an appointment. […] I can feel that it clearly will be a competition” (Adam, West Asian, ON)
	“I was hoping, um yeah, I should have done three [appointments] together, […] my daughter got hers sometime in April, and then I got mine in May, and then my son got it sometime in May […] you know they don’t want us to catch [COVID], why make us go three times. We should just call one time and got everyone got the shots” (Jennifer, East Asian, BC, single mother)
COVID-19 vaccination sites	“[U]rban Indigenous were one of the priority populations after remote Indigenous […] But it was still difficult sometimes to get an appointment locally, and I do know of some urban Indigenous people that had to go to a town an hour away, or that was the soonest they could book” (Tanya, First Nations, ON)
	“But then what about like the single moms or the people who can’t afford bus fare to get to [a vaccination center], like then what? And we’re promoting “don’t go in a car with somebody you don’t live with,” so like what are you going to do, walk downtown to Winnipeg? Like it’s not even safe, right?” (Susan, Métis, MB)
	“There’s this new thing with allowing only one person in stores or go get your vaccine by yourself, or whatever so lots of single parents are […] shamed for having to bring their kid or saying like I need help. […] If you bring your kid with you into a store to go get your vaccine, like if I went to Superstore with my children, I’m definitely going to get dirty looks” (Susan, Métis, MB)
	“The police is just going to scare people away […] You involve them in the whole vaccine thing and that’s just trouble. It’s just, they’re shooting – the health care system’s shooting themselves in the foot” (Justin, Indigenous – not specified, ON)

Table 3. Categories and quotes arising from interviews with Racialized and Indigenous Peoples regarding barriers to COVID-19 vaccine access.

Theme	Representative Quotes from participants (using pseudonyms)
Information about COVID-19 disease and vaccination	“For Indigenous People it’s all about relationships, and not relationships over video or media. You know, going to a First Nation reserve and actually hosting something, not just putting out pamphlets or posting something on social media […] and putting the onus on everyone else to read the information. It just shows a different level of, I guess, respect when you take that time. And I know we’re living in a pandemic and that it’s probably not advised to have those type of conversations necessarily and that it will take a lot of work. But I mean ideally, that would be the best situation, I think” (Denise, Métis, SK)
	“[W]e need clear, concise information least amount of like extra words as possible and make it as like low grade as we can, and that’s just so everyone can understand, and be mindful of people’s understanding and education” (Susan, Métis, MB)
	“[H]aving the information in other languages [beyond English and French], that could be a good idea, especially online as that’s probably not very difficult to do. […] I also liked that when they have the press conferences and announcements, they always have someone with sign language” (Maria, Latin American, AB)
	“[W]e did a lot of work trying to reach Elders, and radio was a medium that they use frequently to get information, but access to translators was very very difficult. I mean, we made it a priority, and it happened, and we were able to translate on the radio and have materials translated. I mean even provincial and federal governments are pumping out information in like […] really common languages, but they weren’t pumping it out Oji-Cree, you know and that took a lot of advocacy [to have that happen]” (Tanya, First Nations, ON)
COVID-19 vaccination booking procedures	“[I]f they could make it something like voting, like a voting ballot. They sent you ballots at home. […] maybe based on again it could be postal code or last name, I don’t know if they could stamp tickets or ballots or something to the mailbox […] Like, “It is your turn now, you have one week, for example, to come and do the vaccination. If you don’t, then you will go to the end of the lineup” or something” (Adam, West Asian, ON)
	“[T]rying to get different languages [beyond English and French] for people to like talk to over the phone for booking the appointment because language could be a barrier for them” (Abdulla, Racialized – ethnicity missing, ON)
	“If we could pre-book or coordinate, I don’t know some sort of provincial kind of registry or something, that might be nice?” (Keith, Métis, BC)
	“They could have like in-person appointments for the technologically lacking people, to make an in-person appointment. Or just maybe have the vaccines as they go, like they don’t need an appointment” (Rohan, South Asian, BC)
COVID-19 vaccination sites	I think the vaccination in [the] community definitely was reassuring for people. Many communities had like blessing ceremonies or things like that when the vaccine arrived in the community. Some places had […] you know that -so they’re monitoring your physical health for 15- or 20-minutes post vaccination, but they [also] had elders available to sort of monitor your spiritual health or smudging available, that kind of thing that, you know, when you’re surrounded by people you trust” (Tanya, First Nations, ON)
	“Maybe we need mobile vaccinations at some point when we’re trying to get to the vulnerable population. Like they have mobile crisis units and parking lots where they can do medical care, maybe as part of that they could offer vaccinations as well” (Denise, Métis, SK)
	“Community centers, libraries, you know these offices that are closed down, you can turn them into a makeshift injection place for COVID quite easily. So whatever it takes to get those all the neighborhoods, get it done. […] I think there’s public health nurses that are out there walking the beat, that are actually doing injections right there on the sidewalk kind of thing” (Ed, First Nations, BC)
	“[P]eople with physical disabilities, for example, would have trouble going there. […] So maybe they could get vaccinated at their place if someone comes in, like injects a shot to them, that could be another concern too” (Abdulla, Racialized – ethnicity missing, ON)