This is part of a continuing series of recommendations put out by CoVaRR-Net. These recommendations are directed to the Federal Deputy Minister of Health, local and Provincial Medical Health Officers, school divisions, parents, Urban Health Network, and the Variants of Concern Expert Panel.

The current environment of the COVID-19 pandemic is constantly changing. Please note the date of the reviews and scans throughout the document, and the date of the release, and be aware that the context may have changed by the time of reading this SBAR document.


Vaccine hesitancy, defined as the delay in acceptance or refusal of vaccination despite availability of vaccination services influenced by the 3-Cs, complacency, convenience, and confidence, is a threat to the success of COVID-19 vaccination programs.

Health Canada authorized the use of the Pfizer-BioNTech Comirnaty COVID-19 vaccine for children 5 to 11 years of age on November 19, 2021. Following that, on July 14, 2022, Health Canada approved the Moderna Spikevax COVID-19 vaccine for children aged 6 months to 5 years old, which makes approximately 1.7 million Canadian children eligible for COVID-19 vaccination. Recently, on September 1, 2022, Health Canada has authorized an adapted version of Moderna Spikevax COVID-19, known as Moderna Bivalent, to target the original SARS-CoV-2 virus strain and the Omicron subvariant. The vaccine has been used as a booster dose for adults 18 years of age or older.

Despite the availability of pediatric vaccinations, vaccine hesitancy in children is still a concerning issue. According to the 2017 Childhood National Immunization Coverage Survey, 17% of Canadian parents are vaccine hesitant. Overall, the lack of confidence in the safety and effectiveness of vaccines is a major contributor to some parents’ decisions not to vaccinate their children. It requires immediate attention as the uptake of the COVID-19 vaccine is key to reducing hospitalizations and death during the pandemic.

Several strategies were employed to scale up vaccination in children. For instance, in September 2021, the Hospital for Sick Kids (Sick Kids) operationalized virtual clinical consultation service for youth and caregivers in Ontario for questions and/or concerns about COVID-19 vaccination to help address vaccine hesitancy and enhance vaccination uptake.

The following SBAR has been updated to review the evidence in the past nine months and to further explore front line strategies for public health officials to adopt to reduce vaccine hesitancy among school aged children and parents.  The SBAR will be updated to further investigate recent media campaigns, education strategies, and successful approaches used by jurisdictions to reduce vaccine hesitancy in school aged children within a COVID-19 context.

CoVaRR-Net Recommendations

At the federal level

  • Fund and support a Canada-wide evaluation of the provincial/territorial child vaccine hesitancy approaches to assess the effectiveness of strategies during the COVID-19 pandemic.
  • Utilize evidenced-based information and local public health evaluations to develop, fund, and support a national framework for vaccine uptake strategies for children and youth. Build evidence-based clinical practice guidelines for future COVID-19 vaccinations, other vaccinations, and recommendations for future pandemic preparedness.

At the provincial/territorial levels

  • Utilize the evidenced-based approaches, listed next, as suggested by the Ontario Science Table.
  • Invest in developing resources for health care providers to learn how to navigate COVID-19 hesitancy conversations, set up and resource a reminder and recall system, and develop public health communication campaigns targeted towards children. Tailor campaigns for marginalized communities.

At the local/regional levels

  • Utilize trusted community leaders, members, and health care professionals to be COVID-19 vaccine ambassadors. Provide additional training, support, and resources for difficult conversations.
  • Work with school divisions/boards to offer school based-vaccination clinics to decrease access barriers as identified by the Ontario Science Table.
  • Provide supports to children at the vaccination site for fear of needles. Coloring books, decorations, therapy dogs, and culturally relevant resources have been utilized in some PTs and can improve vaccination uptake.
  • Health Care Providers: For conversations with children and parents regarding COVID-19 vaccine hesitancy, Motivational Interviewing can be applied during a visit. Motivational Interviewing is an evidence-based and culturally sensitive way to speak with vaccine hesitant parents about receiving the COVID-19 vaccine. The intention of Motivational Interviewing is to help people manage mixed feelings about the vaccine and direct them toward healthy behavior change that is consistent with their beliefs and values.
  • Families/Parents/Caregivers: To assist children with the fear of needles, talk to your child about vaccines and prepare them for the day, bring a distractor to engage your child, and plan something fun for after vaccination. Practice breathing exercises if you notice signs of anxiety in your child.

Read CoVaRR-Net’s full Situation, Background, Assessment and Recommendation (SBAR) document on Vaccine Hesitancy in Children.

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