The evolution of vaccine hesitancy through the COVID-19 pandemic: A semi-structured interview study on booster and bivalent doses

Jeanna Parsons Leigh, Emily A. FitzGerald, Stephana Julia Moss, Michal S. Cherak, Rebecca Brundin-Mather, Alexandra Dodds, Henry T. Stelfox, Ève Dubé, Kirsten M. Fiest, Donna M. Halperin, Sofia B. Ahmed, Shannon E. MacDonald, Sharon E. Straus, Terra Manca, Josh Ng Kamstra, Andrea Soo, Shelly Longmore, Shelly Kupsch, Bonnie Sept, Scott A. Halperin

Research output: Contribution to journalJournal Articlepeer-review


We sought in-depth understanding on the evolution of factors influencing COVID-19 booster dose and bivalent vaccine hesitancy in a longitudinal semi-structured interview-based qualitative study. Serial interviews were conducted between July 25th and September 1st, 2022 (Phase I: univalent booster dose availability), and between November 21st, 2022 and January 11th, 2023 (Phase II: bivalent vaccine availability). Adults (≥18 years) in Canada who had received an initial primary series and had not received a COVID-19 booster dose were eligible for Phase I, and subsequently invited to participate in Phase II. Twenty-two of twenty-three (96%) participants completed interviews for both phases (45 interviews). Nearly half of participants identified as a woman (n = 11), the median age was 37 years (interquartile range: 32–48), and most participants were employed full-time (n = 12); no participant reported needing to vaccinate (with a primary series) for their workplace. No participant reported having received a COVID-19 booster dose at the time of their interview in Phase II. Three themes relating to the development of hesitancy toward continued vaccination against COVID-19 were identified: 1) effectiveness (frequency concerns; infection despite vaccination); 2) necessity (less threatening, low urgency, alternate protective measures); and 3) information (need for data, contradiction and confusion, lack of trust, decreased motivation). The data from interviews with individuals who had not received a COVID-19 booster dose or bivalent vaccine despite having received a primary series of COVID-19 vaccines highlights actionable targets to address vaccine hesitancy and improve public health literacy.

Original languageEnglish
Article number2316417
JournalHuman Vaccines and Immunotherapeutics
Issue number1
Publication statusPublished - 2024


  • COVID-19
  • Vaccine hesitancy
  • bivalent
  • booster
  • interviews
  • public


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