Table 4 Contextual factors impacting COVID-19 vaccine coverage for newcomer refugees and immigrants in Calgary and area (2021–2022) with verbatim quotes

Vaccine supply:

Availability of vaccines was a common challenge early in the vaccine roll-out especially, meaning some clients would arrive to appointments only to find out there were no vaccines available. At other times, vaccines were in oversupply and discarded.

“There were periods when vaccines were in short supply or certain vaccines were in short supply, which meant people were sometimes not able to receive their vaccine even when they booked it or had to wait to receive their preferred dose. Similarly, when vaccines were more widely available, some of the need for the more dedicated community models waned.” (Key informant 01)

Mandates:

During most of the vaccine roll-out period explored, vaccine mandates were in place requiring vaccination for air travel, border crossings, some employment, and some access to facilities. Informants found that this encouraged vaccine uptake but did not necessarily mitigate concerns around vaccine safety.

"Vaccine mandates.. stimulated demand again and so we saw a big spike in demand when the [Restrictions Exemption Program] came in.. after that initial peak it plateaued again.” (Key informant 13)

Accepted vaccines:

What vaccines were acceptable at any given time varied throughout the vaccine roll-out period as new vaccines were being developed and new research being released. This had implications for newcomers who sometimes were vaccinated in a previous country but that vaccine may not have been accepted. Therefore, an individual may have been defined as un-vaccinated in Canada but they had been vaccinated with a non-accepted vaccine. The changing rule around accepted vaccines was also a source of confusion for community members.

“[…] so many people took Sinopharm, so many people took Johnson and Johnson [prior to being with our clinic]. And the system just said no, this is not something legit or not something approved by our health care system. You have to take a full new series, either Moderna or you have to take Pfizer. In just like 2–3 weeks after that, they put on their website like this is all OK.” (Key informant 01)

Eligibility:

Who was available for what vaccine doses changed frequently throughout the vaccine rollout. Therefore, vaccine uptake should be considered in the context of what was available and for whom at any given time. When new groups became eligible or new doses became available, demand would typically increase. Informants noted that when a new demographic group became eligible, for example, youth, there was also an immediate uptick in vaccination rates.

“When Omicron came… we expanded third doses to everybody, there was again an absolute surging demand over supply…” (Key informant 13)

Novelty of vaccine availability:

Informants also observed a pattern related to information needs, hesitancies, and demand that related to the pattern of the vaccine rollout itself, and in some ways to what might be typical for when any new vaccine and medicine comes to be available.

“Questions and concerns changed over time as public knowledge shifted. For example, ‘what is it’ ‘I’m not sure..’ was prevalent in the beginning. Then it shifted towards questions and concerns about documentation, old records, QR codes, Alberta health equivalents, recognition of old vaccines.” (Key informant 13)

In reference to late 2021 and early 2022: “It's higher than the early groups, because again, now everything is on track. Everything is smoother. Most of the people that we are receiving now, they have Pfizer vaccine or J&J. Most of them, either the kids already took Pfizer or they are going to start here.” (Key Informant 01)

Time of arrival and pre-arrival country(ies) of residence:

For incoming newcomers, time of arrival to Canada (in relation to phase of vaccine rollout) and country (or countries) of origin/last residence was also a critical contextual factor. For example, key informants noted that there were more Afghan newcomers needing vaccines in August 2022 (first wave of arrivals to Canada) than a few months later, because those later groups had been able to be vaccinated in the country they were temporarily residing prior to arriving to Canada.

“The type of clients that we're seeing, and where they are in the process has changed.. there's more people who are fully vaccinated [now in mid-2022].” (Key informant 08)

Phase of vaccine roll-out:

Similar to trends related to the novelty of vaccine availability, informants observed an increase to information needs, hesitancies, and demand that related to the accelerating vaccine rollout itself, and in some ways to what might be typical for any time a new vaccine, medicine, or otherwise comes to market. Informants discussed that some of the ebbs and flows in demand and interest/disinterest were not necessarily novel to COVID-19. They also noted that processes became smoother as personnel gained experience with specific vaccination models and populations.

“Questions and concerns changed over time as public knowledge shifted. For example, ‘what is it’ ‘I’m not sure..’ was prevalent in the beginning. Then it shifted towards questions and concerns about documentation, old records, QR codes, Alberta health equivalents, recognition of old vaccines.” (Key informant 13)

In reference to late 2021 and early 2022: “It's higher than the early groups, because again, now everything is on track. Everything is smoother. Most of the people that we are receiving now, they have Pfizer vaccine or J&J. Most of them, either the kids already took Pfizer or they are going to start here.” (Key informant 01)

“We got better at streamlining the process. You know we with the refugees in particular You know a lot of them came from large families, so instead of having three or four people sitting in the chairs, you explain things—you might have 12—so you might have grandparents and cousins so we would still kind of look at them as a group, you know they can ask questions back and forth, and before they ever you know decided what they wanted to have as far as immunizations so that definitely changed, that was a unique approach with them. The translators got pretty skilled at the questions so that became more streamlined for sure. And we found that too, we did some temporary foreign worker clinics in the summer, some outreach clinics there and same thing with the translators after a few clinics. You know they knew what to expect so they were able to streamline the process for us.” (Key informant 03)