Does Vaccination Via Community Pharmacies Work in Favour of or Against Health Equity in Canada?

Abstract

Background: Community pharmacy-based immunization (CPBI) has been used increasingly in Canada. There is evidence that this approach increases vaccination rates but can also result in inequitable access to immunizations in neighborhoods with lower incomes, education levels, and higher proportions of ethnic minorities. As the use of CPBI increases, it is important to understand the extent to which this approach to vaccine distribution impacts health equity. Objectives: To determine if neighborhood-level factors are associated with differences in utilization of CPBI’s for COVID-19 and influenza vaccinations, and if there are provincial differences in CPBI or in the factors influencing the uptake of CPBI. Methods: An ecological study design was used to analyze data on the number of influenza and COVID-19 doses administered in community pharmacies in Alberta, Ontario, and Quebec from 2018-2023. Regional differences were investigated by linking this data to the 2021 Canadian census for neighborhood characteristics. Analysis included visual heat maps, ANOVA, non-parametric tests, and negative binomial regression modelling with corrections for population size and provincial clustering. All analysis was conducted in STATA BE 18.0 with an alpha of 0.05. Results: Differences were found in monthly rate of doses administered per 100,000 people between all 3 provinces for both vaccine types, with Ontario having the highest CPBI utilization followed by Alberta, and Quebec. Lower population density and higher proportion of visible minorities were consistently associated with lower rates of CPBI across provinces and vaccine types. There was evidence that factors influencing CPBI for influenza vaccines were different than the factors for COVID-19 vaccines, suggesting potential differences in vaccine-seeking behaviours beyond those accounted for in this investigation. Conclusions: While community pharmacies can contribute to increasing rates of vaccination, the findings of this study demonstrate important heterogeneity in the distribution of vaccine administrations across regions, illustrating the potential for community pharmacies to work for or against achieving equitable vaccination coverage. As scientists predict more frequent pandemics in the future, it is essential that the federal and provincial governments work together to develop more proactive strategies to improve the equitable administration of effectively reach those who are at highest risk.