Between racism and rumors: understanding vaccine mistrust among older racially diverse adults in Canada

COVID-19 vaccination plays a crucial role in reducing infection, hospitalization, and mortality. However, although the pandemic disproportionately affected racialized and Indigenous older adults, little is known about their attitudes and trust toward vaccines. This cross-sectional study examined COVID-19 vaccine mistrust and its associations with health literacy, conspiracy beliefs, and racial discrimination among racially diverse older Canadians. A cross-sectional online survey was conducted among racially diverse adults aged 55 years and older across Canada using Computer-Assisted Web Interviewing. COVID-19 vaccine mistrust was assessed as the dependent variable, while health literacy, conspiracy beliefs, racial discrimination, and sociodemographic characteristics were examined as independent variables. t-tests, ANOVA, and multivariable regression analyses were performed to examine associations between COVID-19 vaccine mistrust and the independent variables. The sample comprised 581 participants (11.5% Arab, 15.8% Asian, 16.2% Black, 9.0% Indigenous, 8.1% Mixed, 3.6% Other, and 35.8% White). COVID-19 vaccine mistrust varied significantly by race, with Black, Indigenous, Arab, and Asian participants reporting higher mistrust than White counterparts, F(6,574) = 7.14, p < 0.001. COVID-19 vaccine mistrust was greater among adults aged 55-64 (M = 10.5, 95%CI: 10.1-10.9) compared to those aged 65 and more (M = 8.7, 95%CI: 8.3-9.1). Regression analyses showed higher COVID-19 vaccine mistrust among Asian (β = 1.37, p < 0.001) and Black (β = 1.07, p = 0.003) participants. It was associated with lower vaccine confidence (β = -0.39, p < 0.001), and stronger conspiracy beliefs (β = 0.17, p < 0.001). This study reveals persistent racial and age disparities in COVID-19 vaccine mistrust among older Canadians. Beyond misinformation, mistrust reflects historical inequities and exclusion. Culturally grounded communication, improved health and media literacy, and trust-centered public health strategies are essential to strengthen vaccine confidence and promote equity in Canada's diverse aging population.