Ethnic disparities in COVID-19 vaccine uptake among among 55+ year-old Canadians: Exploring the role of racial discrimination, chronic disease comorbidities, and conspiracy beliefs

Background Canada’s COVID-19 vaccination program achieved high overall coverage, yet older racialized and Indigenous people experienced lower uptake and far higher infection and mortality rates. Structural inequities, low health literacy, mistrust, and misinformation contributed to these gaps. Despite early vaccine prioritization, little disaggregated data exist for racialized and Indigenous older adults. This study examines vaccine uptake in these underserved groups to inform more equitable public health strategies and strengthen future pandemic responses. Methods We conducted a Canada-wide cross-sectional online survey of adults aged ≥55 years in March 2025 using Computer-Assisted Web Interviewing. Participants completed measures assessing COVID-19 vaccination doses, experiences of major racial discrimination, conspiracy beliefs, health literacy, chronic conditions, and sociodemographic characteristics. Results Of the 581participants, 90,3% received at least one dose. Black and Indigenous people were more often unvaccinated (17%), compared to 5.5-6% for Asians and Arabs. Receipt of ≥5 doses was observed in 50% of White, 41.8% of Asian and 13.8% of Black individuals. Older adults (≥65 years) had greater uptake (OR=1.58, 95%CI: 1.07–2.32), as did retirees (OR=2.47) and more highly educated participants (college OR=2.29; Bachelor OR=2.77). Higher conspiracy belief scores were significantly associated with lower odds of receiving higher doses (OR=0.91, 95%CI: 0.89–0.93; p <0.001). Additionally, a greater number of chronic diseases was associated with higher odds of being in a higher vaccine-dose category (OR = 1.09, 95% CI: 1.02–1.18). Conclusion Despite pandemic efforts, substantial ethnic disparities in COVID-19 vaccine uptake persisted, with lower coverage in racialized and Indigenous groups. Addressing structural inequities, comorbidities, and misinformation is critical to achieving more equitable, culturally responsive vaccination strategies.