Racial disparities in coverage and determinants of childhood diphtheria, tetanus, and pertussis (DTaP) vaccination in Canada: a post-COVID-19 pandemic analysis

Vaccination is essential for preventing infectious diseases, yet childhood vaccine uptake declined in Canada following the COVID-19 pandemic, raising concerns amid the resurgence of pertussis. This study aimed to assess coverage and determinants of diphtheria, tetanus, and pertussis (DTaP) vaccination among children in Canada in the post-COVID-19 context. We analyzed data from a national survey of Canadian parents of children aged 0-12 years (N = 2528), with oversampling of Arab, Asian, Black, and Indigenous groups to enable accurate racial comparisons. Sociodemographic characteristics, health literacy, and vaccine-related conspiracy beliefs were evaluated. Overall vaccination coverage was 73% for diphtheria, 74% for pertussis, and 77% for tetanus. Significant racial disparities were observed across all outcomes (p < .001), with lower uptake among children of Arab, Asian, Black, and Indigenous parents compared with children of White parents. Vaccination varied significantly across provinces. After adjusting for sociodemographic factors, higher endorsement of vaccine-related conspiracy beliefs was associated with reduced odds of vaccination across all outcomes (diphtheria: aOR = 0.79, 95%CI: 0.72-0.87; tetanus: aOR = 0.70, 95%CI: 0.63-0.77; pertussis: aOR = 0.71, 95%CI: 0.64-0.78), whereas higher health literacy was associated with increased uptake (diphtheria: aOR = 1.37, 95%CI: 1.25-1.50; tetanus: aOR = 1.22, 95%CI: 1.11-1.34; pertussis: aOR = 1.26, 95%CI: 1.15-1.38). These findings demonstrate persistent racial inequities in childhood DTaP vaccination in Canada post-pandemic, shaped by structural and health behaviors' determinants. Targeted, culturally responsive strategies addressing misinformation and improving health literacy are critical to restoring vaccine coverage and preventing future outbreaks.