Vaccine hesitancy among racially diverse parents in Canada: The important role of health literacy, conspiracy beliefs and racial discrimination.

Parental vaccine hesitancy is a global public health issue that leads to lower immunization coverage among children. While vaccine mistrust is increased among racialized adults, whether parental vaccine hesitancy differs by ethnicity in the era of COVID-19 is unknown. Addressing these gaps in the literature, this study explores the factors influencing vaccine hesitancy among a racially diverse and representative sample of Canadian parents of children aged 0 to 12, comparing perspectives across different racial groups. An online survey was administered to a nationally representative sample of Arab, Asian, Black, Indigenous, White, and Mixed-race parents from October to November 2023. Data were collected on demographics, COVID-19 vaccine hesitancy, experience of major racial discrimination, conspiracy beliefs and health literacy. A total of 2528 parents (57.52 % women, 42.29 % men, and 0.20 % identified as non-binary gender) completed the survey. Significant mean differences in vaccine hesitancy were observed among racialized groups, F(7, 2520) = 3.89, p < .001, with Arab parents (M = 23.73, SD = 7.46) reporting higher hesitancy than White parents (M = 21.28, SD = 8.59). Younger participants (14-24 years) showed greater hesitancy (M = 23.98, SD = 8.22) than those aged 55+ (M = 20.26, SD = 7.83), F(4, 2523) = 2.84, p = .023. Regression analyses indicated that conspiracy beliefs (β = 0.48, p < .001) and racial discrimination (β = 0.09, p = .012) are key predictors of vaccine hesitancy. A significant interaction between conspiracy beliefs and discrimination was found among racialized groups (β = 0.24, p < .001). Based on these results, addressing vaccine hesitancy requires nuanced, participatory approaches that foster trust, counter misinformation, and acknowledge systemic racial inequities. As, health literacy, conspiracy beliefs, and racial discrimination significantly shape parental decisions, future policies must integrate culturally and racially tailored strategies to promote vaccination, ensuring that every child in Canada is protected.