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Accessibility matters: Pathways to a more inclusive future
Innovation Issue 36: Spring 2022

Increasing vaccination rates among older adults

Policy & Perspective 

Increasing vaccination rates among older adults

An illustration of medical vials and syringes against a light teal background which includes silhouettes representing viruses


Can the lessons learned about mass vaccination initiatives during the COVID-19 pandemic be applied to protecting older adults from preventable diseases?

In Canada, COVID-19 vaccinations were first made available in mid-December 2020, after the pandemic was declared in March earlier that year. Since then, 93 per cent of the country’s aged 60-plus population has been inoculated against the virus. Researchers from the National Institute on Ageing (NIA), a think tank based at Toronto Metropolitan University’s Ted Rogers School of Management, examined how COVID-19 responses can help to inform policies aimed at increasing vaccination rates for influenza, pneumonia and shingles.

In their report released in November 2021, the research team, led by Dr. Samir Sinha, the NIA’s director of health policy, made seven recommendations for how to increase the number of older adults in Canada getting vaccinated against what are known as the “Big 3” – influenza, pneumonia and shingles – based on COVID-19 immunization rollouts from across different Canadian and international jurisdictions. Vaccination rate successes during the pandemic have challenged the perception that older adults are vaccine hesitant, says Dr. Sinha, who is also the director of geriatrics at Sinai Health and the University Health Network in Toronto. “They want to do things that will help them stay healthy and independent for as long as possible,” he said. 

Pneumonia and influenza cause thousands of deaths every year, he says, adding that shingles, while not as deadly, can lead to a significant decrease in the overall quality of life. 

While the Public Health Agency of Canada (PHAC) has set national immunization targets at 80 per cent for adults aged 65 and over, the actual rates for influenza and pneumonia vaccinations are well below that. 

The PHAC vaccination coverage survey of adults aged 50 and up says that while 70 per cent stated getting the annual flu shot, 55 per cent reported having the pneumococcal vaccine and only 27 per cent reported receiving the shingles vaccine in 2021. The NIA’s recommendations include measures aimed at increasing public awareness and confidence about the available vaccinations, and policy suggestions that would help to increase accessibility and decrease barriers for this age group.

“Making sure that people can access key health interventions by taking away financial barriers, really making sure that there’s good communication campaigns, and making sure that we actually deal with accessibility issues, for example, whether it be transportation, language, digital or other concerns,” said Dr. Sinha.

While influenza and pneumonia vaccines are publicly funded for older adults in most jurisdictions in Canada, the shingles vaccine can cost individuals several hundred dollars. The NIA recommends making all three vaccinations free for older adults. The researchers further suggest applying other features of the COVID-19 vaccine campaign to these three types of inoculations, such as expanding access to vaccine types and services through pharmacies, community clinics and especially homebound vaccination programs. Another accessibility recommendation is to create culturally targeted communication campaigns, including providing information in different languages, to reach diverse populations.

“Vaccination is actually a really, really good public health intervention that could really not only save costs, but also significantly improve people’s overall quality of life,” Dr. Sinha said of the NIA’s policy recommendations to improve vaccination coverage. In addition to the NIA report, the researchers have published a comparative analysis of different COVID-19 strategies for older adults employed in Alberta and Ontario in the Journal of the American Geriatrics Society., external link

The NIA report, PDF fileLessons Learned: What Successful COVID-19 Immunization Efforts Taught Us About Improving Vaccine Coverage Among Older Canadians for Other Vaccine-Preventable Diseases, external link and its recommendations were developed by Dr. Sinha, policy analyst Natalie Iciaszczyk and research coordinator Cameron Feil. A previous NIA report, PDF fileA Cautionary Tale: Canada’s COVID-19 Vaccine Rollout for Older Canadians, external link, by the research team and Emily Boucher, a junior research fellow at the NIA, examined the COVID-19 rollout for older Canadians. 

Dr. Sinha has also contributed to briefs published by the Ontario COVID-19 Science Advisory Table, such as a recent brief on mobile, in-home vaccinations for homebound older adults in Ontario., external link

Read A comparative impact analysis of different COVID-19 vaccination strategies for older adults across two Canadian provinces in the Journal of the American Geriatrics Society., external link



The NIA’s recommendations include measures aimed at increasing public awareness and confidence about the available vaccinations, and policy suggestions that would help to increase accessibility and decrease barriers for this age group.




The work of the National Institute on Ageing is supported by the Ted Rogers School of Management and a number of charitable partners.