IntroductionImmigrants were disproportionately impacted by COVID-19 and experience unique vaccination barriers. In Canada (37 million people), 23% of the population is foreign-born. Immigrants constitute 60% of the country’s racialized (non-white) population and over half of immigrants reside in Ontario, the country’s most populous province. Ontario had several strategies aimed at improving vaccine equity including geographic targeting of vaccine supply and clinics, as well as numerous community-led efforts. Our objectives were to (1) compare primary series vaccine coverage after it was widely available, and first booster coverage 6 months after its availability, between immigrants and other Ontario residents and (2) identify subgroups experiencing low coverage.Materials and methodsUsing linked immigration and health administrative data, we conducted a retrospective population-based cohort study including all community-dwelling adults in Ontario, Canada as of January 1, 2021. We compared primary series (two-dose) vaccine coverage by September 2021, and first booster (three-dose) coverage by March 2022 among immigrants and other Ontarians, and across sociodemographic and immigration characteristics. We used multivariable log-binomial regression to estimate adjusted risk ratios (aRR).ResultsOf 11,844,221 adults, 22% were immigrants. By September 2021, 72.6% of immigrants received two doses (vs. 76.4%, other Ontarians) and by March 2022 46.1% received three doses (vs. 58.2%). Across characteristics, two-dose coverage was similar or slightly lower, while three-dose coverage was much lower, among immigrants compared to other Ontarians. Across neighborhood SARS-CoV-2 risk deciles, differences in two-dose coverage were smaller in higher risk deciles and larger in the lower risk deciles; with larger differences across all deciles for three-dose coverage. Compared to other Ontarians, immigrants from Central Africa had the lowest two-dose (aRR = 0.60 [95% CI 0.58–0.61]) and three-dose coverage (aRR = 0.36 [95% CI 0.34–0.37]) followed by Eastern Europeans and Caribbeans, while Southeast Asians were more likely to receive both doses. Compared to economic immigrants, resettled refugees and successful asylum-claimants had the lowest three-dose coverage (aRR = 0.68 [95% CI 0.68–0.68] and aRR = 0.78 [95% CI 0.77–0.78], respectively).ConclusionTwo dose coverage was more equitable than 3. Differences by immigrant region of birth were substantial. Community-engaged approaches should be re-invigorated to close gaps and promote the bivalent booster.

Canada’s appeal as an immigration destination has been increasing over the past two decades, with a total of 464,265 people immigrating to the country in 2024. This figure is an increase from 2000-2001, when approximately 252,527 immigrants came to Canada. Immigration to the Great White North Between July 1, 2022 and June 30, 2023, there were an estimated 199,297 immigrants to Ontario, making it the most popular immigration destination out of any province. While the number of immigrants has been increasing over the years, in 2024 over half of surveyed Canadians believed that there were too many immigrants in the country. However, in 2017, the Canadian government announced its aim to significantly increase the number of permanent residents to Canada in order to combat an aging workforce and the decline of working-age adults. Profiles of immigrants to Canada The gender of immigrants to Canada in 2023 was just about an even split, with 234,279 male immigrants and 234,538 female immigrants. In addition, most foreign-born individuals in Canada came from India, followed by China and the Philippines. The United States was the fifth most common origin country for foreign-born residents in Canada.