Alberta's COVID-19 vaccination rates tied to levels of formal education, data shows

An analysis of COVID-19 vaccination rates in Alberta suggests one socio-economic factor, more than others, is correlated to vaccine uptake. And it's not income, language or cultural barriers.

It's education.

This presents a particularly tricky challenge for those trying to combat vaccine hesitancy, especially as demand for first doses in the province appears to be waning. 

Roughly 69 per cent of eligible Albertans have received a first dose so far, with just over 20 per cent being fully vaccinated. However, the province has been pushing for a threshold of 70 per cent with at least one shot in order to move to Stage 3 of its three-stage reopening plan, which would see many of its restrictions lifted.

Experts who have reviewed the education data say they are not particularly surprised by what it shows. In poll after poll of public opinion, people with higher levels of formal education tend to express more willingness — even eagerness — to get vaccinated against COVID-19.

That now looks to be playing out in the vaccination rates Alberta Health publishes for each of its 132 local health areas.

But teasing out exactly what's going on — and what to do about it — is not so simple.

Researchers stress that correlation is not causation, and since levels of education are interrelated with so many other factors, it's hard to say exactly what's behind the relationship between these two variables.

There's hope, though, that a better understanding of this relationship will help in the effort to boost vaccination rates and further stamp out the virus that causes COVID-19.

What the data show

Economist Blake Shaffer is the kind of guy who does a multivariate regression analysis in his spare time.

He recently took it upon himself to wade through reams of vaccination and census data, looking for patterns among the many social and economic indicators that might help explain why some Albertans have snapped up vaccines — and others haven't.

"What I found was it's actually education, more so than income, that seems to be driving it," said Shaffer, who works at the University of Calgary.

Simply put, he said, areas where more people have a university degree tend to have higher vaccination rates.

Conversely, areas where fewer people have a high school diploma tend to have lower vaccination rates.

The relationship is so pronounced, Shaffer said, it can't be ignored.

But he cautioned that a couple of charts only tell a small part of the story.

"Correlation is not causation, right? This is a correlation we're plotting," he said.

Figuring out what's causing the relationship would require "richer research," Shaffer said, which would require more data and more time — two things in short supply when fighting a pandemic.

It might be tempting to look for simple answers, but that can be fraught, said Marie-Claire Shanahan, a professor of learning sciences at the University of Calgary.

Education is not the same as intelligence

Shanahan is careful to use the term "formal education" when discussing the role this social indicator plays in a variety of academic research, including vaccine hesitancy.

It's important to not conflate a person's highest level of academic achievement with their intelligence, she said. "Thinking about it in that way is both discriminatory and unhelpful."

Past research has shown a strong link between education and vaccine willingness, Shanahan noted, but it's not a perfectly linear relationship.

"If we're looking at … seasonal flu vaccines or routine childhood vaccines, there tends to be increased hesitancy with lower rates of education. But then there also seems to be a group in the higher education levels that is also hesitant," she said.

"The ones with higher education levels are actually more likely to act on their hesitancy, to be more firmly committed to 'I am absolutely not vaccinating my children,' or 'I do not get the seasonal flu vaccine.'"

Alberta's rate of COVID-19 vaccination is an evolving picture, as new numbers roll in daily. But so far, Shanahan said the same pattern of hesitancy doesn't seem to appear at the high end of the education spectrum.

She believes this suggests the education data may actually be masking several other "entrenched reasons" that are themselves correlated with both education and the lower COVID-19 vaccine uptake in some parts of the province.

"Education leads to changes in the way you live your adult life," she said. "And that then impacts things like relationships to health care and access to health care."

Shaffer agrees.

"It could be for reasons of work or family or time … but it could also be simply access," he said.

"I think this pandemic has really shone a spotlight on different levels of access to the health-care system, even in a country like Canada that prides itself on universal access."

Access to information and trustworthy sources

Access doesn't just mean having a vaccine clinic near your house, Shanahan said.

It can also mean having a family doctor who is willing to listen to your concerns, or a trusted neighbour who works in the health-care field, or simply friends in your social circles with enough spare time to keep up with the latest vaccine advice and eligibility criteria — so you don't have to.

These types of things are not equally distributed in our society, she said, and it's often people with higher levels of formal education who tend to enjoy easier access to high-quality information.

Public health officials try to keep it simple, but vaccine advice is often complicated, nuanced and full of medical jargon. And there are plenty of other voices competing for attention with simpler messages that may or may not be rooted in fact.

When in doubt, humans tend to trust the people around them, said Dr. Cora Constantinescu, a pediatrician at the Alberta Children's Hospital who specializes in infectious disease and vaccine hesitancy.

"The message is not as important as the messenger," she said.

"This idea that you can educate somebody and then they will change their mind is not true — on a lot of health issues. And we've been at this for so long in medicine; we feel that if we just tell people the correct information, they'll do the right thing. But we have failed at that time and time again."

A better approach, Constantinescu said, is to "meet people where they're at."

"You have to understand the reasons why they feel this way," she said of people who have doubts about the safety or efficacy of vaccines.

"And it might be for people who have fewer years of formal education, they're just at a different sort of trust. So they're not going to listen to the experts on CBC News."

Still, as Alberta looks to boost its vaccination rates toward the elusive goal of herd immunity, she believes "vaccine champions" will be key to our chances of success.

"Those people who have gone ahead and been vaccinated, now is the time to advocate for others to go ahead and take control of their own health, take control of their own protection and get vaccinated," she said.

"Because 60 per cent or 70 per cent with one dose is not enough."