Abstract
Background:
In Canada, influenza vaccination rates are below recommended targets, with pharmacies the leading setting for vaccine administration. This work aimed to determine the Canadian public’s current knowledge, attitudes and practices related to pharmacy-based influenza vaccination services.
Methods:
We surveyed 3000 Canadian residents aged ≥18 years using a cross-sectional, self-reported, online structured questionnaire between December 5 and 21, 2022. A representative survey population was recruited from the Léger Opinion (LEO) consumer panel. Data were weighted by age, region and gender, based on 2021 census data.
Results:
During the 2022–2023 season, 56.6% (95% confidence interval [CI], 54%-59.2%) of respondents reported receiving an influenza vaccine at a pharmacy, including 57.5% (95% CI, 54.2%-60.8%) of respondents considered to be at high risk of complications from influenza. Among respondents previously vaccinated at a pharmacy, 94.1% (95% CI, 91%-97.2%) were satisfied with the experience, citing convenience, accessibility and availability as factors influencing their decision. Among all respondents, 29.3% (95% CI, 27.5%-31.1%) reported that a pharmacist’s recommendation for the influenza vaccine would affect their decision to be vaccinated, yet only 10.4% (95% CI, 5.9%-15%) who had discussions with a pharmacist specifically discussed the importance of influenza vaccination.
Conclusion:
Canadians are satisfied with pharmacy-based influenza vaccinations and value pharmacist recommendations. Pharmacists have an opportunity to boost influenza vaccination coverage in Canada by providing counselling on the importance of influenza vaccination to those seeking their advice on other health care needs, including younger adults and those with risk factors for serious illness from influenza.
Introduction
Before and after the COVID-19 pandemic, influenza ranked among the top 10 causes of death in Canada. 1 Influenza causes an average of 12,000 hospitalizations per year, with the average direct medical costs of each hospitalization totaling $14,612 CAD.2,3 Influenza is also associated with high indirect costs related to lost productivity and premature death. 4 In addition, influenza infections increase the risk of cardiovascular events, with consequent health and cost burdens for the individual and society.5,6
Knowledge into Practice.
Community pharmacies provide most influenza vaccinations in Canada.
While pharmacists are regularly consulted on health care conditions, only a small percentage of patients discuss the importance of influenza vaccination; most vaccination-related discussions are focused on the logistics of obtaining vaccination.
Pharmacists should take advantage of all health care consultations to promote the benefits of influenza vaccination, which could in turn help boost vaccination rates in Canada.
Vaccination against influenza is the most effective strategy to reduce associated morbidity and mortality.6 -8 The Public Health Agency of Canada (PHAC) has established a vaccination coverage goal of 80% for persons at risk of complications from influenza, including adults ≥65 years, those aged 18–64 years with certain chronic medical conditions and health care workers who may come in contact with these groups. 9 In the 2022–2023 season, 74% of older adults and only 43% of younger adults with chronic conditions were vaccinated against influenza. 10
Pharmacy-based influenza vaccinations began to be authorized in 2009 and are now publicly funded and pharmacist administered in most Canadian provinces and territories. 11 Prior to the COVID-19 pandemic, research in Canada showed that this expanded role was associated with increases in influenza vaccination coverage and reductions in direct and indirect costs.12,13 In light of decreasing rates of influenza vaccination among adults younger than 65 years in Canada from 2019–2022, 14 the purpose of this study is to examine Canadians’ attitudes and beliefs regarding influenza vaccination in pharmacies in the 2022–2023 influenza season as well as their preferences and unmet needs regarding influenza vaccination.
Methods
Study design
This observational study was conducted using a cross-sectional, self-reported, online survey of 3000 Canadian adults between December 5 and 21, 2022. The survey instrument comprised a structured questionnaire available electronically via multiple Internet-accessible platforms in both English and French. The study design was approved by the Veritas Independent Review Board (IRB), and all survey participants provided informed consent in accordance with the IRB requirements and applicable laws and regulations. Before data collection, aggregation and analysis, all respondents’ information was fully anonymized. The present analysis focuses on questions related to vaccination in a pharmacy setting. Data on vaccine knowledge and uptake among high-risk populations have been reported in a prior publication. 15
Mise En Pratique Des Connaissances.
Les pharmacies communautaires fournissent la majorité des vaccins contre la grippe au Canada.
Bien que les pharmaciens soient régulièrement consultés pour des problèmes de santé, seul un faible pourcentage de patients discutent de l’importance de la vaccination contre la grippe; la plupart des discussions liées à la vaccination sont axées sur la logistique de l’obtention de la vaccination.
Les pharmaciens doivent élargir les consultations existantes en matière de soins de santé afin de promouvoir les avantages de la vaccination contre la grippe, ce qui pourrait à son tour aider à augmenter les taux de vaccination au Canada.
Participants
The study population included Canadian residents aged ≥18 years drawn from the Léger Opinion (LEO) consumer panel, which includes nearly 500,000 active members. In a random selection process, traditional and mobile telephone methodologies were used to assemble a regionally and demographically representative survey panel. Léger continued to recruit prospective survey respondents, providing each with a unique link to the survey, until the target of 3000 respondents had been achieved. Where consistent with local regulations, compensation to fair market value was offered to respondents who completed the survey. E-mail invitations for the survey were systematically distributed, using 2021 Canadian census data on region, gender and age to ensure representativeness. Respondents who opened the survey and those who completed the survey were very similar to the 2021 census data, with weighting applied to the final study sample to correct for minor discrepancies. Léger does not disclose the topic of research in the survey invitations to reduce the potential for participation bias.
Multiple entries and fraudulent panelists were excluded through the use of usernames and strict restrictions on passwords, a detailed profiling questionnaire for all panelists and de-duplication routines to prevent existing panel members from participating more than once in the survey.
The respondent panel included a prespecified high-risk subgroup of participants who met at least 1 of the following criteria defined by the Canadian National Advisory Committee on Immunization (NACI) as being at high risk of complications from influenza: ≥65 years of age, pregnant, resident of a long-term care facility, Indigenous ancestry or having a high-risk medical condition (hypertension, diabetes or other metabolic disease, asthma, other chronic lung disease, heart disease, body mass index ≥40 kg/m2, anemia, immune disorder, cancer or conditions that adversely affect respiratory secretions and/or increase risk of aspiration). 16
Survey instrument
The Decipher Survey Platform (Forsta, Vancouver, British Columbia, Canada) hosted the survey, which was accessible via website using a computer, smartphone or tablet or by using a proprietary app for mobile devices.
The online questionnaire (Appendix 1, available in Supplementary Materials) took approximately 15 minutes to complete and included the following survey domains: demographics, general attitudes toward vaccines, COVID-19 vaccination status, discussions with health care providers about influenza vaccines, influenza vaccination status, influenza vaccination experience at pharmacies, knowledge and awareness of enhanced influenza vaccines and awareness of different types of influenza vaccines recommended for high-risk groups. The survey comprised approximately 70 questions, including screening and introductory questions and contextual updates. The final number of questions varied depending on respondents’ answers because some responses prompted follow-up questions. Most questions included multiple-choice answers, but some were open-ended, where respondents filled in a blank answer box. For reporting purposes, these open-ended responses were grouped into relevant categories by qualified and trained coders based on similar or recurring words in an iterative coding process. Data were analyzed and organized using coding software (Coder, Ascribe, Cincinnati, OH).
All respondents who began the survey were assigned a unique identifier that was linked to each respondent’s LEO panel account. The survey was programmed to advance to the next question only after respondents clicked on an answer and then clicked on the “continue” button on each screen. The last screen included a “finish” button; those who answered all questions and clicked “finish” were recorded as a “complete” in the system. The system also recorded terminations, in which case the respondent was excluded from the survey. Respondents attempting the survey more than once were recognized based on their unique identifier and were shown a message that they had already completed the survey.
Statistical methodology
The target population of 3000 was projected to yield a margin of error of ±1.79%, based on a 95% confidence level. To meet this target, approximately 22,000 potential respondents were invited to participate in the study based on the assumptions that 90% of LEO panel members would meet study entry criteria and the response rate would be 15%. Throughout the recruitment phase, sampling was adjusted to meet recruitment quotas by age, gender and region to ensure collected data were representative based on 2021 Canadian census data. 17 At the end of the data collection, data were weighted by age, region and gender based on 2021 census data, to further ensure representativeness.
The statistical software Q/SPSS and Microsoft Excel were used to perform the analysis. Relationships within the data were primarily analyzed using cross-tabulation. Primary independent variables such as vaccination status and intent to become vaccinated were analyzed along with key demographic characteristics, including age, gender and ethnicity. The statistical significance of cross-tabulations was tested using z test for proportions and t test for means, with a 95% confidence interval (CI).
Results
Study population
The analysis included 3000 survey participants’ responses out of 22,012 invited potential respondents and 3587 who accessed the survey between December 5 and 21, 2022. Excluded respondents included 6 who completed the survey but whose cohort had already reached its target number of participants and 581 prospective participants who did not meet entry criteria, did not complete the survey or whose responses did not meet data quality criteria (Table 1).
Table 1.
Disposition of survey respondents
| Invited to participate | 22,012 |
| Screened (i.e., opened survey) | 3587 |
| Excluded | 587 |
| <18 years of age or preferred not to provide age (n = 29) | |
| Declined informed consent (n = 58) | |
| Withdrew after reading adverse event statement (n = 127) | |
| Did not complete survey (n = 292) | |
| Data quality problems (n = 75) | |
| Cohort quota full (n = 6) | |
| Included in analysis | 3000 |
The study population was divided fairly evenly between male and female respondents, and 76.4% were younger than 65 years of age (Table 2). Representation from racial and ethnic groups, Canadian provinces and different community sizes was reflective of the Canadian population. Individuals at high risk of influenza complications, including older adults aged ≥65 years, pregnant adults, persons with Indigenous ancestry, long-term care residents and persons with high-risk medical conditions, comprised 50.5% (95% CI, 48.7%-52.3%) of the study population. The subgroup with underlying high-risk medical conditions accounted for 37.2% (95% CI, 35.4%-39%) of the study population—this group has been described previously. 15
Table 2.
Demographic characteristics of the study population (N = 3000)
| Characteristic, n (%) | Weighted | Unweighted |
|---|---|---|
| Gender | ||
| Male | 1447 (48.2) | 1422 (47.4) |
| Female | 1537 (51.2) | 1565 (52.2) |
| Other, nonbinary or not specified | 16 (0.6) | 13 (0.4) |
| Age group, years | ||
| 18-24 | 302 (10.1) | 267 (8.9) |
| 25–34 | 498 (16.6) | 464 (15.5) |
| 35-44 | 495 (16.5) | 497 (16.6) |
| 45-54 | 471 (15.7) | 551 (18.4) |
| 55-64 | 526 (17.5) | 529 (17.6) |
| 65-74 | 409 (13.6) | 490 (16.3) |
| ≥75 | 299 (10) | 202 (6.7) |
| Race and ethnicity | ||
| White | 2328 (77.6) | 2356 (78.5) |
| Black | 82 (2.7) | 77 (2.6) |
| Asian | 408 (13.6) | 387 (12.9) |
| Indigenous | 94 (3.1) | 92 (3.1) |
| Latin American | 25 (0.8) | 25 (0.8) |
| Other | 90 (3) | 88 (2.9) |
| Prefer not to say | 52 (1.7) | 52 (1.7) |
| Region | ||
| Alberta | 334 (11.1) | 329 (11) |
| Atlantic region* | 202 (6.7) | 237 (7.9) |
| British Columbia | 416 (13.9) | 392 (13.1) |
| Manitoba | 107 (3.6) | 118 (3.9) |
| Ontario | 1162 (38.7) | 1150 (38.3) |
| Quebec | 692 (23.1) | 675 (22.5) |
| Saskatchewan | 85 (2.8) | 96 (3.2) |
| Northwest Territories, Nunavut, Yukon † | 2 (0.06) | 3 (0.08) |
| Community size | ||
| Rural (population <50,000) | 717 (23.9) | 747 (24.9) |
| Small town (population 50,000-249,999) | 770 (25.7) | 756 (25.2) |
| Large city (population 250,000-999,999) | 836 (27.9) | 834 (27.8) |
| Metropolis (population ≥1,000,000) | 638 (21.3) | 625 (20.8) |
| Don’t know/not sure | 29 (1) | 27 (0.9) |
| Prefer not to say | 11 (0.4) | 11 (0.4) |
| High risk of influenza complications ‡ | 1515 (50.5) | 1519 (50.6) |
| Any high-risk medical condition ‡ | 1116 (37.2) | 1130 (37.7) |
New Brunswick, Newfoundland, Nova Scotia and Prince Edward Island.
No respondents resided in the Northwest Territories.
National Advisory Committee on Immunization (NACI) criteria: age ≥65 years; pregnancy; resident of chronic care facility; Indigenous Canadian ancestry; or chronic health condition including chronic lung disease or severe respiratory disease, heart disease, hypertension, cancer, diabetes or other metabolic diseases, chronic liver disease, chronic kidney disease, immune disorder or immunosuppressive therapy, spleen problems or removal, blood disorders (anemia, thalassemia or hemoglobinopathy), body mass index >40 kg/m2 or chronic cerebrospinal fluid leak. 16
Vaccination patterns
Across all respondents, 72.6% (95% CI, 70.8%-74.4%) reported having been previously vaccinated against influenza. Those reporting a recent influenza vaccination included 47.7% (95% CI, 45.9%-49.5%) during the 2021-2022 influenza season and 47.3% (95% CI, 45.5%-49.1%) during the 2022-2023 season.
Interactions with pharmacists and other health care professionals
Most respondents reported having consulted with a health care provider about any condition in the previous 12 months, including 74.1% (95% CI, 72.3%-75.9%) who reported speaking with a general practitioner (GP) or family physician (FP), with an average of 2 consultations in the past year and 54.9% (95% CI, 53.1%-56.7%) who reported speaking with a pharmacist, also with an average of 2 consultations in the past year. Other physicians and nurses were reportedly consulted by 38.2% (95% CI, 36.4%-40%) and 22.1% (95% CI, 20.3%-23.9%) of respondents, respectively, with an average frequency of once in the previous 12 months.
During the 2022-2023 influenza season, 1166 of 3000 (39.1% [95% CI, 37.3%-40.9%]) respondents reported consulting a health care professional about influenza vaccines and 38.9% (95% CI, 36%-41.8%) of this group reported speaking with a pharmacist (Figure 1). Pharmacist consultations were more commonly reported by older (aged ≥65 years) than by younger adults (P < 0.001) and those at high risk than those not at high risk from influenza complications (P = 0.038) (Figure 1).
Figure 1.
Health care professional consultations related to influenza*
*Left panel: Type of HCP consulted by respondents who answered “yes” to the question (n = 1166): “Did you discuss flu vaccines with a health care provider (e.g., physician, nurse, pharmacist, etc.) this flu season (that is, between September and now)?” Right panel: Proportions of respondents who reported consulting a pharmacist about influenza vaccines divided by age, overall risk of influenza complications and presence or absence of underlying medical conditions among respondents aged 18 to 64 years.
CI, confidence interval; FP, family physician; GP, general practitioner; HCP, health care professional.
The topics covered during pharmacist consultations tended to be focused on the logistics of obtaining an influenza vaccination, whereas GP consultations were more likely to cover the importance or necessity of the influenza vaccine (Figure 2). Of the entire study population (N = 3000), 29.3% (95% CI, 27.5%-31.1%) reported that a pharmacist’s recommendation for the influenza vaccine would have an impact on their decision to receive the influenza vaccine. This was defined as providing an answer of 4 or 5 in response to the question, “To what extent does ‘Recommendation from a pharmacist’ impact your decision whether to get a flu vaccine or not? Please use a scale from 1-5, where 1 is ‘does not impact at all’ and 5 is ‘has a huge impact.’”
Figure 2.
Topics related to influenza vaccination discussed with general practitioners (GP) or family physicians (FP) vs pharmacists
GP, general practitioner; FP, family physician; Q, question (see Supplementary Materials: Survey Instrument).
Location of influenza vaccination
Among respondents who reported being vaccinated against influenza, 53.7% (95% CI, 51.1%-56.3%) reported receiving the 2021-2022 seasonal influenza vaccine in a pharmacy, as did 56.6% (95% CI, 54%-59.2%) of those reporting vaccination in the 2022-2023 season. Participants reporting a pharmacy-administered vaccine during the most recent season included 47.5% (95% CI, 40.9%-54.1%) of respondents aged <35 years, 59.6% (95% CI, 55.8%-63.4%) of those aged 35-64 years and 57.2% (95% CI, 52.9%-61.5%) of those aged ≥65 years. Of the high-risk group, 57.5% (95% CI, 54.2%-60.8%) received their influenza vaccine at a pharmacy.
Among respondents who reported receiving an influenza vaccine at a pharmacy in the past, 94.1% (95% CI, 91%-97.2%) reported being satisfied with their experience. The most frequently reported reasons for satisfaction included efficient service, short wait times and a simple, well-organized process of vaccination. More than half of respondents who reported being vaccinated at a pharmacy booked a vaccine appointment in advance, but approximately one-third received their vaccine on a walk-in basis, including those who reported walking into the pharmacy for the vaccine and those who obtained the vaccine while obtaining other medications or products (Figure 3).
Figure 3.
Means by which respondents reporting influenza vaccination at a pharmacy arranged for or obtained their vaccine administration
Q, question.
Accessibility, proximity and availability of appointments were the 3 most commonly cited reasons for choosing a pharmacy as the location for an influenza vaccination among those who reported a pharmacy vaccination in that setting (Figure 4A). Respondents who did not receive their influenza vaccine at a pharmacy cited lack of availability, more convenient locations and preference for other locations as their reasons for going elsewhere or as barriers to receipt of the influenza vaccine at their pharmacy (Figure 4B).
Figure 4.
Factors favouring (A) or discouraging (B) receipt of influenza vaccine at a pharmacy among respondents who reported receiving the vaccine at a pharmacy (n = 1022) versus elsewhere (n = 1060)
Open answer refers to open-ended responses that were grouped into relevant categories shown here. Only responses with a frequency of >10% are shown.
Q, question.
Regional differences in influenza-related interactions with pharmacists
When responses were compared across Canadian provinces (Figure 5), the highest proportion of respondents reporting a consultation with a pharmacist in the previous 12 months for any condition came from Quebec. However, those from Quebec accounted for the lowest proportion of respondents reporting they had discussed influenza with a pharmacist or that they received their influenza vaccine at a pharmacy. The latter finding contrasted with the rest of Canada, where most respondents reported being vaccinated against influenza at a pharmacy. Respondents from the Atlantic region accounted for the highest proportion (41.9% [95% CI, 35%-48.8%]) reporting that a pharmacist’s recommendation would influence their decision on influenza vaccination, while those from Quebec accounted for the lowest (22.5% [95% CI, 18.8%-26.2%]).
Figure 5.
Proportions of respondents by region who reported consulting with a health care provider (HCP) for any condition in the past 12 months, discussing influenza vaccines with a pharmacist, receipt of an influenza vaccine at a pharmacy and that a pharmacist’s recommendation for an influenza vaccine would influence their decision to receive one
Q, question.
Discussion
Of 3000 Canadian residents surveyed in December 2022, just less than half reported being vaccinated against influenza during the 2022-2023 season. Slightly more than half of vaccinated individuals had received their influenza vaccine in a pharmacy. Although most respondents reported consulting with pharmacists about general health care concerns an average of twice a year, less than 40% reported discussing influenza vaccination with their pharmacist. Nearly all respondents who received their influenza vaccine at a pharmacy reported being satisfied with their experience, citing efficient service, short wait times and well-organized systems and processes at these locations. Roughly two-thirds of respondents made an appointment for the influenza vaccine, but the rest took advantage of the ability to obtain an influenza vaccine on a walk-in basis or while visiting the pharmacy for another reason. Respondents cited the convenience and accessibility of the pharmacy vaccine experience, along with the availability of appointments, as reasons for preferring pharmacies for their influenza vaccines. However, these same factors were cited as reasons to avoid pharmacies as a location for influenza vaccination, suggesting variability in respondents’ experience with their local pharmacies.
Our findings are consistent with other studies of influenza vaccination at pharmacies. In its survey of vaccine coverage during the 2022-2023 season, the PHAC reported that 52% of Canadians had received the influenza vaccine in a pharmacy, a 17% increase over the 2018-2019 season.10,18 Pharmacy claims data show a steady increase in influenza vaccinations since 2012, attesting to the rising importance of pharmacies as a site for influenza vaccination. 19 This increase in pharmacy delivery of influenza vaccines is associated with rising rates of influenza vaccine coverage overall and with corresponding reductions in influenza-related burden during the pre–COVID-19 era.12,13 Between the 2011-2012 season, before Ontario pharmacists were permitted to administer influenza vaccines, and the 2013-2014 season, an increase of nearly 450,000 influenza vaccinations by pharmacists was associated with $2.3 million of savings in direct health care costs and lost productivity in Ontario alone. 13
At 74% in 2022-2023, coverage among older adults is relatively close to the Canadian goal of 80% coverage for people at risk of complications from influenza. 10 However, between the 2019-2020 influenza season, when SARS-CoV2 began to circulate, and the 2021-2022 season, influenza vaccine coverage declined in adults overall and in those younger than 65 years. Notably, the rate of vaccination among adults aged 18-64 years with high-risk medical conditions decreased from 44% in 2019-2020 to 38% in 2021-2022 and has since increased to 43% in 2022-2023.10,14 While an improvement, this nevertheless remains far below the target of 80% coverage for this population. In our survey, 57.5% of respondents with high-risk medical conditions were vaccinated at a pharmacy, which suggests that pharmacists may play an important role in encouraging influenza vaccination with this group.
Pharmacists’ growing scope of practice and recognition as key members of interdisciplinary primary care teams supports opportunities to boost immunization rates. 11 For example, while most survey respondents discussed health topics with a pharmacist twice a year, on average, only 39% of respondents recalled discussing influenza vaccination with a pharmacist and those consultations were primarily about logistical concerns. Coupling vaccination assessment with other services such as medication reviews, travel consultations, chronic disease management, prescription drug counselling and consultations for nonprescription drugs for the management of respiratory illness may encourage immunization among those who would otherwise remain unvaccinated. Survey findings that 29.3% of respondents’ decision-making on influenza vaccination can be positively influenced by a pharmacist recommendation support the importance of proactive engagement. Pharmacists can also address complacency by identifying and notifying those at high risk of complications of the benefits of vaccination, as previously published findings from this survey identified that 64.2% of individuals at high risk were unaware of their personal risk factors. 15 Compensation for influenza vaccinations given by pharmacists in Canada remains contingent on administration and is not inclusive of screening and presumptive recommendation. Remuneration for pharmacist vaccinations across Canada varies considerably by jurisdiction. Given the current workload experienced by pharmacists amid their rapidly expanding scope, additional reimbursement opportunities should be implemented to facilitate proactive identification and recommendation of influenza vaccination to high-risk groups.
Our survey study design limits our findings to the recollection and perceptions of participating respondents, and it is not possible to verify the collected information against other data sources. Recall bias of the respondents may further influence the accuracy of the reported information and the quality of the data. However, results from previous studies suggest that self-reported data may provide accurate estimates of vaccine uptake.20,21 We are also unable to demonstrate cause-and-effect relationships due to the cross-sectional nature of the study. That our findings are consistent with reported observations from PHAC supports the strength and validity of our study. Other limitations include the requirement for Internet access and the ability to complete the survey online, which may exclude potential respondents from older age groups or those of lower socioeconomic status, who may also have less access to health services. In addition, data collection ended mid-way through the respiratory season and thus did not capture those vaccinated after December 21. However, most Canadians were vaccinated in October and November of 2022. 10 Finally, in our survey, vaccination rates were higher among adults younger than 65 years and lower among those older than 65 years, which may reflect participation bias with the younger population and the fact that the online methodology may have excluded some higher-risk older adults who were vaccinated, such as residents of long-term care facilities.
In conclusion, in a survey of 3000 Canadian residents, we found that most of those who were vaccinated against influenza received their vaccine at a pharmacy, and 94% of these individuals were satisfied with the experience. In our survey, 55% of respondents reported consulting with pharmacists on health topics an average of twice a year. These consultations may provide pharmacists with an opportunity to provide information on influenza and influenza vaccines, which may in turn promote an increase in influenza vaccination coverage.
Supplemental Material
Supplemental material, sj-pdf-1-cph-10.1177_17151635241240464 for Influenza vaccination in community pharmacy: A cross-sectional survey of Canadian adults’ knowledge, attitude and beliefs by Sherilyn K. D. Houle, Ajit Johal, Paul Roumeliotis, Bertrand Roy and Wendy Boivin in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada
Footnotes
Author Contributions: The authors equally contributed and co-developed the research objectives, protocol/questionnaire and data analysis/publication for this manuscript.
B. Roy and W. Boivin are employees of CSL Seqirus Inc.
Funding: The investigation work of P. Roumeliotis, S. K. D. Houle and A. Johal was funded by CSL Seqirus Inc.
Supplemental Material: Supplemental material for this article is available online.
ORCID iDs: Sherilyn K. D. Houle 
https://orcid.org/0000-0001-5084-4357
Ajit Johal
https://orcid.org/0009-0005-6436-5572
Wendy Boivin
https://orcid.org/0000-0001-7056-1768
Contributor Information
Sherilyn K. D. Houle, School of Pharmacy, University of Waterloo, Kitchener, Ontario.
Ajit Johal, Immunize.io Health Association, Vancouver, British Columbia; TravelRx Education Inc., Vancouver, British Columbia.
Paul Roumeliotis, School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario.
Bertrand Roy, CSL Seqirus, Quebec City, Quebec.
Wendy Boivin, CSL Seqirus, Quebec City, Quebec.
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Supplementary Materials
Supplemental material, sj-pdf-1-cph-10.1177_17151635241240464 for Influenza vaccination in community pharmacy: A cross-sectional survey of Canadian adults’ knowledge, attitude and beliefs by Sherilyn K. D. Houle, Ajit Johal, Paul Roumeliotis, Bertrand Roy and Wendy Boivin in Canadian Pharmacists Journal / Revue des Pharmaciens du Canada