Racial disparities in the rates of COVID-19 vaccine uptake among children from Arab, Asian, Black, Indigenous, White and Mixed racial families in Canada.

Pediatric COVID-19 vaccination reduces symptomatic infections and hospitalizations. However, race-based disparities in pediatric COVID-19 vaccine uptake in Canada remain underexplored, despite well-documented inequities among adults. This study examines racial disparities in pediatric COVID-19 vaccine coverage in Canada and identifies key predictors, including structural and individual-level factors. A cross-sectional survey was conducted among a nationally representative and ethnically diverse sample of 2528 parents of 4386 children aged 0-12 years in Canada. Parents completed measures assessing child's COVID-19 vaccine uptake, COVID-19 vaccine mistrust, health literacy, experiences of racial discrimination, and child's prior COVID-19 infection. Adjusted odd ratios was performed to identify factors associated with vaccine uptake. Overall pediatric vaccine coverage was 56.8 %. Coverage was lowest among children of Black (39.4 %, 95 % CI: 35.4, 43.5) and Arab (42.9 %, 95 % CI: 38.4, 47.5) parents, compared to White (59.5 %, 95 % CI: 57.4, 61.5) and Asian (71.6 %, 95 % CI: 67.3, 75.6) parents (p < .001). Logistic regression with Generalized Estimating Equations (GEE) analyses, child's age, prior COVID-19 infection, and parental vaccine mistrust were determinants of vaccine coverage. Among racialized parents, experiences of major racial discrimination and lower health literacy were additional predictors of lower vaccine uptake. We observed racial disparities in pediatric COVID-19 vaccination, with significantly lower coverage among Black and Arab communities. Beyond individual and family level factors, structural experiences such as racial discrimination and limited health literacy contribute to inequities in vaccine uptake. Public health interventions must be culturally sensitive and equity-driven, addressing mistrust and systemic barriers to improve vaccine coverage and pandemic resilience in diverse populations.