Vaccine Outreach Integrating Community Engagement & Science (VOICES): Addressing COVID-19 Vaccine Hesitancy and Promoting Uptake among Racialized Sexual and Gender Minority Populations

The rapid development of COVID-19 vaccines is a huge scientific achievement; to be effective, however, people must get the vaccine. With disparities in COVID-19 infections and severe disease outcomes among marginalized populations in Canada, vaccination is crucial; yet racialized sexual and gender minority people are among those least likely to be vaccinated-they are also under-represented in pandemic response planning. Systemic discrimination, economic and health inequities, and past unethical medical research heighten distrust of vaccines and health authorities, posing barriers to COVID-19 vaccination. "Vaccine hesitancy" (VH)-delays in acceptance or refusal of vaccination, even when vaccines are available-is often attributed to anti-vaxxers and 'deficits' in scientific literacy among 'lay people'. However, WHO and leading research emphasize the need to examine multilevel drivers of VH among specific populations and locations-structural factors (e.g. sociocultural, historical, health system, economic); social and community influences (e.g. community norms about vaccination, COVID-19 stigma)-and for specific vaccines, such as COVID-19. VOICES, an ethnoracially-, gender-, and sexually-diverse multidisciplinary team, will apply a Public Understanding of Science framework and mixed methods-an online survey with discrete choice analysis, follow-up community focus groups, and participatory video to: 1) Explore local understandings of COVID-19 and VH among racialized sexual and gender minority communities in the Greater Toronto & Hamilton Area; 2) Examine multilevel structural and social factors associated with VH; and 3) Engage with community partners in knowledge mobilization to reduce COVID-19 VH and promote informed decision-making. VOICES will accelerate the availability of high-quality and real-time evidence to support Canada's COVID-19 response by enhancing public and 'expert' understanding, dialogue, and COVID-19 vaccination among marginalized populations.