A process evaluation of Ontario, Canada's 2023-24 older-adult RSV vaccination program

Respiratory syncytial virus (RSV) is a major cause of respiratory illness in older adults. During the 2023-2024 respiratory season, Ontario was the first and only province in Canada to launch a publicly funded RSV vaccination program for older adults. A process evaluation of the program was completed to better understand the experiences of the local Public Health Units (PHUs) and long-term care homes (LTCHs) implementing the program. Two process evaluation surveys, one each for PHUs and LTCHs, and a separate immunization coverage survey for LTCHs were distributed. The coverage survey found that 58.5% of residents, among all those living in LTCHs responding to the survey, received the RSV vaccine. Process evaluation surveys found that both PHUs and LTCHs perceived the RSV vaccine to be of lower priority than influenza and COVID-19 vaccines. There was also concordance between PHU and LTCH respondents regarding barriers to program implementation, which included temporary guidance against routine co-administration, a detailed informed consent procedure, and the timing of program roll-out. An additional barrier for LTCH respondents was vaccine hesitancy among staff and residents or their substitute decision makers. Facilitators to program implementation were effective communication with program partners, availability of technical resources, and programmatic supports. These evaluation findings are being shared to assist other jurisdictions in their planning of potential older adult or LTCH vaccination programs, including RSV vaccination. An important consideration for future program implementation is how to improve vaccine confidence in LTCH residents and staff in a rapidly changing vaccine landscape.