Equity-informed strategies to promote COVID-19 vaccination uptake undertaken by public health units in Ontario, Canada.

This paper examined local public health strategies to promote COVID-19 vaccination equity in Ontario, Canada between 2020 and 2023. Our descriptive mixed-methods study gathered data from local public health units (PHUs) in Ontario on public health's COVID-19 equity-driven vaccination efforts. PHUs are responsible for delivering local public health services in the province and are provincially mandated to address health equity in their geographic boundaries. Data was collected through a seven-item questionnaire. Open-ended questions were analyzed through an inductive content analysis. From all 34 PHUs, 25 agreed to participate. Eighty-percent of the participating PHUs reported provision of information, community engagement, and improved physical accessibility to COVID-19 vaccines were high/very high priorities. Only 39.1% of PHUs indicated social determinants of health-related data collection as a high/very high priority. Overall, 90% of PHUs reported prioritizing groups, including those with lower socioeconomic status, Indigenous populations, and people experiencing homelessness or precarious housing, in their vaccination response. Four emergent themes included: (1) defining priority populations with data-driven and health equity-oriented processes; (2) promoting vaccination through health equity-informed strategies; (3) prioritizing Indigenous health and sovereignty in vaccination efforts; and (4) recommendations to address health equity-related barriers to COVID-19 vaccination. Examples of recommendations included: adopting culturally-sensitive and context-relevant communication strategies; enabling data linkage of data sources; and providing guidance on the development of intersectoral collaborations. Health equity-informed efforts in COVID-19 vaccination decision-making and actions were broadly adopted to better respond to local needs. Recommendations made by PHUs to address the gaps hindering COVID-19 vaccine equity promotion should be considered before future health crises. Supplementary Information: The online version contains supplementary material available at 10.1186/s12982-025-01317-8.