MONTREAL — Medically vulnerable Canadians at high risk for negative sequelae from COVID remain highly burdened by the virus, but many are not taking necessary steps to mitigate their risks, largely due to lack of knowledge and access to care.

These are the main findings of an industry-sponsored patient survey presented at Public Health 2026, the annual meeting of the Canadian Public Health Association.

“This [survey] has important implications for policy making and is trying to establish equitable and evidence-informed approaches to diagnosing and managing [COVID in vulnerable populations,]” lead author Jean-Christophe Simard, PhD, told Medscape News Canada. “We’re 6 years past the date when COVID-19 appeared, and there’s still limited evidence about how medically vulnerable patients see COVID-19.” Simard is a medical affairs scientist specializing in vaccines and antivirals at Pfizer in Montreal.

A Patient-Led Initiative

The Attitudes about COVID and Community Engagement with Patients study arose from a meeting among eight medically vulnerable patient organizations from across the globe. Together, they devised a 41-question online survey exploring respondents’ attitudes, knowledge, and practices surrounding the ongoing threat of COVID. Participants were recruited via a community database using online and offline advertising, direct mail, patient leaflets, telephone outreach, member referrals, and social media.

Between March 4 and 18, 2025, a representative sample of 5000 medically vulnerable adults from various countries completed the survey. Of these, 500 were from Canada, and Simard presented data on those patients.

Participants were mostly 31-64 years of age (69.4%), and 58.0% were women. This population was highly vulnerable as 18.5% had one chronic health condition, 28.6% had two, 24.3% had three, and 28.6% had four or more. The most common chronic health conditions were overweight and obesity (38.6%), mental health conditions (37.4%), current or former smoking (33.4%), diabetes (25.4%), and chronic lung disease (23.0%).

High COVID Burden

The burden of COVID was high among participants as 52.8% had been diagnosed with the condition two or more times, and 13.0% were hospitalized for it. In total, 35.4% reported that COVID had worsened their preexisting conditions, and this response was most common among women. In addition, 24.8% reported experiencing long COVID symptoms, including 36.2% who reported symptoms lasting more than 1 year, and 19.8% reporting symptoms lasting more than 2 years. In addition, 85.3% reported that COVID had worsened their physical health, and 74.2% reported it had worsened their mental health.

Despite these impacts, nearly one third (31.2%) did not perceive themselves as being at high risk for progression to severe COVID. While 93.6% had been vaccinated against COVID, only 59% said they were “likely” or “very likely” to receive an annual booster, and 51% were not up to date with their COVID vaccine schedule.

Concern about COVID remained high, however, with 69.4% reporting that COVID risks affected their daily lives, and 40.2% reporting they were “extremely” or “very” concerned about catching COVID again. “There’s a lack of awareness around who’s at risk,” said Simard.

Limited Access to Testing and Treatment

Previously, 83.4% of patients were tested for COVID when symptomatic, usually via a home test (77.6%). But currently, only 39.5% reported that they had access to a home test. For younger individuals in particular, barriers to testing were largely cost, need to take time off from work or school, and difficulty accessing a healthcare professional.

Only 41.2% of participants considered themselves eligible for COVID treatment. During their previous infection, only 17.8% were offered an antiviral, a number that Simard noted was lower for Canada than any other country represented in the global survey.

Among those not offered antivirals, 34% were not even aware of the availability of the treatment, and 58% said they would be likely to take an antiviral for a future infection. Overall, 64% considered antiviral therapy to be important, but only 31.2% thought it was easily accessible, and 52.4% said improved access would have a major influence on their daily lives and mental well-being.

The study was limited by sample sizes that did not permit provincial comparisons or assessments of variation among racial or ethnic groups. Participation required a certain level of digital literacy and accessibility, which may have limited the generalizability of the findings.

Nevertheless, Simard said, “It’s important to remind healthcare providers and public health decision-makers about the ongoing burden [of COVID]. What we’ve tried to do with this [survey] is provide the perspective of high-risk patients, [to demonstrate] how medically vulnerable patients see COVID-19 nowadays.”

This study was sponsored and conducted by Pfizer.