19 to Zero adopts a multimodal and interdisciplinary research approach to guide interventions aimed at improving people’s health behaviours.

19 to Zero has conducted a number of mixed-method studies to understand Canadians' attitudes and behaviours towards COVID-19 public health measures and vaccinations. Our team has continued our research into how to enhance overall vaccine confidence in other non-COVID related areas. Our goal is to promote healthier behaviours whether it be encouraging vaccinations, redesigning models of care, or helping close care gaps (i.e. cancer screening). We want to bring our research and insights to help design and develop tailored strategies and solutions for encouraging healthier behaviours.
Research & Insights
Primary Research


Since March 2020, we have engaged Canadians to hear their perspectives about public health and health topics.

To understand Canadians' perspectives, attitudes, and awareness of vaccines, we engage directly with individuals through nation-wide surveys and community-based focused groups. This work allows us to understand sentiments towards a variety of public health topics such as:

  • Vaccine hesitancy

  • Brand preferences

  • Public health measures

  • Access

  • Vaccination site preferences (e.g. pharmacies)

  • Government approval

  • Trust and concerns

We also explore the nuance of how demographic, geographic, and psychographic factors can impact Canadians' views towards topics related to various healthcare challenges.

Through our primary research, we also test each of our interventions with communities and the general public to ensure they are effective, accessible, and culturally relevant.​

Survey Insights

Some examples of surveys we have been analyzing. If you are interested in learning more about our findings or conducting research, please contact us at

State of Immunizations

Understanding the impacts of the COVID-19 pandemic on routine immunizations.  Post-pandemic coverage rates continue to be well below recommended targets and millions of Canadians have missed or have had delayed routine immunizations during the pandemic.  


Fall 2021 National Polling Results

Ontario Parents School-Based Vaccine 

Ontario parents with children between the ages of 10 - 18 were surveyed to gain a deeper understanding of parent’s knowledge and perceptions regarding school-based vaccines. The survey examined awareness, attitudes, and concerns around human papillomavirus (HPV), meningococcal, and hepatitis B vaccines.

ON Parents School-Based Vaccine Survey Results

Pediatric COVID-19 Vaccination

Parents with a child under the age of 18 and over the age of six months were surveyed to determine the anticipated uptake of pediatric vaccinations across Canada. The survey examines pediatric vaccine hesitancy and attitudes towards COVID-19 vaccines for children.

Pediatric COVID-19 Vaccination Survey Results

Understanding Canadian awareness and attitudes towards the co-administration of COVID-19 and routine vaccines.  Respondents were asked about who they preferred to administer the vaccines (pharmacists, physicians, or nurse practitioners) and how many vaccines they would be willing to have co-administered. Healthcare workers (focused on pharmacists and physicians) were also asked about their awareness of, attitudes towards, and opportunities they see around co-administering vaccines.

Co-Administration of Vaccination Survey Results

Co-Administration of Vaccination 
Shingles Vaccine 

19 to Zero recently conducted a survey (May/June 2022) regarding shingles awareness and vaccination sentiment. Respondents aged 50 and over from Alberta and British Columbia were asked a number of questions related to their knowledge of and opinions of shingles vaccination.

Shingles Vaccine Survey Results

Social Media Analytics

Our artificial intelligence and machine learning team focuses on using natural language processing and machine learning to track public health behaviours and vaccine sentiment on social media across North America.


For example, we can develop network analysis maps that can quantifiably help us understand better how vaccine hesitant and confident groups interact with each other.  This work also helps us identify key influencers and help us more deeply understand the extent of vaccine hesitant conversations on digital platforms.


Example: COVID-19 network analysis map on Twitter between April 10, 2021 and April 16, 2021. Overall, this network map represents 771,748 individual accounts and 1,592,188 specific tweets.

Network analysis map.png

COVID-19 Social Media Trends

Using deep-learning modeling of natural language processing, we analyze on a weekly basis the nature of the conversations in vaccine hesitant and vaccine confident networks. Our team has also started looking at non-vaccine related public health conversations.  


Example: During COVID-19 we saw vaccine hesitancy fueled by mistrust in institutions and how deeply political the nature of COVID-19 vaccines were during the pandemic.  In most cases, this was a greater concern than vaccine safety.

19toZero Bump Chart.png
Behaviour Change Research

Our research is focused on promoting behaviour change.  During the COVID-19 pandemic, we created ‘concern archetypes,’ or general demographic trends that correlate with patterns of COVID-19-related attitudes and behaviours based on survey data from 2,000 Canadians. This allowed for an evidence-based approach to target segments of the population that demonstrated low concern or low prosocial behaviours with regards to COVID-19. 19 to Zero has engaged with thousands of Canadians through surveys, interviews, and focus groups since December 2020. These research activities inform 19 to Zero’s ongoing strategies for enhancing vaccine confidence.


  1. Benham JL, Lang R, Kovacs Burns K, MacKean G, Leveille T, McCormack B, Sheikh H, Fullerton MM, Tang T, Boucher JC, Constantinescu C, Mourali M, Oxoby RJ, Manns BJ, Hu J, Marshall DA. (2021). Attitudes, current behaviours and barriers to public health measures that reduce COVID-19 transmission and what can motivate change: A qualitative study to inform public health messaging. PLoS One. 16(2):e0246941.

  2. Raynell L, Benham JL, Atabati O, Hollis A, Tombe T, Shaffer B, Kovacs Burns K, MacKean G, Léveillé T, McCormack B, Sheikh H, Fullerton MM, Tang T, Boucher JC, Constantinescu C, Mourali M, Manns BJ, Marshall DA, Hu Ju, Oxoby RJ. (2021). Attitudes, Behaviours and barriers to public health measures for COVID-19: a survey to inform public health messaging. BMC Public Health. Apr;21(1):765. DOI: 10.1186/s12889-021-10790-0.

  3. Boucher JC, Cornelson K, Benham JL, Fullerton MM, Tang T, Constantinescu C, Mourali M, Oxoby RJ, Marshall DA, Hemmati H, Badami A, Hu J, Lang R. (2021). Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study. JMIR Infodemiology. 12;1(1):e28800. doi: 10.2196/28800.

  4. Desveaux L, Savage RD, Tadrous M, Kithulegoda N, Thai K,  Stall NM, Ivers NM. (2021). Beliefs associated with Intentions of Non-Physician Healthcare Workers to Receive the COVID-19 Vaccine in Ontario, Canada. BMC Public Health. 

  5. Lang R, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Sheikh H, Fullerton MM, Tang T, Leigh JP, Manns BJ, Marshall DA. Characterization of non-adopters of COVID-19 non-pharmaceutical interventions through a national cross-sectional survey to assess attitudes and behaviours. Scientific reports. 2021 Nov 5;11(1):1-4.

  6. Benham JL, Atabati O, Oxoby RJ, Mourali M, Shaffer B, Fullerton MM, Tang T, Sheikh H, Constantinescu C, Manns BJ, Marshall DA, Ivers NM, Ratzan SC, Hu J, Lang R. COVID-19 vaccine-related attitudes and beliefs in Canada: National cross-sectional survey and cluster analysis. JMIR Public Health Surveill. 2021;7(12)e30424. PMID: 34779784.

  7. Merkley E, Loewen PJ. Assessment of communication strategies for mitigating COVID-19 vaccine-specific hesitancy in Canada. JAMA network open. 2021 Sep 1;4(9):e2126635-.

  8. Jeffrey V Lazarus, Katarzyna Wyka, Trenton M White, Camila A Picchio, Kenneth Rabin, Scott C Ratzan, Jeanna Parsons Leigh, Jia Hu, Ayman El-Mohandes. Revisiting COVID-19 vaccine hesitancy around the world, data from across 23 countries in 2021. Accepted for publication by Nature Communications. 

  9. Fullerton MM, Benham J, Graves A, Fazel S, Doucette EJ, Oxoby RJ, Mourali M, Boucher JC, Constantinescu C, Leigh JP, Tang T. Challenges and recommendations for COVID-19 public health messaging: a Canada-wide qualitative study using virtual focus groups. BMJ open. 2022 Apr 1;12(4):e054635.

  10. Gao G, Lang R, Oxoby RJ, Mourali M, Sheikh H, Fullerton MM, Tang T, Manns BJ, Marshall DA, Hu J, Benham JL. Drivers of downloading and reasons for not downloading COVID-19 contact tracing and exposure notification apps: A national cross-sectional survey. Plos one. 2022 Jul 15;17(7):e0269783.