Canada's vaccine gaps are built into the system, not just chosen by individuals

Simon Fraser University

A single mother works nine to five. The vaccination clinic also runs nine to five. She does not get vaccinated. Is that a personal choice?

A refugee without a family doctor searches the internet for vaccine information and encounters misinformation. Is that vaccine hesitancy?

A patient who cannot get a translator at a clinic relies on community members who may themselves be poorly informed. Is that an anti-vax stance?

Researchers at Simon Fraser University argue that in each case, the answer is no. A new study published in Vaccine in March 2026 analyzed 41 peer-reviewed papers to map how cultural, administrative, institutional, and governance barriers in Canada systematically prevent vaccination in ways that are routinely misattributed to individual choice.

Four layers of structural failure

Lead author Haaris Tiwana and colleagues organized their findings across four domains:

Cultural and community norms. Many refugees, Indigenous peoples, and racialized communities carry deep mistrust rooted in historical discrimination and negative experiences with healthcare systems. Religious concerns and social norms further shape vaccine attitudes. These are not irrational objections. They are responses to real experiences with institutions that have earned distrust.

Governance structures. Top-down vaccination strategies that exclude marginalized communities from decision-making fail to build trust. Inconsistent messaging between provinces, territories, and regional health authorities sows confusion. A lack of transparency about how public health decisions are made compounds the problem. When different jurisdictions give different guidance, people notice.

Laws and budgets. Administrative requirements like identification rules and eligibility criteria create barriers for newcomers, undocumented people, and those without stable housing. Provinces and territories have different requirements, adding frustration. Community-led vaccination programs, which the evidence consistently shows increase access and trust, remain chronically underfunded and excluded from formal decision-making structures.

Institutional design. Many vaccination sites are hard to reach or operate on schedules that do not accommodate work or caregiving demands. Staffing shortages, rigid processes, and a lack of culturally safe care further reduce access. The absence of race-based data in many jurisdictions limits the ability to identify and target specific gaps.

Community-led programs work but lack stable support

The review found that peer-run and community-led clinics consistently increase both access and trust. When community organizations partner with local health authorities to offer culturally tailored services, including after-hours clinics and translation support, vaccination rates improve. People are more likely to ask questions, understand risks and benefits, and ultimately choose vaccination when the setting feels safe and the messengers are trusted.

Co-author Julia Smith, adjunct health sciences professor at SFU, noted that interpersonal and community networks are often as effective as scientific evidence for building vaccination trust, and sometimes more so.

But these programs operate on short-term crisis budgets. They lack stable funding. They are excluded from formal policy-making. The very approach that works best is the one most likely to be defunded when the immediate crisis passes.

Recommendations that target systems, not individuals

The study offers specific recommendations. Involve affected communities directly in planning and messaging. Ensure identification rules do not exclude newcomers or people without stable housing. Support community-led programming beyond crisis budgets. Train providers, expand translation supports, and adapt care to religious or cultural contexts, such as offering vaccination outside fasting hours. Develop coordinated data systems to track disparities and guide equitable policy.

These are structural interventions aimed at structural problems. They require sustained political commitment and budget allocation, not just public messaging campaigns telling people to get vaccinated.

A review, not a trial

This is a systematic review of existing literature, not an original data collection. It synthesizes findings from 41 papers, each with its own methodology, sample, and limitations. The review captures what has been studied and published, which may not fully represent the experiences of the most marginalized communities, who are often underrepresented in research.

The findings are specific to Canada, though many of the structural barriers described, including scheduling inflexibility, ID requirements, and underfunded community health programs, exist in other countries.

The review does not quantify how much of Canada's vaccination gap is attributable to structural barriers versus genuine philosophical objection to vaccines. Some proportion of unvaccinated people have made a considered choice. The study's argument is that the proportion is smaller than commonly assumed, and that many people counted as "hesitant" are actually facing practical obstacles.