Vaccine gaps rooted in structural forces, not just personal choices: SFU study

(Press-News.org) A Simon Fraser University study is pushing back against the “easy narrative” that not getting vaccinated is entirely a personal decision.

Rather, vaccine hesitancy in Canada comes down to significant cultural, administrative, institutional and governance barrers that reinforce mistrust and create inequitable access to vaccines, say SFU researchers. 

Published in the journal Vaccine, the study analyzed 41 peer‑reviewed papers to map how barriers emerge across four areas: cultural and community norms, governance structures, laws and budgets, and institutional design. 

Key findings:

Top‑down decisions, weak transparency and mixed messages reduce trust. Poor data systems and a lack of race-based data limits targeted action.  Rigid processes, staffing gaps, and inconvenient clinic hours reduce access. Removing ID barriers and providing culturally safe, anti-racist vaccine delivery helps vaccine uptake. Peer- and community-led models improve access but lack stable funding. “It’s an easy narrative to say someone just chooses not to get vaccinated, but that’s unfair and incomplete. If the systems build in extra steps, you may not be ‘anti-vax’, but you're not going to get vaccinated just the same,” says Haaris Tiwana, health sciences researcher and lead author of the study.

“A single mother who works nine to five can’t get to a clinic that only runs nine to five. Someone without a family doctor may turn to the internet for information and get misinformation. Someone who can’t get a translator will go to other community members who may not be well informed. These are not individual failings. These are structural barriers.”

The study found cultural mistrust, religious concerns and social norms strongly shape vaccine views. Many refugees, Indigenous peoples and racialized communities carry deep mistrust rooted in discrimination and negative experiences with the healthcare system, Tiwana says.

Inconsistent messaging and a lack of transparency into how and who makes public health decisions around vaccines only compounds the problem. Top-down vaccination strategies fail because they exclude marginalized communities from decision making, leaving community organizations to fill gaps with little funding or influence, explains Tiwana. 

“People want to feel heard. Trusted messengers like elders, faith leaders or community advocates often have as much influence as public health messaging, and sometimes more,” Tiwana says. “We found that community‑led and peer‑run clinics consistently increase access and trust yet remain chronically underfunded and excluded from formal decision‑making.”

Administrative rules, like identification requirements and eligibility criteria, also makes getting vaccinated more difficult, especially for marginalized people or newcomers to Canada who don’t yet have access to primary health-care coverage programs, Tiwana says. Provinces, territories and even regional health authorities have different messaging and requirements around vaccinations, which only sows more frustration and mistrust, he adds.

Finally, the study found the way healthcare services are delivered directly impacts vaccination rates. Many sites are hard to reach or operate on schedules that don’t fit work schedules or caregiving demands. 

Community-led solutions hold key to vaccination trust The study found lack of culturally safe care can reinforce mistrust, while weak data systems, staffing shortages and rigid practices make equitable access even more difficult. 

“It’s important not just label people as anti-vax or vaccine hesitant,” says Julia Smith, adjunct health sciences professor and co-author of the study. “We need to ask why they are not vaccinated and ensure they have access to vaccination services where they feel safe.”

Interpersonal and community networks are often just as or more effective than scientific evidence for building vaccination trust, she adds.

When community organizations partner with local health authorities, like culturally tailored or after-hours clinics in B.C., for example, people are more likely to ask questions, understand risks and benefits, and ultimately choose vaccination, says Tiwana.

“Those community groups are an important way to let people ask the questions they need to ask, in a safe and culturally appropriate space,” he says. “We need policies, budgets, and practices to reflect lived experience and engage people at the community level.”

Study recommendations:

Involve affected communities directly in planning and messaging. Ensure identification rules and eligibility criteria don’t exclude newcomers, undocumented people or those without stable housing. Support community‑led programming beyond short‑term crisis budgets. Train providers, expand translation supports, and adapt care to religious or cultural contexts (for example, offering vaccination outside fasting hours). Develop coordinated systems to track disparities and guide equitable policy. This research was carried out by the Bridge Research Consortium (BRC) as part of Canada's Immuno-Engineering and Biomanufacturing Hub. The BRC is funded by the Canada Biomedical Research Fund and Biomedical Research Infrastructure Fund/BC Knowledge Development Fund.

END