Researchers point to access barriers behind Canada's vaccine gaps

Canadian vaccine gaps are being described too narrowly as a problem of personal hesitancy, researchers Muhammad Haaris Tiwana and Julia Smith argue in The Conversation. They say that framing can miss the practical and institutional barriers that shape whether people get vaccinated.

The authors point to falling adult influenza vaccination rates in Canada and lower child measles vaccination rates in British Columbia as examples of public health concerns often explained by misinformation, cultural beliefs or religion. Those factors can affect decisions, they write, but Canadian research also links vaccination uptake to policy, health system design and daily access problems.

Access can block uptake

Tiwana and Smith say vaccine services may be available in theory while remaining hard to use for many people. Clinics can be far from rural or lower-income communities, and hours can clash with work schedules.

Statistics Canada data cited by the authors says 60% of Canadians work shifts or other nontraditional hours. That makes standard daytime clinic hours a barrier for some workers, according to the researchers.

Other obstacles include child care, transport and paperwork, Tiwana and Smith write. They note that during the first COVID-19 vaccination campaign, adults could take paid time off to get their own shots but not necessarily to take children for vaccination.

Transportation can also limit access, especially outside large urban centres. A Hope Air survey cited by the authors found about one in four residents in rural and northern communities in Northern Ontario had canceled a medical appointment because of the distance to care.

Administrative rules can create another barrier, according to Tiwana and Smith. Identification requirements may exclude undocumented people or people without stable housing, they write.

Trust depends on experience

Public health campaigns often put heavy weight on clearer messaging, but Tiwana and Smith argue that information alone does not build trust. They say trust is shaped by how people have been treated by health systems.

The authors cite Indigenous, Black and racialized immigrant communities in Canada as groups whose interactions with health services have often included discrimination, exclusion or neglect. Those experiences can affect how official vaccine guidance is received, they write.

During the COVID-19 pandemic, frequent policy changes and inconsistent public messages also weakened confidence, according to research cited by Tiwana and Smith. In some cases, they write, health workers themselves had difficulty keeping up with changing guidance.

Community groups fill gaps

Tiwana and Smith say vaccination programs are often designed from the top down, with limited input from communities they are meant to serve. That can leave gaps in language, culture and accessibility.

Community organizations have helped bridge those gaps by translating information, booking appointments, organizing mobile or pop-up clinics, arranging transportation and working with trusted faith or community leaders, according to the authors. During the COVID-19 pandemic, some public health units partnered with faith-based and ethnocultural organizations to hold clinics in places of worship and community centres.

The researchers say those partnerships helped improve trust and access among racialized communities, but they also warn that such efforts are often temporary and underfunded. They argue that community-led work is not consistently built into formal health systems.

Policy changes proposed

Tiwana and Smith call for vaccination strategies that address access as well as attitudes. Their recommendations include flexible clinic hours, easier-to-reach locations, fewer administrative barriers, more funding for community partnerships, clearer communication and community involvement in program decisions.

The authors say this approach does not dismiss individual choice. Their argument is that choices are made within systems, and vaccination rates are likely to suffer when services are hard to reach, trust is weak and programs do not reflect community needs.

This story draws on original reporting from Medical Xpress.