The Simon Fraser University study pushes back against the “easy narrative” that not getting vaccinated is an entirely personal decision.
Rather, SFU researchers say vaccine hesitancy in Canada comes down to significant cultural, administrative, institutional and governance barriers that increase mistrust and create inequitable access to vaccines.
Published in a magazine vaccineThe study analyzed 41 peer-reviewed papers and mapped 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 lack of race-based data limit targeted actions.
- Rigid processes, understaffing, and inconvenient clinic hours reduce access.
- Removing identity barriers and providing culturally safe, anti-racist vaccine distribution will accelerate vaccine uptake.
- Peer and community-driven models improve access but lack stable funding.
It’s easy to say someone just chose not to get vaccinated, but that’s unfair and incomplete. If your system has additional steps built into it, you may not be “anti-vax” but you won’t be able to get vaccinated in the same way. ā
Harith Tiwana, health science researcher and lead author of the study
“A single mother who works a 9-to-5 job cannot go to a clinic that only operates 9-to-5. People who don’t have a family doctor may seek information on the internet and get incorrect information. Those who cannot hire an interpreter will rely on other community members who may not have sufficient information. These are not individual failures. These are structural barriers.”
The study found that cultural mistrust, religious concerns and social norms strongly shape perceptions of vaccines. Tiwana said many refugees, indigenous peoples and racialized communities harbor deep mistrust rooted in discrimination and negative experiences with the health care system.
Inconsistent messaging and a lack of transparency about who makes public health decisions about vaccines and how they are only making the problem worse. Tiwana explains that top-down vaccination strategies fail because they exclude marginalized communities from decision-making and leave community organizations with little funding or influence to fill the gaps.
“People want to feel heard, and trusted messengers such as elders, faith leaders, and community advocates often have just as much impact, and sometimes more, than public health messages,” Tiwana says. āWe found that although community-led and peer-run clinics consistently increase access and trust, they remain chronically underfunded and excluded from formal decision-making.ā
Administrative rules, such as identification requirements and eligibility criteria, also make vaccination more difficult, especially for marginalized populations and newcomers to Canada who don’t yet have access to primary health insurance programs, Tiwana said. She added that states, territories and even local health authorities have different messages and requirements regarding vaccination, which only increases frustration and mistrust.
Finally, the study found that the way health services are delivered has a direct impact on vaccination rates. Many sites are difficult to access or operate on schedules that do not accommodate work schedules or caregiving demands.
Community-led solutions hold the key to vaccination confidence
The study found that a lack of culturally safe care exacerbates mistrust, while weak data systems, staff shortages and rigid practices further complicate equitable access.
“It’s important that we don’t just label people as anti-vaxxers or vaccine-hesitant,” said Julia Smith, an adjunct professor of health sciences and co-author of the study. āWe need to ask why people are not getting vaccinated and make sure they are able to access vaccination services that they feel are safe.ā
Interpersonal and community networks are often as effective or more effective than scientific evidence in building confidence in vaccination, she added.
For example, when community organizations partner with local health authorities, such as B.C.’s culturally tailored clinics and after-hours clinics, Tiwana says people are more likely to ask questions, understand the risks and benefits, and ultimately choose to get vaccinated.
āThese community groups are an important way to allow people to ask the questions they need to ask in a safe and culturally appropriate space,ā he says. āWe need policies, budgets and practices that reflect lived experience and involve people at the community level.ā
Research recommendations:
- Involve affected communities directly in planning and messaging.
- Ensure that identification rules and eligibility criteria do not exclude newcomers, undocumented immigrants, or those without stable housing.
- Support community-driven programs beyond short-term crisis budgets.
- Train health care providers, expand translation support, and adapt health care to religious or cultural contexts (e.g., providing vaccinations outside of fasting hours).
- Develop a coordinated system to track disparities and guide equitable policies.
This research was conducted by the Bridge Research Consortium (BRC) as part of the Canadian Immunotechnology and Biomanufacturing Hub. The BRC is funded by the Biomedical Research Fund of Canada and the Biomedical Research Infrastructure Fund/BC Knowledge Development Fund.
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Reference magazines:
Tiwana, M. H., and Smith, J. (2026). Structural determinants of vaccine access: A comprehensive review of the Canadian literature. vaccine. DOI: 10.1016/j.vaccine.2026.128324. https://www.sciencedirect.com/science/article/pii/S0264410X26001325?via%3Dihub
