When vaccination rates drop — as is the case with adult influenza vaccinations in Canada and child measles vaccinations in British Columbia — the explanation is often that people are “hesitant.”

The unvaccinated are frequently described as influenced by misinformation, cultural beliefs or religion. The solution, then, is assumed to be health education or clearer messaging, suggesting that the main barrier to vaccination lies within individual attitudes, fears or choices.

There is some truth to this. As ample research demonstrates, beliefs do matter and misinformation does influence vaccine decision-making. But focusing only on individual behaviour and beliefs risks overlooking the context in which decisions are made. Across multiple Canadian studies, barriers to vaccination consistently extend beyond personal choice. They are embedded in policies, institutions and everyday experiences with the health system.

In other words, vaccine uptake is not just a behavioural issue. It is also a structural one.

When access isn’t truly accessible

One of the most consistent findings in Canadian research is that access to vaccines is uneven. Vaccination clinics may be located far from rural or lower-income communities, or operate only during standard working hours — despite the fact that 60 per cent of Canadians work shifts or non-traditional hours.

For others, logistical barriers create challenges. Parents may struggle to find childcare. During the initial COVID vaccination campaign, for........

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