Improving vaccine equity in Canada

Vaccinations are routinely lauded as one of the top public health interventions, but benefits of immunization remain unequally distributed. While there is great variation across and within Canadian provinces in terms of immunization rates, racialized and Indigenous communities are generally vaccinated at lower rates than those of their White counterparts. Immunization rates are impacted by a number of factors, including accessibility, vaccine hesitancy and socioeconomic standing – which, like race and ethnicity – contribute to disparities in immunization that ultimately reproduce systemic inequities.

To better understand this issue, the University of Washington Population Health Initiative led a mixed methods study to track trends in Canadian immunization rates over the last decade. The project team compared key observations from the Canadian context with those from our parallel study of vaccine equity in the U.S. to identify how racial inequity presents differently in the context of a nationalized healthcare system versus a more fragmented one.

The project, which ended in September 2024, had three key research objectives:

1. Conduct a comprehensive review of literature, reports, policy and available datasets in the provinces of British Columbia, Ontario and Quebec over the last decade to better understand the current state of vaccination rates among racial minorities in Canada.
2. Undertake qualitative analysis with diverse stakeholders to identify which programs, policies or practices have most significantly impacted racial immunization equity, and what key factors or considerations contributed to the success or failure of specific interventions.
3. Compare data with findings from the United States to refine recommendations and produce outputs with broad, multinational relevance.

Major findings from the study included:

• Routine childhood vaccination rates in Canada lag behind those in the U.S., despite advantages of a publicly funded healthcare system.
• Significant racial disparities persist in both Canada and the US. However, limitations in available data prevent a comprehensive understanding of these health inequities at the local level.
• Data gaps arise from both logistical and sensitivity-related challenges. Participants emphasized the need for improved data systems, greater community engagement, and a focus on transparency, security, and sensitivity when handling race and ethnicity-based data.
• Despite these data limitations, health agencies and community organizations are actively working to combat the effects of systemic racism on childhood vaccination rates. Participants highlighted several key strategies for enhancing vaccine equity, including fostering trust, leveraging community-led, multi-sectoral partnerships, strengthening institutional capacities, and empowering through education.
• Results demonstrated the cyclical nature of vaccine hesitancy in underserved populations, and how hesitancy cannot be improved without a real commitment to improving the access and availability of vaccines.

We believe these research insights will guide policymakers, healthcare providers and community leaders in developing more informed and resilient immunization equity strategies in both the U.S. and Canada.

The project team included faculty and staff from the UW School of Medicine, College of Arts & Sciences, School of Public Health and the Population Health Initiative.

Read the Final ReportRead a Supplementary Toolkit

Funding Acknowledgement

This study was funded by a research grant from the Investigator-Initiated Studies Program of Merck Sharp & Dohme Corp (MISP Reference Number 101152).