Institutional factors influencing vaccine access in Canada: a scoping review

While existing literature has examined vaccine access primarily at individual and community levels in Canada, there remains limited synthesis and knowledge consolidation of how institutional factors shape vaccine access. Where institutional influences have been explored, prior reviews have been limited in scope to specific vaccine programs, populations, or single jurisdictions. This scoping review addresses this gap by systematically mapping how formal and informal institutional factors across federal and provincial governance structures shape vaccine access among all vaccine types and populations in Canada.

The review adhered to PRISMA Extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) methodological frameworks. Database searches identified English-language sources published 2004-2024. Screening and data extraction were conducted through Zotero, Covidence, and Microsoft Excel. Included sources (n = 134) underwent iterative inductive-deductive thematic coding. Finally, descriptive analysis synthesized findings into narrative summaries categorizing institutional factors as barriers or facilitators.

Six institutional barriers in Canada to vaccine access were identified: inconsistent vaccine supply and availability, public funding and coordination structures, geographic constraints, regulatory prioritization mechanisms, vaccine hesitancy, and information access inequities. Four facilitators demonstrated effectiveness: expanded vaccinator scope of practice, technological advancements, targeted vaccination initiatives, and inter-institutional and community collaboration.

This review extends current evidence on factors influencing vaccine access through consolidation of evidence on institutional determinants of vaccine access in Canada across disciplines, governance levels, and vaccine types with an explicit application of North's institutional theory framework. Findings support evidence-based policy development and health systems strengthening to advance vaccine equity. Priority interventions include harmonization of cross-jurisdictional frameworks, sustainable funding models for community-based delivery, and enhanced data infrastructure supporting equitable access.