Submission ID 118496
| Issue/Objective | Vaccine access is crucial for a population's public health. However, access is influenced by several complex and interconnected factors. These include institutional factors that are the focus of our research because they are significant in terms of availability, access, acceptability and uptake of vaccines. The aim of this review is to examine the institutional barriers and facilitators in Canada that have an impact on the population's access to vaccines. |
|---|---|
| Methodology/Approach | We conducted a scoping review following the guidelines for Preferred Reporting Items for Systematic Reviews and Meta Analyses extension for Scoping Reviews (PRISMA-ScR) and Joanna Briggs Institute (JBI) Framework. We searched for published peer-reviewed literature in three databases: Ovid Medline, Ovid Embase, Scopus. The Google Advanced Search engine was used to collect grey literature. The eligibility criteria were based on population, intervention, comparator, outcome (PICO) framework. Publications between 2004 to 2024 that discussed factors influencing access to vaccines in Canada were included. |
| Results | The issue of inconsistent vaccine availability across healthcare settings was evident throughout the extracted literature. Some healthcare providers did not routinely stock certain vaccines, requiring patients to visit pharmacies to obtain them before returning to their primary care provider for administration (Thambinathan et al., 2024). Policy interventions, including regulation, public expenditure, and ownership strategies, were used to support family physician leadership in vaccination efforts, enhance infection prevention and control measures, and ensure the provision of key healthcare services such as virtual care and COVID-19 vaccination programs (Mathews et al., 2023). Vaccine manufacturing and distribution challenges significantly impacted access in Canada. The country's reliance on international production led to delays, as it lacked domestic capacity for manufacturing mRNA vaccines (Eren et al., 2023). Broader production and supply limitations further exacerbated shortages, restricting distribution efforts (Simms et al., 2023; Aghajafari et al., 2024). Structural barriers such as information inequities, past negative healthcare experiences, and logistical challenges also contributed to under vaccination (Aghajafari et al., 2024). Key determinants included provider-related factors like affordability and availability, as well as patient-level barriers such as financial constraints and accessibility issues (Khan et al., 2023). Additional challenges included cold chain storage requirements, space limitations, and provider confidence in administering and documenting vaccines (Khan et al., 2023a). Pharmacies played a significant role in vaccine distribution but faced frequent shortages, order fulfillment delays, and instances of turning patients away due to supply issues (Fonseca et al., 2021). Distribution system changes led to regional disparities, particularly for pharmacies outside Toronto (Fonseca et al., 2021). Suggested improvements included increasing early-season availability, offering more pre-filled syringe formats, and enhancing communication between distributors and providers (Fonseca et al., 2021). Equity concerns also influenced vaccine distribution, with high-risk populations such as cancer patients, Indigenous communities, and residents in high COVID-19 transmission areas prioritized for vaccination (Powis et al., 2023). However, a "first come, first served" model raised concerns about equitable access (Robitaille et al., 2023). Financial considerations further impacted distribution, as some pharmacists viewed vaccinations as unprofitable (Robitaille et al., 2023). Inconsistencies in regional public health policies led to disparities, with some pharmacies receiving preferential treatment over others in vaccine distribution (Robitaille et al., 2023). |
| Discussion/Conclusion | Our findings highlight the complex interplay of institutional factors influencing vaccine access in Canada. Overcoming these challenges require strengthening collaboration across health institutions, streamlining regulatory processes, and improving accessibility of health professionals in vaccine delivery particularly for marginalised communities. Addressing these institutional barriers is essential to ensuring equitable access and uptake. |
| Presenters and affiliations | Jillian Kohler University of Toronto Subrana Rahman University of Toronto Anaam Khan University of Toronto Chris Adanty University of Toronto Kristy Scarfone University of Toronto Gil Maor University of Toronto David Sanchez Villa University of Toronto |
