Vaccine hesitancy
Each year, according to the WHO, vaccination prevents 3.5 to 5 million deaths from diseases such as diphtheria, tetanus, pertussis, influenza and rubella. In 2019, the WHO named vaccine hesitancy as one of the biggest threats to global health.
This reluctance may result from misinformation and mistrust towards pharmaceutical lobbying, health professionals and also from the influence of colonialist history.
Inequalities in the access to resources
Oppression has a negative impact on people’s health and well-being. Some Indigenous, Black or racialized people experience intergenerational trauma related to care practices or clinical spaces and may refuse to be exposed to them.
Social health determinants, including access to health care, housing and adequate income, have an impact on health. They are part of a socio-economic and political context ingrained with inequities and injustices. Many live in poverty, precarious housing conditions or experience food insecurity, which all accentuate vulnerability in terms of health, being more likely to be ill or to suffer from serious complications.
In addition, they come up against systemic racism, gender discrimination and professionals who are not adequately trained. According to the French study Santé LGBTQ : les minorités de genre et de sexualité face aux soins (LGBTQ Health: gender and sexual minorities’ perception of care), published by Éditions du bord de l’eau in 2020, more than one in two people of the LGBTQ+ community have already felt discriminated against in a context of care. A recent example of systemic racism and discrimination is the death of Joyce Echaquan, an Atikamekw from Manawan, Quebec. Her death was attributed to the unfair treatment received from health care workers on September 28, 2020.
The combination of health determinants must also be taken into account. Indeed, the different systems of oppression articulate and reinforce each other: class, gender, disability, age, ethnic origin, sexual orientation, etc. For example, a person with a disability who is also a refugee applicant will face more obstacles in terms of access to health care.
Receiving training on trauma informed and culturally safe care makes it possible to develop a personalized, adapted and reassuring communication strategy, promoting informed choice, in the context of vaccination.
Another avenue for change is to support organizations and individuals working to formally denounce the harms committed by public health and health systems.
Accessibility barriers
Accessibility barriers include : economic (cost of the intervention, travel, time away from work), geographic (remoteness, time of service) and cultural (language, audio-visual) barriers.
Several initiatives can be undertaken to counter these barriers such as mobile clinics, visual material with images and in several languages, interpreters, involvement of community leaders. Providing more community-based immunization services may also facilitate access to vaccines, since many people want to avoid hospital/clinic settings. An example of a midwife community that provided vaccines to their community is Seventh Generation Midwives in Toronto. During the pandemic, a home vaccination program was implemented for Indigenous people and their families.
Another barrier is the dynamics of the global vaccine market which is not conducive to vaccine development, supply and access. Vaccines prioritized by the WHO are often not developed due to limited profit potential. Lack of transparency from pharmaceutical companies and global inequality in access to vaccines accentuate health disparities.