Despite high coverage overall, routine childhood immunization coverage rates vary across Canada, and are in decline in some regions. Numerous systematic and social factors affect vaccine uptake, including access to healthcare services, vaccine hesitancy, and misinformation. Interviews with public health stakeholders, a review of international best practices in selected countries, and case studies of British Columbia, Alberta, Manitoba, and Ontario identify relative successes and limitations to inform potential policy interventions. This study assesses four policies: mobile immunization clinics, school reporting structures, provider incentives, and extended recall-reminder programs. While jurisdictions have improved accessibility of immunization services, further steps are needed to prompt behavioural change among hesitant parents of under-immunized children. To promote widespread immunization coverage, facilitate data collection, and enhance outbreak management, mobile outreach and immunization clinics are recommended, along with province-wide immunization requirements for school entry. Developing electronic immunization registries remains a foundational priority to target policies for under-vaccinated populations.
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