Understanding Vaccine Hesitancy and Trust

Juliet Camus & Lynn Scherloski

We know hesitancy around vaccines exists. What we tend to overlook is the deeper question of what drives it and why. Too often, it is treated as a simple information gap or lumped into a single anti-vaccine mindset. But the data points to something more nuanced. For many Canadians, trust plays a defining role in vaccine decisions, particularly trust in institutions, experts and the people closest to them. Recent measles trends in Canada underscore the real-world consequences of vaccine trust. 

After more than a year of sustained measles transmission linked to an outbreak spanning several provinces, Canada lost its measles elimination status in 2025.  The Public Health Agency of Canada reported that the outbreak has persisted for more than 12 months largely in under-vaccinated communities, and Canada must go a full year without transmission to regain its elimination status. There have been over 1,000 measles cases this year alone, emphasizing how declining confidence in vaccines can threaten public health and leave communities vulnerable to the return of preventable diseases. 

Understanding the vaccine trust divide matters because it challenges how vaccine hesitancy is understood and how it should be approached. According to the latest CanTrust Index, nearly a quarter of Canadians say they have declined a vaccine recommended by a doctor at some point. This is not a group defined by a single point of view. Compared with vaccine accepters, this group assesses risk differently and places less trust in authority, the health care system, regulators and the pharmaceutical industry. In other words, many people are not rejecting a single message; they are responding from a different trust baseline altogether. 

That difference shows up clearly in who people listen to for information on vaccines. Family doctors are the most trusted source overall, but trust is higher among vaccine accepters (83 per cent) than vaccine hesitators (62 per cent). For those who are hesitant, family and close friends are trusted as much as doctors, underscoring that trust is shaped by relationships and conversation as well as expertise. Facts matter, but the messenger matters too. 

The reasons people give for declining vaccination also challenge some common assumptions. The biggest barriers are rarely ideological. More often, they relate to concerns about side effects, a low perceived need for the vaccine, uncertainty about the balance of risks and benefits and a desire for reassurance that vaccines have been studied over time. Addressing these concerns calls for specific, relevant information and a deeper understanding of the trust conditions people bring to the decision-making process. 

Vaccine confidence cannot be built through volume of information alone. It must be built through trust. And trust is rarely a ‘one-size-fits-all’ approach. Understanding where trust resides, why it breaks down and who people rely on for guidance may be just as important as the facts themselves. As Canada’s measles resurgence makes clear, this is a public health imperative. The better we understand those dynamics, the better equipped we will be to strengthen confidence, narrow the gap and help keep populations safe and healthy.