The vaccination system in Canada differs from some other countries in that it does not have federal laws on mandatory vaccination. Instead, each province and territory sets its own immunization requirements. However, all provinces and territories have similar routine vaccination programs recommended by Canada's National Advisory Committee on Immunization (NACI). This means that although some vaccines are officially mandatory for school attendance in certain provinces, most vaccines in Canada are provided as recommended public programs rather than legally binding requirements.
Mandatory vaccines for children in school
Legally, only three provinces in Canada have laws that require vaccination for school attendance: Ontario, New Brunswick, and Manitoba. Ontario and New Brunswick have the most comprehensive legislation, which was passed in 1982 and updated in 2017. These laws are governed by the Immunization of School Pupils Act (ISPA).
Ontario requirements
In Ontario, children must be vaccinated against nine diseases to attend elementary and secondary school unless they have a valid exemption. These vaccines include protection against diphtheria, tetanus, polio, measles, mumps, rubella, meningococcus, pertussis, and chickenpox. Chickenpox is only mandatory for children born in 2010 or later. Hepatitis B and human papillomavirus (HPV) have recently been added to this list, although these vaccines are considered separate from the basic mandatory requirements.
New Brunswick requirements
In New Brunswick, children must receive vaccines against diphtheria, tetanus, polio, pertussis, measles, rubella, mumps, chickenpox, and meningococcal disease. New Brunswick's legislation requiring these vaccines for school attendance was last updated to reflect advances in vaccine science and the inclusion of new vaccines in the provincial routine immunization schedule.
Manitoba requirements
In Manitoba, the mandatory vaccination law is much less comprehensive than in Ontario and New Brunswick. Manitoba requires mandatory vaccination only against measles. However, the province does not stop there and offers a comprehensive routine vaccination program that covers many more diseases.
Requirements in other provinces and territories
In all other provinces and territories of Canada, vaccination is not legally required for school, although routine vaccination for the same diseases continues to be offered to all children through publicly funded health programs. Parents in these provinces can choose to vaccinate their children, but it is not a legal requirement for school attendance.
Vaccination exemption options
For those provinces that have mandatory vaccination requirements, there are exemption options. Exemptions can be obtained on medical, religious, or conscientious grounds. The process for obtaining an exemption varies depending on the province and the type of exemption. Medical exemptions require a doctor's note, while non-medical exemptions can be obtained through a parental declaration or by completing an educational course, depending on the province.
Routine vaccination of children from birth to school age
Although vaccination is not mandatory in most provinces, the Canadian healthcare system provides a comprehensive routine vaccination program funded by the government. These vaccines are recommended for all children and are generally administered from a very early age.
Vaccines at 2 months of age
Vaccination of children in Canada begins at 2 months of age. At this stage, children are given a combination vaccine, commonly referred to as DTaP-IPV-Hib-HB. This single vaccine protects the child against five diseases at once: diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type b (Hib) infection, and hepatitis B. In addition, children are also given a pneumococcal vaccine (Pneu-C) and a rotavirus vaccine (Rot).
Vaccines at 4 months
Children receive a second dose of the DTaP-IPV-Hib-HB combination vaccine, as well as a second dose of the pneumococcal and rotavirus vaccines.
Vaccines at 6 months
Children receive the third dose of the DTaP-IPV-Hib combination vaccine, the pneumococcal vaccine, and the third dose of the rotavirus vaccine (if the three-dose version is used) or the second dose of the rotavirus vaccine (if the two-dose version is used).
Vaccines at 12 months
During the first year of life, children receive the measles, mumps, rubella, and varicella vaccine (MMRV or MMR and varicella separately). They also receive the meningococcal type C vaccine (Men-C-C) and the fourth dose of the pneumococcal vaccine, if provided for in the provincial program.
Vaccines at 15-18 months
At around 15-18 months, children receive a fourth dose of the DTaP-IPV-Hib combination vaccine and the chickenpox vaccine (if it was not given at the MMRV stage).
Vaccines at 4-6 years of age
Before school, children receive a booster dose of the DTaP-IPV vaccine, which protects against diphtheria, pertussis, tetanus, and polio. At this stage, children also receive a second dose of the MMRV vaccine, if it was not given earlier.
Vaccines at ages 6-9 and older
Children 6 years and older are recommended to receive the flu vaccine annually, starting in the fall. Children younger than 9 years of age who are receiving the flu vaccine for the first time need two doses at least 4 weeks apart. Children who have received the flu vaccine in previous seasons need only one dose per year.
Vaccines at school
Grade 6
At this stage of school education, children receive two or three doses of the human papillomavirus (HPV) vaccine. In most Canadian provinces, HPV vaccination for girls began earlier, but in recent years it has been extended to boys. Children are also given the hepatitis B vaccine if they did not receive it as infants.
Grade 9
At this stage, children receive a booster dose of the Tdap vaccine (tetanus, diphtheria, and acellular pertussis). In most provinces, this age also corresponds to the administration of the meningococcal ACYW vaccine (Men-C-ACYW) or a double dose of the meningococcal B vaccine (4CMenB or MenB-fHBP).
Recommended (but not mandatory) vaccinations for children and adolescents
In addition to the core vaccines recommended for all children, there are vaccines that are recommended for children with certain risk factors or based on individual choice. The COVID-19 vaccine is an example of such a vaccine. Although the COVID-19 vaccine is not a mandatory requirement for school in Ontario, it is recommended by the National Advisory Committee on Immunization for children over 6 months of age, especially those at increased risk of severe disease.
The respiratory syncytial virus (RSV) vaccine is also recommended for certain groups of children. Infants born between October 2025 and March 31, 2026, are eligible for one dose of the RSV vaccine to protect them during their first RSV season.
Adult vaccination
The adult vaccination system in Canada is significantly different from that for children. There are no legally required vaccines for adults (with some exceptions for military personnel and certain groups of healthcare workers). Instead, adult vaccination is based on recommendations that vary depending on the person's age and health status.
Vaccination for adults aged 18-49
Adults in this age group are advised to review their immunization status for tetanus and diphtheria (Td). If an adult has not received Td in the last 10 years, a booster dose is recommended. If an adult has never received Tdap (a vaccine that also protects against pertussis), one dose of Tdap is recommended instead of Td.
Adults in this age group are also recommended to receive the varicella vaccine if they are not immune to this disease. Adults are also recommended to receive the influenza vaccine annually.
Vaccination for adults aged 50-64
At this stage of life, it is recommended to start vaccination against shingles. Canadian health authorities recommend a two-dose series of a recombinant shingles vaccine (RZV) called Shingrix. This vaccine provides 97% protection for people aged 50-69 and at least 91% protection for people over 70. Shingrix is administered in two doses 2-6 months apart.
Adults in this age group are also recommended to get an annual flu shot and review their tetanus/diphtheria status.
Vaccination for adults aged 65 and older
This is the most important age group in terms of recommended vaccination. All adults aged 65 years or older are recommended to receive the pneumococcal vaccine. Pneu-C-20 (20-valent pneumococcal conjugate vaccine) is specifically recommended. This vaccine covers the entire adult population aged 65+ with a single dose.
Adults aged 65 and older are also recommended to continue the Shingrix series against shingles if they have not received it before.
Vaccination of adults aged 75 and older
For this older age group, the respiratory syncytial virus (RSV) vaccine is recommended. This vaccine provides significant protection: it reduces the risk of acute RSV respiratory infection by 72%, RSV pneumonia by 83%, and severe RSV (requiring oxygen or hospitalization) by 94% in people over 60 years of age.
COVID-19 vaccination for adults
In early 2025, the National Advisory Committee on Immunization identified groups of adults who should receive the COVID-19 vaccine. All adults aged 65 and older are recommended to receive the COVID-19 vaccine because they are at increased risk of severe disease. The COVID-19 vaccine is also recommended for other adults at increased risk (including people with certain medical conditions and those with weakened immune systems). One dose per year is recommended for most immunized individuals, but some groups, including adults 80 years of age and older, may receive a second dose per year.
Annual flu vaccination
Annual flu vaccination is recommended for all adults, especially those over 65 or with chronic medical conditions.
Vaccines for adults with certain risk factors
In addition to the basic recommendations for all adults, there are additional vaccines for adults with certain risk factors. These factors include people with weakened immune systems due to illness or therapy, people with certain chronic medical conditions, people who live in specialized facilities, and people who travel to certain countries.
Adults with risk factors may be recommended additional doses of meningococcal, pneumococcal, and hepatitis B vaccines, depending on their specific situation and level of risk. People with certain immunodeficiency conditions may receive vaccines that are not generally recommended for the healthy population, such as the Haemophilus influenzae type B (Hib) vaccine and the adult polio vaccine (IPV).
Vaccine funding and availability
In Canada, all vaccines included in provincial routine immunization schedules are provided free of charge. This means that children receive vaccines from birth through school age, including booster doses, at no cost to the family. Adults are also provided with recommended vaccines free of charge through the public health care system, especially for adults over 65 years of age.
However, some vaccines that are not included in the official routine vaccination schedule can be purchased privately. Examples include the yellow fever vaccine for travelers or vaccines for travelers going to certain countries. These vaccines can be purchased at private clinics or pharmacies, but they are not funded by the government.
Changes to vaccination programs over time
Canadian vaccination programs are constantly evolving based on new scientific research and available vaccines. Examples of how programs have changed include the introduction of vaccines against HPV and RSV and the expansion of schedules for meningococcal vaccines. For example, until 2018, not all provinces included the hepatitis B vaccine in their infant programs; however, provinces such as Alberta have gradually expanded their programs to include this vaccine in the early stages of life. Similarly, the meningococcal serogroup B vaccine was included in programs at different times in different provinces.
Balance between public health and parental choice
The Canadian vaccination system strikes a balance between ensuring public health and respecting parental choice. Although most vaccines are not legally mandatory (except in three provinces), the system is designed to provide free access to important vaccines to protect against serious diseases. Recognizing the importance of vaccination for public health, the Canadian system also provides for exemptions on medical, religious, and conscientious grounds where permitted by provincial law.