Canada's recently approved RSV prevention tools, including vaccines for older adults and pregnant individuals, and a monoclonal antibody for infants, are facing significant access disparities due to provincial program variations. Despite national recommendations from the National Advisory Committee on Immunization, provinces retain the authority to decide public funding and eligibility, leading to a fragmented system where access often hinges on geographic location and local health priorities rather than solely medical need. This situation highlights a governance gap, as no single entity is clearly accountable for ensuring national equity in vaccine access, a challenge underscored by the COVID-19 rollout and potentially exacerbated by new, population-specific innovations.