Canadian Medical Association Journal editorial calls for national vaccination strategy

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Canada badly needs a cross-country vaccination strategy, including keeping track of who has been vaccinated, according to an editorial in a prominent journal.

The piece published on Monday in the Canadian Medical Association Journal comes as some provinces finally begin rolling out parts of a national public health surveillance system that was called for more than a decade ago after the SARS outbreak.

Better national co-ordination could help Canada tackle the measles, a vaccine-preventable disease that popped up in British Columbia, Alberta, Saskatchewan and Ontario this year, the journal says.

Without coast-to-coast standards, the editorial says, Canada is left with a patchwork of problems: Vaccine schedules differ from province to province; only three provinces make shots mandatory for entering school; and there is no national registry to track who has and has not been immunized for a variety of communicable diseases.

The creation of a national vaccine registry was supposed to be solved long ago.

The registry was envisioned as part of a national public health surveillance system that was a key recommendation of an expert report published after the 2003 SARS crisis.

Dubbed Panorama, the system is designed to track disease outbreaks, vaccine supplies and immunization coverage, among other things, but it has been plagued by financial, technical and co-operation challenges, all of which illustrate the tremendous difficulty of tracking and containing communicable diseases in a country with 14 different health care bureaucracies, including the one in Ottawa.

"The process took far longer than anybody expected," said Scott Halperin, a pediatric infectious disease specialist at the IWK Health Centre in Halifax. "The expectation was that this would be something that would happen soon, because the whole reason this started was because there was a clear, clear indication by everybody involved that we needed a vaccine registry in Canada. We knew that 15 or 20 years ago."

Alberta opted out of Panorama from the start. PEI and New Brunswick are not taking part, while Nova Scotia and Newfoundland and Labrador have put their participation on hold indefinitely.

"Panorama was a very complex system and over-expensive for relatively small provinces like Nova Scotia," said Frank Atherton, deputy chief medical officer of health for Nova Scotia.

The remaining provinces have either just begun to use parts of Panorama or are preparing to do so in the next year or two.

Ottawa has committed $133-million to Panorama through a federal agency called Canada Health Infoway, $97-million of which had been spent as of the end of February. The participating provinces have doled out millions of their own, mostly for capital costs. British Columbia, which spearheaded the project, has spent about $130-million over eight years.

Jennifer Zelmer, the executive vice-president of Canada Health Infoway, which is helping create and manage electronic health technology, including Panorama, said the complexity of the Canadian public health landscape is one reason for the delay.

"It was important to get it right," Dr. Zelmer said. "There was a slower start at the beginning, but we're now at the stage where Panorama modules are live in provinces covering about three-quarters of the Canadian population."

The provinces that have begun to use the system have high hopes for it. Ontario, for instance, was the first to use the registry part in a live environment, and last summer rolled it out in six public health units. It is expected to be province-wide in August.

The CMAJ editorial does not mention Panorama specifically, but warns that a national solution is key.

"Though certain illnesses might respect geographic boundaries, measles will not remain within provincial borders, because it has such a high transmissibility," according to the editorial, written by Gordon Giddings, an Ottawa palliative care doctor and editorial fellow at the CMAJ.

"It must be managed and monitored with a national solution."

The Public Health Agency of Canada, meanwhile, says Canada has a "first-class" immunization program with generally high uptake rates. The agency recently launched a free smart phone application that helps Canadians track their vaccinations.