Canada has one of the worst rates of childhood immunization in the developed world.
That doesn't mean that Canadians are anti-vaccination. More than anything else, it reflects the fact that our system for vaccinating kids is shamefully clunky and disorganized.
An estimated 85 per cent of children have a full complement of protective vaccines. (Ideally, that number should be 90 per cent to 95 per cent.) Notice the word "estimated" there, because it's a reminder that we don't even have an accurate count of who is vaccinated and who isn't. That's because every province tracks vaccination differently, if at all. British Columbia, for example, knows how many two-year-olds are up-to-date on their shots, but Ontario doesn't have that information until children start kindergarten at the age of 4.
Of the 13 provinces and territories, only five (Alberta, Saskatchewan, Manitoba, Prince Edward Island, and Newfoundland and Labrador) actually have a registry, though Quebec will join their ranks next year.
Not to mention that who does vaccinations – nurses, family doctors, pediatricians – varies between jurisdictions and that few provinces have any standardized methods of encouraging parents to get kids vaccinated, follow-up procedures for those who miss their shots or stringent rules about who can opt out.
The C.D. Howe Institute, in a new report titled In Need of a Booster: How To Improve Childhood Vaccination Coverage in Canada, provides a detailed look at this incomprehensible mishmash of policies. What the report doesn't linger on, and perhaps should, is that Canadian public-health officials have been discussing the urgent need for a National Immunization Strategy for decades. This strategy, fashioned in 2003, would consist of three elements:
- A national vaccination registry;
- A single immunization schedule from coast to coast to coast;
- Harmonized delivery and access to vaccines.
Since the simple plan was put forward in 2003, progress has been painfully slow. Ottawa invested $135-million in a computerized registry system, but not all provinces use it, or use it fully. That means that, in many cases, parents and physicians are left to track vaccines in a little yellow booklet. Or they can download the excellent CANImmunize app. But neither is a substitute for proper tracking.
The most significant development has been that the purchase of vaccines is now done centrally. That means all kids (can) get all 14 childhood vaccinations at no cost. Yet, when new vaccines come along, it takes time to pick up. Inexplicably, each province has its own schedule for administering vaccines. This is particularly problematic when children move between jurisdictions, as approximately 85,000 do each year, in addition to the arrival of about 95,000 new immigrants and refugee children.
In recent years, there has been an upsurge of outbreaks of vaccine-preventable illnesses such as measles, mumps and whooping cough (pertussis). This makes having good records all the more important. But it's also a reminder of the cost of poor vaccine coverage, and we owe it to ourselves to understand why this is occurring.
As the C.D. Howe report notes, only about 2 per cent of parents are hard-core anti-vaccination. But there are a growing number of vaccine-hesitant parents. They tend to fall into one of three categories:
1) Complacency: those who take vaccines for granted;
2) Confidence: those who have doubts about the safety or necessity of vaccines and;
3) Convenience: parents who don't get around to vaccinating because it takes time and effort, or don't like that the shots inflict pain. There's a lot of research showing how to nudge parents in each of those categories toward vaccination. But the upshot is that it takes a bit of time and one-on-one attention from vaccine providers.
That's why, for example, provinces where nurses are responsible for vaccination have much higher rates. Little things, such as reminder phone calls and e-mails, also make a big difference. So, too, does timely access and minimizing pain with campaigns such as "it doesn't have to hurt." Other jurisdictions, including Australia, even provide financial incentives, such as a higher child benefit for fully immunized children.
That's a good investment, particularly when you consider that for each dollar spent on vaccination, the health system saves $16. But it all begins with good tracking and consistent policies. As the legendary economist John Kenneth Galbraith said, "If you don't count it, it doesn't count."
If our children's health matters to us, we should make darn sure they get their childhood vaccines, and do so as easily, conveniently and painlessly as possible.
André Picard