Vaccines are the single most important and cost-effective health intervention we have, especially for children.
So, is there any reason a child in Saskatchewan should not get the same vaccines as a child in New Brunswick? Why the hepatitis B vaccine is given in infancy in some provinces and in pre-adolescence in others? Why some provinces provide the flu vaccine free to everyone while others target only high-risk groups such as seniors?
Why, in the 21st century, do we continue to use a little yellow booklet filled with illegible scribbles - not a computerized registry - as a vaccination record?
Why are vaccines not purchased centrally to save money?
So many questions and one obvious answer: Canada desperately needs a national immunization strategy. Or, at least, it needs to revive and bolster the current strategy, which exists only on paper.
So what do we need to do to bring a national immunization strategy to life? There are five key elements:
• Replacement of the 14 childhood immunization schedules that exist now in Canada with a single one. The current mishmash is unnecessarily confusing for parents and health professionals and too many children miss key vaccines as a result;
• A national immunization registry where there is a central record of all vaccines individuals have received. Some provinces currently have registries, but they are not linked. Children get about two dozen shots before they start school and a growing number during the school years: Paper records just don't cut it any more;
• A harmonized vaccine-approval policy to ensure that the same vaccines are funded in every province and territory at the same time;
• Central purchasing so that taxpayers can benefit from the savings that come from bulk buying;
• Priority given to vaccine safety by improving monitoring and research, both of which are greatly facilitated with a national registry and coherent policies.
The benefits are so glaringly evident that there is virtually universal agreement on what needs to be done.
But inaction has been justified, or at least tolerated, because … health is provincial responsibility.
Sigh.
Yes, there is a constitutional division of powers. But could we please stop using that fact to excuse dithering and stupidity?
Our politicians have to decide, once and for all, that the mindless pursuit of provincial autonomy takes a back seat to the health of Canadians - and, in this case, universal child health.
At the Canadian Immunization Conference, held this week in Quebec City, delegates have heard repeatedly how a number of other countries - notably Britain, the United States and Australia - put Canada to shame with their sensible vaccination policies.
Let's focus on Australia because, like Canada, it is a federation where states (like provinces) have constitutional responsibility for health.
In Australia, there is a single vaccination schedule fashioned by the Technical Advisory Group on Immunization. (Canada has an identical body, the National Advisory Committee on Immunization, which, by the way, has a perfectly sensible immunization schedule.)
There is also a second group that examines cost-effectiveness. (Canada has a similar body, the Common Drug Review.) In Australia, a new vaccine is not funded until it is demonstrated to be both beneficial and cost-effective.
The key difference is that, in Australia, the recommendations of these committees have teeth: They are, for all intents and purposes, binding. In Canada, they are suggestions that can be acted upon or not.
That is because, in Australia, once a vaccine has the blessing of the committees, it will be paid for, in full, by the federal government.
By using its spending power, the central government ensures that vaccines are available to all children free.
You want money? Then you need to respect the immunization schedule and sign on to a national registry. That is a sensible use of the constitutional division of powers. It is a perfect approach for Canada.
Let's not forget that the federal government already transfers $38.5-billion to the provinces and territories annually for health. There is no reason it cannot direct some of that money specifically for a national vaccination program.
The fear, of course, is that a national strategy would be costly. But vaccines are already being purchased. The additional costs for organizing the system would be minimal, and might even be offset by more sensible centralized purchasing.
The Australian experience holds another important lesson. While vaccines are federally funded, the states maintain complete autonomy in the delivery of vaccines. Some do so in schools, others in clinics or doctors' offices. Those details don't matter much if everyone has the same basic schedule. The states can even choose between competing brands of vaccines, though purchasing is done centrally.
Further, the national strategy does not preclude having special vaccination programs in high-need areas. Like Canada, Australia has a large aboriginal population living in remote areas and with specific health challenges. In its Northern Territories, it vaccinates against tuberculosis and hepatitis A (as we do in Canada), and states where there are outbreaks of disease - say meningococcal disease - are free to respond, and federal funding is provided.
Canada's current vaccine patchwork is inefficient and inequitable. It is also inexcusable.
We need to give fixing this our best shot.
Want to know what immunizations your children should get and when? Check out the interactive immunization schedule on the Public Health Agency of Canada website at: www.phac-aspc.gc.ca/im/iyc-vve/is-cv-eng.php
André Picard