As Ottawa and the provinces embark on negotiations to renew the Health Accord in 2014, they should take the opportunity to invest in a truly national vaccination strategy, public health leaders say.
"Right now, we have a patchwork of approaches across the country," Debra Lynkowski, CEO of the Canadian Public Health Association, said in an interview. "It's time for a harmonized and national approach."
She was speaking on behalf of a coalition of public health officials, government and industry representatives who are calling for a strategy that includes several elements, including:
- A national immunization registry where there is a central record of all vaccines individuals have received - currently some provinces have registries but they are not linked;
- Creating a single childhood immunization schedule so children get the same vaccines at the same time across Canada - there are now wide variations between jurisdictions and some children miss key vaccines as a result;
- Harmonizing vaccine delivery and access to ensure the same vaccines are funded in every province and territory at the same time.
Ian Gemmill, past chair of the Canadian Coalition for Immunization Awareness and Promotion, said such a strategy exists on paper but not in practice.
"It needs a kick start. Our governments need to make a sustained investment in the health of our children," he said.
The coalition has not put a dollar figure on the initiative but, based on past efforts, at least $100-million a year would be required.
Speaking before more than 1,000 delegates of the Canadian Immunization Conference in Quebec City on Sunday, federal Health Minister Leona Aglukkaq hailed vaccination as one of the single most important health measures available.
The minister said there is currently a review of the National Immunization Strategy underway, and that she was committed to "ensuring it will be as effective and efficient as possible." Ms. Aglukkaq, however, did not make any monetary commitments.
In 2003, Ottawa set aside $300-million for a national immunization strategy, money that was used principally to help poorer provinces purchase meningococcal, pneumococcal and chicken pox vaccine so they could keep pace with policies in larger provinces.
In the 2007 budget, Ottawa set aside another $300-million for immunization, money that went to paying for a new vaccine that protects against human papillomavirus. (HPV is the principal cause of cervical cancer, throat cancer and anal cancer and a number of other gynecological and urological cancers.)
Dr. Gemmill said that instead of those one-off initiatives, there needs to be a philosophy in place that "every kid has the same access to the same vaccines all the time."
He said a key component of a vaccination strategy also needs to be an education program to answer the concerns of parents and counter the fears created by anti-vaccinationists.
In the keynote address to the conference on Sunday, Scott Halperin, director of the Canadian Centre for Vaccinology in Halifax, said he does not believe there is an anti-vaccine movement.
Rather, he said there is a broad array of people who have disparate worries about vaccines and "vaccine promoters have lumped together all those with anti-vaccination sentiment" and created the impression of a movement where none exists.
Dr. Halperin said there is no question that vaccines - like all drugs - have adverse events and that should not be denied. But, at the same time, he said, the benefits of vaccines need to be promoted more aggressively to get across the message that benefits outweigh risks.
The phenomenon of anti-vaccination activists
The Canadian Immunization Conference heard yesterday that there is no anti-vaccine movement. Rather, there is a pot-pourri of individuals and groups who are concerned about vaccination policies for a variety of reasons, good and bad.
Dr. Scott Halperin, head of pediatric infectious diseases IWK Health Centre in Halifax, said he has come across four broad categories of parents:
The uninformed and educatable: People who know very little about the benefits or risks of vaccines;
The misinformed and correctable: People who are concerned about the dangers of vaccines, in large part based on what they have read on the Web;
The convinced and content: People who have thought through the benefits and risks of vaccines and are generally supportive;
The committed and missionary: People who are convinced vaccines are a danger and determined to convert others to their point-of-view.
Dr. Halperin said while there are some well-organized groups that oppose vaccination like the U.S. National Vaccine Information Center and Vaccination Risk Awareness Network, there is no single unifying ideology or philosophy.
The underlying reasons for opposing vaccination include:
- Fear of side effects or "poison" in vaccines
- Doubt about the necessity of vaccines
- Civil liberty concerns, in particular opposition to mandatory vaccination (something that is common in the U.S. but not Canada)
- Dislike or hatred for pharmaceutical companies
- Promoting alternatives like complementary medicine and homeopathy
- Providing fuel for lawsuits
- Conspiracy theories