Canada’s response to the COVID-19 pandemic has been choppy: A federal framework, combined with a patchwork of provincial and territorial strategies, created many of the same challenges the country’s health care system has been through in years past. Examples include the 2003 SARS (severe acute respiratory syndrome) outbreak and the tainted blood scandal in the early 1980s.
Medical experts say the issues are systemic, given that Canada has a decentralized health care system that’s managed by each province and territory. But instead of accepting the system for what it is, some in the medical community are calling for a formal pan-Canadian approach to fix Canada’s immunization system for the future.
The idea is to create a Canadian Immunization Services organization, modelled after Canadian Blood Services (CBS), the non-profit established in 1998 in response to the major health system failure that saw nearly 2,000 Canadians become infected with HIV from tainted blood products and another 30,000 infected with the hepatitis C.
“Creating a Canadian Immunization Services using the model for the Canadian Blood Services could address historical challenges related to variability in immunization practices and sharing of data across Canada,” argues a paper published recently in the Canadian Medical Association Journal. It was written by physicians Kumanan Wilson (a medical professor and member of the Centre for Health Law, Policy and Ethics at the University of Ottawa), Graham Sher (chief executive officer of CBS) and Jane Philpott (a former MP and dean of Queen’s University Faculty of Health Sciences).
CBS, which is funded mainly by the federal and provincial governments, takes a national approach to equitable acquisition, distribution, inventory management and data sharing to help serve Canadians in need of blood and blood products. It operates with a transparent and shared lens which allows for better supply chain management and rapid access to expertise.
It has also produced a safer blood system Canadians feel they can count on. Dr. Wilson acknowledges he was critical of the CBS at first, because it experienced some growing pains early on, but now supports it as a way to drive pan-Canadian collaboration.
A system that was centralized similar to the CBS would’ve helped during SARS, Dr. Wilson says, not to mention the current COVID-19 pandemic.
“It became apparent there was a general failure in our ability to conduct surveillance and how the government interacted” during the SARS crisis, Dr. Wilson says. “There wasn’t a sharing of data between provinces and the federal government and that resulted in the travel advisory, that was otherwise avoidable.”
In terms of COVID-19 vaccinations, Dr. Wilson says inconsistencies from one jurisdiction to the next can create headaches for Canadians. For example, proof of vaccination varies from province to province. “We don’t have harmonization and that could become a very practical problem as people move from province and territory,” Dr. Wilson says.
Canada played catchup
Dr. Sher of CBS says Canada has been a laggard worldwide when it comes to vaccine delivery, pointing to places like the United Kingdom as more advanced.
“Why would the U.K., which has a single health care system to serve the whole country, be able to access and deliver vaccines easily 8 to 12 weeks ahead of Canada?” he asks.
Organizationally, he says the provincial rollouts affected the health and safety of 3,500 employees at CBS. “Our front-line health care workers in many cases could not get equitable access to vaccination,” Dr. Sher says. “So a nurse in Vancouver was having a very different likelihood of getting a vaccine compared to somebody in Halifax or Charlottetown or Toronto.”
Based in Ottawa, Dr. Sher experienced the same confusion many Ontarians initially experienced, from when to get the jab to second-guessing the safety of vaccines. “At the end of the day, [many of us are] vaccinated and that’s great. But I think the country could’ve had a better experience,” he says.
Challenges of a centralized system
While a centralized immunization system would provide benefits, Katherine Fierlbeck, a professor and chair in the department of political science at Dalhousie University, says implementation would be tricky.
“In Canada, public health services are largely provided by the provinces and that is based on constitutional law. And, as that is devilishly difficult to manage, we are largely constrained by this reality,” Dr. Fierlbeck explains. She also notes there are existing collaborative systems such as the National Advisory Committee on Immunization, an advisory body that makes vaccine recommendations, and the Immunization Partnership Fund, a federal service that helps improve access to vaccines.
“There have been consistent attempts to establish linkages between jurisdictions, but they do fall short of what would’ve been successful when COVID-19 descended on us,” she says.
The timing for a new system might also be off, Dr. Fierlbeck adds. “The pandemic has also put heavy strains on provincial health care systems, and it may also be the case that [a centralized immunization service] is seen as a luxury that will have to wait.”
On Nov. 30, The Globe and Mail hosted a virtual event called Regenerative medicine: Where will stem cells take us? Presented by Bayer, the webinar explored the way researchers are working on stem cell advances that could change the future of medicine. Read more here.