Public-health programs exist to protect the health and safety of the population and are often especially important to those most vulnerable to infection and disease, such as the very old and very young.
The introduction of a new vaccine in the last decade to guard against rotavirus, a gastrointestinal infection that spreads quickly and can cause severe illness, is an excellent example of a medical solution to a persistent public-health problem.
Rotavirus is a virus that causes gastroenteritis, or severe diarrhea and vomiting. Virtually every child will have a rotavirus infection by age five, and about one in 20 will go to the emergency department as a result. According to the World Health Organization, it is the most common cause of severe diarrhea in infants and is responsible for nearly 530,000 deaths around the world each year.
Although rotavirus is rarely deadly in developed countries like Canada, where clean water for rehydration and good medical care is readily available, hundreds of Canadian children are hospitalized each year because of rotavirus and thousands others suffer with the illness and pass it on to others.
So why do most provinces fail to fund a vaccine that could largely prevent these problems?
In 2006 and 2008, Health Canada approved RotaTeq and Rotarix, two new vaccines that help protect against rotavirus. The medications are given orally when children are between six weeks and eight months old and cost under $200. Research shows the vaccines are about 75-per-cent effective. Some vaccinated children may still experience some symptoms, but they are generally much less severe than those experienced by their unvaccinated peers, said Dr. Marina Salvadori, associate professor at the University of Western Ontario and section head of pediatric infectious disease at London Health Sciences Centre.
The World Health Organization, the Canadian Paediatric Society and the National Advisory Committee on Immunization all recommend children be vaccinated against rotavirus.
Canada lags behind many countries such as the United States and many South American and African countries in this area, and more provinces should consider universal coverage, Salvadori said.
Rotavirus vaccines are now covered in British Columbia, Ontario, Quebec and Prince Edward Island. Other provinces, including Alberta, Saskatchewan, New Brunswick, Nova Scotia and Newfoundland and Labrador don't provide universal access.
Residents are free to purchase the vaccine out-of-pocket, but it's unclear how many actually do. To justify the lack of coverage, many provinces cite competing health-care priorities and the need to fund other public-health programs.
Tony Kiritsis, a spokesman for the Department of Health and Wellness in Nova Scotia, said in an e-mailed statement that in order to fund a new vaccination program, the province would have to weigh "multiple factors" including the rate of infection, at-risk groups, the fiscal climate and program costs. He did not clarify whether the province is considering funding the vaccine.
Cost versus benefit
But in a system where health-care dollars are always stretched, there is a compelling case for funding the rotavirus vaccine.
A 2010 study published in the Pediatric Infectious Disease Journal sought to determine the scope and scale of rotavirus in hospitals by testing children for the infection. (Because rotavirus is so common and generally not life-threatening, testing is usually not performed at hospitals.) The researchers found there were 1,359 children hospitalized with laboratory-confirmed cases of rotavirus at 12 Canadian centres from 2005 to 2007. About 60 per cent were younger than age two. If a universal vaccination program had been in place, researchers estimate that 726 of those admissions could have been prevented.
The study also found that a sizable subset of children admitted to the hospital with rotavirus actually didn't display the classic symptoms of vomiting and diarrhea, but instead had seizures or very high fevers. In those cases, doctors would likely perform a battery of tests, including a spinal tap, to rule out meningitis, according to Salvadori. Many of those painful and unnecessary procedures could be prevented if more children were protected from rotavirus, she said.
The bottom line
Most children with rotavirus don't end up in the hospital. They experience vomiting and diarrhea for a few days and generally recover within a week. Since it's not a major burden on the health-care system, some provinces may decide it's not a priority. But infectious-disease experts say this is short-sighted and ignores the huge impact of rotavirus on our most vulnerable populations.
"It has so many beneficial impacts with no real harms and it's hard to see how some of the other things we're spending money on would be more important than this," said Dr. Joanne Langley, a pediatric infectious-disease specialist at Dalhousie University in Nova Scotia.
"It's up to us to put child welfare at the top of our priority list."