Canada’s vaccine problem

When Tasha Kang became pregnant, she never thought she’d have to worry about her child catching measles or the mumps — infectious diseases that once appeared to be all but eradicated in Canada. But as the 33-year-old from Whitby awaits the arrival of her firstborn in early May, she says she’s concerned about “that one kid whose parents decided not to vaccinate.”

Kang is not just a worrywart — nor is she alone. There’s a growing fear among parents and public health experts about Canada’s dismal vaccination rates, which fall well below international standards and show little sign of improvement.

According to UNICEF, Canada has the second lowest rate of childhood vaccination among developed countries. While public health experts don’t know for sure what that rate is (for lack of a robust national tracking system), it’s generally accepted to be around 85 per cent — considerably less than the World Health Organizations’s 90 to 95 per cent target. (Adult rates tend to be even lower; for example, only 30 to 40 percent get their flu shots.)

“It actually embarrasses me when I am in other countries that are doing so much better than we are,” says Noni MacDonald, a pediatrician and expert in children’s infectious diseases who teaches at Dalhousie University.

Few people in this country, MacDonald says, subscribe to conspiracy theories about vaccinations, such as the false belief that they can cause autism. The problem is the roughly 15 per cent of Canadians who acknowledge that vaccines are beneficial but have lingering doubts about their safety or face barriers to access. (Low-income families and shift workers, for example, often have trouble getting to a clinic during regular hours, while newcomers to Canada may not understand when or how to get vaccinated if they can’t find the information in their native language.)

MacDonald believes little can be done to change the minds of the roughly 4 per cent of Canadians who deny the benefits of vaccines altogether and refuse to have them. Instead, she says, health professionals should focus on everyone else: support those who vaccinate so they won’t lose track of their shots and fall behind, and reassure those who are open to the idea but have religious concerns or are worried about the pain associated with needles.

Kang says she’ll be relying on doctors and other health-care professionals to remind her what vaccines her child requires and when. She counts herself lucky to live in Ontario, where parents are required by law to prove their children have been vaccinated — or demonstrate why they should be exempted — before they can start school. While some provinces lack a vaccine registry of any kind, Ontario retains records for all school-aged children in an electronic database called Panorama.

Even so, the province has big gaps to fill. According to a 2015 report from the C.D. Howe Institute, Ontario is failing to meet national targets for most routine childhood vaccinations — including those for chickenpox, diphtheria, measles, mumps, polio, rubella, and tetanus.

Toronto Public Health associate medical officer Vinita Dubey says part of the problem is that Ontario only tracks children enrolled in school, leaving unvaccinated preschoolers unidentified — even though kids are more vulnerable to diseases around that age.

Outside the school system, parents can track their children’s shots (and their own) using yellow immunization cards. But data from those cards has yet to be digitized. “We have no way of knowing adult vaccinations, infant vaccinations, people who get vaccinated outside the school system, homeschoolers, or even preschoolers in daycare,” says Dubey, who also notes that public health reminders for seasonal immunizations or booster shots are inconsistent.

During the recent mumps and measles outbreaks in the GTA, Dubey and her colleagues were unable to identify vulnerable people or geographic areas with low vaccination rates, because such information is simply not available. And while TPH sends out reminder letters and holds immunization clinics at schools, they tend to do so after outbreaks, not before.

It doesn’t help that vaccine scheduling is complicated (especially in early childhood) and, consequently, hard to keep track of. There are 14 different types of immunizations recommended for children, some with additional boosters — and each province has its own distinct scheduling program.

To help solve this problem, Kumanan Wilson of the Ottawa Hospital Research Institute has developed a free vaccine-tracking app called CANImmunize. “In this day and age,” he says, “we should not be relying on a piece of paper to tell you if you’ve been vaccinated or not.”

Users download the app to their smartphone and upload their vaccination history — then the app sends reminders customized to those details and the user’s location, and provides information about vaccine-preventable diseases and how shots work to boost immunity. Wilson says he is also testing out new modules that stress the importance of vaccines for children with chronic diseases and help new immigrants catch up on their shots when they arrive in Canada.

MacDonald says the app is a step in the right direction, but notes that universal tracking remains a long way off: more than 1 million babies have been born in Canada since Wilson launched his app launched in 2014, yet there have been only 200,000 downloads.

Wilson acknowledges that it’s tough to create a nationwide solution when shots are offered in so many ways — whether through family doctors and pharmacists, immunization programs at schools and workplaces, or clinics for travel vaccines. The beauty of the app, he says, is that it complements existing monitoring systems by combining the information public health already has with what users upload. Wilson is piloting the technology with Ottawa Public Health, and if all goes well, he’ll scale up to other parts of Ontario and across the country.

Until Canada’s vaccination rates improve, Kang says she plans to check with other parents to make sure their children have been inoculated before she lets her son attend birthday parties or play dates. “As awkward as the conversation is, it is a concern now,” she says. “How else will I know that the other kid isn’t carrying mumps or rubella or whooping cough?”

Rebecca Fortin is a public health professional; Seema Marwaha is an internal medicine physician and researcher. Both are 2017 Fellows in Global Journalism at the Munk School of Global Affairs.