Canada needs a national immunization strategy, experts tell minister

Mar 03, 2003
 

Richard Chang (right) receives a vaccination at Toronto General Hospital in Toronto.

TORONTO - Canadian vaccination programs are an inequitable patchwork quilt that provides better coverage to some children than to others, two experts say in an open letter asking Health Minister Anne McLellan to create a national immunization strategy.

"We must end the current provincial vaccination hodgepodge that results in treating some children (and adolescents and adults) as more precious than others," Drs. Monika Naus and David Scheifele said in their letter, published Tuesday in the Canadian Medical Association Journal.

The journal supported the call in an editorial which used the recent death of a young Ottawa girl to illustrate the problem.

The child died of meningococcal meningitis, a disease for which there is a vaccine; the vaccine is not provided free to children in Ontario. Had she lived across the Ottawa River in Quebec, the vaccine would have been a standard part of her preventive health care.

Scheifele is the director of the vaccine evaluation centre at B.C.'s Children's Hospital while Naus is the associate director of epidemiology services at the B.C. Centre for Disease Control. She is also a former member of Health Canada's national advisory committee on immunization and is a specialist in communicable disease control.

Their letter deplored the current system whereby 10 provincial and three territorial governments (along with the federal government which is responsible for First Nations health care) each decide which vaccines they will cover.

Naus and Scheifele noted the United States, Britain and Australia all have federally funded vaccination programs.

"Even the much-maligned U.S. health-care system provides varicella and conjugate pneumococcal vaccines to the majority of children through the federally funded Vaccines for Children Program or private health insurance schemes," they said.

Varicella is chickenpox; the conjugate pneumococcal vaccine is a seven-in-one vaccine that protects against a variety of diseases including some forms of meningitis, a blood stream infection called bacteremia, and some of the viruses that cause ear infections.

The use of these as well as several other new vaccines has been advocated by the advisory committee on immunization, but most provinces have not yet agreed to pick up the tab, meaning parents who want them for their children have to pay out of their own pockets.

That can be expensive. In Ontario, for instance, the cost of the pneumococcus vaccine is about $370. The journal's editorial noted that one advantage of a national system would be that of bulk purchasing.

"If this vaccine were made a staple of childhood immunization, its cost would plummet and the cost-benefit ratio would become more favourable," it stated.

In the meantime, costs like those almost certainly mean that children from lower income homes won't be protected, Naus and Scheifele said. And the inequities will likely only deepen as a flurry of new vaccines hits the market in coming years.

"It's probably only going to get worse rather than better in terms of inequities around the country . . . unless the federal government takes a very active role in trying to find solutions to our fractured immunization program," Naus said in an interview.

She admitted she is not optimistic the federal and provincial governments will be able to set aside decades of battling over health-care jurisdiction and funding to come together on even so important an issue.

That's why, she said, she urges immunization advocates to keep "chipping away" at their own provincial governments to get them to agree to cover the costs of new vaccines.

Health Canada spokesman Alex Swann notes that the recent federal budget provides $45 million over five years for a vaccination strategy.

"The department has been working and consulting with all the key players on this," said Swann.

"We're committed to expanding the co-ordination in this area between provinces and territories and the federal government. And the goal is, as enunciated in the budget, in part to improve the equitability across the country."