A measles outbreak in New Brunswick and a surge of cases across Canada has renewed calls for a national vaccination registry.
New Brunswick has 50 confirmed cases of the highly infectious respiratory disease, as of Thursday — all in health Zone 3, which includes Fredericton and parts of the Upper St. John River Valley area, and all linked to an initial travel-related case reported on Oct. 24.
The province’s outbreak has pushed Canada’s annual case count to 131, including the death of child under five in Hamilton, the highest number of cases the country has seen in a decade.
“It’s definitely scary,” said Dr. Joanne Langley, a pediatric infectious disease specialist at the IWK Health Centre in Halifax and a member of the Canadian Center for Vaccinology.
She believes creating a national registry where people could access their immunization records would help increase vaccine uptake, and reduce the incidence of measles and other vaccine-preventable diseases, along with the associated health-care costs. It would also allow health officials to assess coverage, effectiveness and safety.
“Lots of folks” have been working on the concept since the last measles outbreak in New Brunswick in 2019, during the COVID-19 pandemic and subsequent outbreaks of pneumococcal disease and respiratory syncytial virus, or RSV, said Langley, who is also a professor at Dalhousie University.
While individual provinces and territories have improved their registries, Canada’s ability to integrate that data to get a national picture “is still quite far behind,” she said.
“And that puts us at a deficit compared to other countries that have national vaccine programs where you can rapidly assess where the problems are, where you need to direct efforts and remediate those so that we’re prepared for any infectious disease outbreak that’s preventable by a vaccine.”
IWK pediatrician and health officials say a national database is needed to see who’s been vaccinated, something they say is particularly important for measles, which is easily transmitted
Many European countries have such a system, said Tim Sly, an epidemiologist and professor emeritus in the School of Occupational and Public Health at Toronto Metropolitan University.
But in Canada, “We’re rummaging in the kitchen drawer looking for a little yellow card” for information about vaccines we might have received decades ago, when we may have been living in another province.
“That’s no good,” said Sly. “In this day of information technology, we need a national database to see who’s been vaccinated.”
This is particularly important for measles, which is highly contagious. At least 95 per cent of the population needs to be immunized with two doses of the measles, mumps and rubella, or MMR, vaccine to prevent spread, said Sly.
“We’ve let that drop to … 80 per cent in Canada, and this is why we’re going to see more of these little sprouting outbreaks.”
Crucial 1st step to saving health-care system
Ian Culbert, executive director of the Canadian Public Health Association, an independent advocate for public health based in Ottawa, contends a national vaccine database is “a crucial first step to saving our health-care system.”
Immunization is one of the most valuable tools public health has to prevent diseases, said Culbert, but as it stands, officials don’t know who in the country is vaccinated.
“Without a national registry — or even provincial registries — we can’t pinpoint our efforts to get under-immunized communities up to speed with their vaccinations,” he said.
Meanwhile, every jurisdiction is struggling with doctor shortages and long emergency room wait times, said Culbert.
“The simplest thing that we can do and the most cost-effective thing we can do is prevent those diseases in the first place. Vaccines give us the power to do that.”
He pointed out how quickly every province and territory managed to develop a registry for COVID-19 vaccines, when people had to prove they had been vaccinated.
But there hasn’t been the “political will” to make the necessary investments in a national registry for all vaccines, according to Culbert. Governments appear to be “much more interested” in investing in acute care than public health, he said, which he attributes to the backlash faced over vaccine mandates and restrictions during the pandemic.
Privacy concerns could be a factor
Langley thinks privacy concerns could be holding some provinces and territories back, but she described those as “not substantiated.” There are “rigorous” systems to ensure individual citizens are not identifiable, such as assigning each person a number, she said.
Many people already voluntarily give “way more” private information to companies, such as when using smartphones, or joining social media platforms, than a vaccine registry would require, she noted.
Public Health Agency of Canada spokesperson Nicholas Janveau said there are a number of significant challenges to creating a centralized national registry, which are “rooted in the structural, legal, and operational realities of the country’s decentralized health-care system.” Privacy is among them, he said, given different rules and approaches to privacy management.
A centralized system also presents an increased risk of data breaches “due to the concentration of personal health information and … broader access,” Janveau said in an emailed statement.
Incomplete data reduces effectiveness
In addition, unlike some other countries, Canada’s federal government does not oversee a national immunization program or have national legislation mandating health-care providers to report or track immunizations in a centralized system, he said.
Health care, including vaccination, falls under provincial and territorial jurisdiction. Only provincial governments can mandate the recording of immunization events in a registry.
Without uniform mandates, many immunizations, such as those given in pharmacies and doctors’ offices, could go unrecorded, particularly if they still use paper records, said Janveau. That risks incomplete data and reduces the effectiveness of a national registry.
“A more pragmatic approach,” he said, is to focus instead on improving interoperability between existing provincial and territorial systems to enable data sharing and support public health monitoring.
That work is underway, building upon the success of COVID vaccine registries, he said.
Langley believes with dedicated resources, a registry that links 13 jurisdictions could be up and running within a year.
Doctors busy fielding questions
Meanwhile, New Brunswick doctors are fielding questions about measles vaccines from concerned patients and parents, said Dr. Lise Babin, president of the province’s medical society, who works as a family doctor in Dieppe.
“They’re asking if they should be vaccinated. … They’re unsure of their vaccination status,” or whether they need a booster, she said, noting electronic records have made it easier for doctors to track and share information with Public Health.
She said it’s “surprising” and “concerning” that 28 per cent of kindergarten students last year failed to provide proof of full immunization against nine diseases, including measles, as required under the Public Health Act.
“Measles is one of the most contagious diseases that we know of, so it doesn’t take that many unvaccinated people to see a real outbreak,” she said. “And we know the best protection for the measles is the vaccine.”
