This past summer started with an unexpected scramble for many parents in Ontario: A frantic search for their children\u2019s immunization records, particularly proof of measles vaccinations. Summer camps required it. In June, many Toronto families got notices that pupils might miss school without up-to-date shots. <\/p>\n
It was then that several parents realized they\u2019d misplaced the \u201cyellow card,\u201d the piece of paper that is still the province\u2019s centrepiece of children\u2019s immunization records. Some who still had the card were shocked to see no sign of an MMRV shot, which contains the second dose of measles vaccinations, usually administered by age six. Was it because the child had missed their shot? Or because the vaccination had never been recorded?<\/p>\n
That chaos is the latest sign of a chronic issue in Canada\u2019s health care system: A lack of comprehensive vaccine registries (along with systems in Ontario and other provinces that, incomprehensibly, continue to rely heavily on paper records, such as the tattered yellow cards).<\/p>\n
A simple idea<\/p>\n
The idea is shockingly commonsensical and something health care providers and public health experts have been demanding for 30 years. Whenever someone who administers vaccines \u2013 be it doctors, public health units, pharmacies or hospitals \u2013 records immunizations in their own system, the data should also seamlessly flow into a centralized database.<\/p>\n
Provinces would have up-to-date and complete immunization records for everyone, from newborns to seniors (for whom there is a growing list of recommended shots, from shingles to respiratory syncytial virus vaccines). Health authorities would be able to tell with confidence which communities have lower vaccination rates, an essential piece of information when responding to outbreaks or trying to prevent them. <\/p>\n
People would use the system to check their or their kids\u2019 vaccination histories. Health care providers would log in to glean that information about new patients, which can help with diagnoses. The records would automatically follow patients who move from one jurisdiction to another. And with automatic reminders, everyone would know when it\u2019s time for another shot.<\/p>\n
Open this photo in gallery:<\/a><\/p>\n Scarborough school children receive the measles vaccine at Danforth Gardens Public School in January, 1968. A lack of comprehensive vaccine registries is a chronic issue in Canadian health care, and some jurisdictions continue to rely heavily on paper records.Fred Ross\/The Globe and Mail<\/p>\n A shambolic reality<\/p>\n In Canada, that simple idea remains the stuff of science fiction. Alberta, Manitoba and Prince Edward Island are among the provinces that have made strides in tracking children immunizations, but records for adults remain spotty. <\/p>\n The same holds for Quebec, where all vaccines administered since 2019 must be recorded in a central system. Also, the province\u2019s data is meant primarily for doctors and nurses. Patients who want to access personal information must do so via paper mail or fax.<\/p>\n In Nova Scotia, which collects data from sources including public health clinics, doctors\u2019 offices and pharmacies, records can take up to a month and a half to load.<\/p>\n Then there\u2019s Ontario, a laggard among laggards. Among adults, the province no established mechanism to tell who has received what vaccines, with the exception of COVID-19 immunizations.<\/p>\n Young children attending licensed childcare centres and school-aged kids must generally have proof of vaccination. But there is no requirement for family doctors and pediatricians, who provide a lot of the routine childhood vaccines, to report immunizations to public health authorities.<\/p>\n Instead, that onus falls primarily on families. Parents are supposed to keep track of vaccine schedules. The province doesn\u2019t send them reminders, although some doctors\u2019 offices do. And there is no system to automatically flag students who haven\u2019t received all the required shots. Instead, public health units generally conduct periodic campaigns prodding households to provide or update records.<\/p>\n Worse, much of the record-keeping revolves around the paper yellow card. A digital version of it has been around for more than a decade, but doctors don\u2019t use it. Ontarians are still told to bring their paper card to vaccine appointments. Instead, the digital one is only a database where parents can can report their children\u2019s vaccinations to public health units and where adults can note their own shots to have an electronic backup of their records. <\/p>\n The concerning results speak for themselves. The province\u2019s data show that measles immunization coverage among seven-year-olds was 86 per cent in the 2019-2020 academic year, far below the 95 per cent rate that is the minimum recommended to prevent outbreaks. By 2023-2024, the rate had fallen even lower, to 70 per cent. <\/p>\n It\u2019s unclear why the coverage gap has been widening. It\u2019s possible that parental concerns about immunizations \u2013 or simply vaccine fatigue \u2013 have increased since the onset of COVID-19. (However, the share of school-aged children with vaccine exemptions motivated by religious or other beliefs has remained stable since 2019.)<\/p>\n Vaccine experts suspect that reporting and record-keeping fell behind in the pandemic, meaning that true coverage rates are higher. But there are also anecdotes of children who truly missed some of their immunizations simply because everyone forgot they were due for another shot.<\/p>\n The bottom line is that Ontario, which at one point this year had more measles cases than in all of the United States \u2013 with infants, children and adolescents making up more than three-quarters of cases \u2013 isn\u2019t sure about the vaccination status of about 30 per cent of its school-aged population.<\/p>\n That is simply unacceptable. And to be clear, it is a governance, not a parenting, fail. An upcoming immunization isn\u2019t something that should be allowed to fall through the cracks the way a classmate\u2019s birthday party might if it didn\u2019t make it into the family calendar.<\/p>\n Parents aren\u2019t allowed to forget about sending their kids to school. Within minutes of a no-show, schools typically send out an email or call asking where the children are.<\/p>\n Families that want vaccines should receive similar prompts about staying on track with immunizations. As for record-keeping, it should happen automatically, as kids \u2013 or any other patient \u2013 receive their shots.<\/p>\n Open this photo in gallery:<\/a><\/p>\n A dose of the MMR vaccination awaits a patient at a vaccine clinic in St. Thomas, Ont. While school-aged kids generally must have proof of vaccination, there is no centralized database for adult vaccination records in Ontario.Geoff Robins\/The Canadian Press<\/p>\n A lack of political will, a surplus of institutional inertia<\/p>\n This country struggles with vaccine registries for the same reason it has trouble creating online portals where doctors can readily access patients\u2019 complete medical records and people can look up their own medical history. <\/p>\n Canada treats health care providers as custodians of the patient data they generate or receive. And while there are strict obligations to protect patient privacy, there aren\u2019t equally strong incentives to share data when warranted, as this space has argued<\/a>. <\/p>\n The outcome is a patchwork system in which a variety of providers zealously guard their disparate bits of information on databases that weren\u2019t built to communicate with each other. <\/p>\n Creating central repositories invariably requires overriding technological hurdles and a significant amount of institutional inertia. For example, digital platforms that support doctors\u2019 electronic patient records often have little incentive to spend money on linking up with provincial registries. Overworked doctors, on the other hand, have understandably resisted the idea of manually recording immunization data in a provincial database as well as in their own records, an additional administrative task for which they wouldn\u2019t get paid.<\/p>\n Even in provinces where vaccine information flows automatically from practitioners\u2019 records to government registries, the data often require cleaning up and reformatting.<\/p>\n Ottawa can help by establishing national standards for health information sharing, including vaccine data. A federal bill to do just that died when Parliament was prorogued. The Carney government should revive it.<\/p>\n None of these challenges is insurmountable. It is telling that, with some assistance from Ottawa, every jurisdiction was able to create a COVID-19 proof of vaccination portal at the height of the pandemic. When there was the political will to prioritize the creation of a proper vaccine-tracking system, provinces found a way to make it happen.<\/p>\n With Canada now at risk of losing its long-held designation as a country where endemic measles had been eliminated, governments should summon that same will to finally set up registries for most vaccines \u2013 and finally tear up those tattered yellow cards.<\/p>\n The Sunday Editorial <\/p>\n A thanksgiving for the Canadian habit and history of muddling through<\/a><\/p>\n