C.D Howe Institute

Project Title:  Vaccination Policy: The Way Forward: C.D. Howe Institute Research Project
Funding Recipient:  C.D. Howe Institute
Project Contact:  Hal Koblin – Director of Research Advancement (hkoblin@cdhowe.org)
Project Period:  October 20th, 2016 – March 31st, 2018

About the Project

The C.D. Howe Institute conducted a detailed province-by-province assessment of Canadian vaccination policies and best vaccination practices, reviewed federal government policies and practices, and produced detailed recommendations for governments on what aspects of provincial vaccination programs are working well in order to boost immunization uptake, and where there are gaps that need to be addressed.  The assessment built on the Institute’s 2015 research study that examined childhood immunization rates and policies in Newfoundland, Ontario, and Alberta, which made recommendations on how to improve vaccination policy. This project yielded two research reports, one focused on child vaccination policy and the other on adult vaccination policy, with each taking into account the complexity of vaccine hesitancy and provincial vaccination models. 

Objectives

• Shape public awareness of the key issues
• Provide policy leaders with an effective toolkit to increase Canadian vaccination rates

Outcomes 

This project produced two research papers based on national assessments of the strengths and weaknesses of Canadian vaccination policies and identified best practices for children and for adults. Recommendations were made on the following: 

• Provincial policies and practices;
• Relevant areas for federal action, including a consideration of the policy frameworks and objectives of the Public Health Agency of Canada and the National Advisory Committee on Immunization, and; 
• The impact of economic considerations on vaccine accessibility and uptake.

These reports identified opportunities for improvement within each jurisdiction, as well as for the federal government, to ensure that access to vaccines improves, as confidence in public health vaccination programs increases, while appropriate mechanisms to reduce complacency are identified and encouraged for uptake. 

The challenge that the project addresses

The previous C.D. Howe Institute research study found that most Canadian provinces fail to meet national immunization targets for key diseases, and coverage ratios among children are falling over time. If immunization coverage continues to fall, more vulnerable populations, such as children, the elderly, and people with medical conditions that may prevent them from being immunized, will be put at risk. It is also vital to emphasize that adults also require immunization to restore waning immunity against some vaccine preventable diseases and to establish immunity against other diseases that are more common in adults, such as herpes zoster, human papillomavirus, and bacterial pneumonias. Despite advances, the vaccination rates of adults and children in Canada are low, with the result that many Canadians remain vulnerable to vaccine preventable diseases. Additionally, the issue of vaccination and vaccine hesitancy is a challenge that policy makers and health care professional face when boosting vaccination uptake. 

Lessons learned 

A vocal few Canadians – perhaps 2 percent of the population – hold anti-vaccine views, but they are not the main reason for insufficient vaccination coverage, and arguably too much attention and energy are spent trying to engage them. A more sensible strategy would instead target the large group of “vaccine hesitant” parents, whose children get some but not all vaccines, or fall behind schedule. The diverse reasons that these children are unimmunized or under-immunized rule out a simple solution; instead, the study on childhood vaccination advocated varied, multifaceted interventions.

We also learned that adult vaccination rates urgently need a booster shot in Canada. Better and more regular uptake of vaccines during adulthood and retirement could improve the well-being of older Canadians and offset some of the challenges associated with an aging society. Alongside a digital strategy to create databases to monitor coverage of all adult vaccines, policies should build upon many patients’ preference to get their annual influenza shot at their local pharmacy by expanding pharmacists access to immunization databases, building greater links to primary care, and expanding pharmacists’ ability to set up immunization reminders for patients upon pharmacy visits, plus encouraging the use of digital apps. Going forward, the focus should shift to overcoming complacency with more use of automatic scheduling and reminders. Pharmacies, often a very convenient location for most urban-dwelling Canadians, could act as important parts of multidisciplinary primary care efforts to gather data on publicly funded adult vaccines – likely through digital platforms – and create reminders and prompts to overcome complacency as well.

About the C.D. Howe Institute  

The C. D. Howe Institute is an independent, not-for-profit research institute. It is Canada’s trusted source of essential policy intelligence, distinguished by research that is nonpartisan, evidence-based, and subject to definitive expert review. The C.D. Howe Institute’s Healthcare Policy Initiative (HPI) encourages policy improvements by producing research, analysis and events, under the guidance of high-level decision-makers and influencers in Canadian healthcare. The program addresses: the performance of public healthcare in Canada; the funding gaps for non-acute health services, such as drugs and long-term care; and the drivers for change and barriers to reform. As with all C.D. Howe Institute work, the program provides evidence-based, peer-reviewed research as well as actionable recommendations.