Does Canada need to improve its immunization rates?

Evidence

For most health care workers, the case for vaccination is self-evident—it is one of the top 10 public health interventions. However, this is often not appreciated by the general public. Parents of young children today have not seen measles, mumps, or rubella, let alone diphtheria or smallpox, so the protective effect of vaccines can seem theoretical. Is it surprising then that they hesitate to submit their happy, healthy infant to the pain of a needle? Or that they feel guilty when they see their child with a red, swollen arm after vaccination? In Canada’s most recent Childhood National Immunization Coverage Survey, 70% of parents indicated that they were concerned about vaccine side effects, 37% believed that a vaccine could cause the same disease it was meant to prevent, and a small proportion believed that homeopathy and chiropractic care could eliminate the need for vaccines.² Some hesitate over the idea of 5 vaccines all in one shot. Further, there is a lot of misinformation out there. For example, most parents have heard that vaccines can cause autism, but not all now realize this spurious association has long been debunked.³

Although our calculated immunization rate of 84% might be an underestimate because we do not have a national registry, Canada does need to improve its immunization rate. Our elimination status for measles is not assured in the long term, and pertussis continues to circulate and cause outbreaks. With the spectre of antimicrobial resistance,⁴ preventing infections in the first place is now more important than ever. Fortunately, there is a growing body of research on vaccine hesitancy to inform a constructive approach to addressing it. For example, it is not a good idea to advocate too strongly for vaccines, as research has shown this can actually increase vaccine hesitancy.⁵ A best practice is to routinely explore the perspectives your patients or their parents have on vaccines, and tailor your communications accordingly.⁶ If they are accepting of vaccination, reinforce how this promotes resiliency and discuss common side effects to maintain trust. If they are vaccine hesitant, build rapport, accept questions and concerns, and provide risk-benefit information. For the few adamant vaccine refusers, avoid debating back and forth; keep discussion brief but leave the door open—and know where to find resources that will help dispel misinformation.

Bottom line

Canada is fortunate to have a large number of publicly funded vaccines. However, we have some progress to make before we can be proud of our national immunization rates. The good news is that, increasingly, Canadian health care providers can access the evidence base and resources needed to help make this happen.⁷