In Need of a Booster: How to Improve Childhood Vaccination Coverage in Canada

Recent outbreaks of infectious disease are a troubling reminder of insufficient vaccination coverage in many communities across Canada. These outbreaks should renew efforts in policies and programs that can expand vaccination coverage, especially among young children. There is also a good economic case. Evidence shows that public funds spent on childhood measles, mumps and rubella immunization results in major cost savings from reduced visits to healthcare providers, fewer hospitalizations and premature deaths, as well as reduced time off by parents to care for sick children. Parents who do not have their children vaccinated cannot be classified neatly as “anti-vaccine.” Some feel they lack information or have safety concerns, others might find themselves too busy and many are unaware of the risks of infectious disease. The reasons behind incomplete immunization are complex, context- and often community-specific. In this Commentary, we explore the many reasons immunization coverage is falling below national targets and we analyze the differences in how provinces organize their immunization programs, encouraging provinces to share lessons learned and embrace common challenges. 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 underimmunized rule out a simple solution; instead, we advocate varied, multifaceted interventions. Most provinces need to supplement the unique aspects of their childhood vaccination frameworks with features that help to bolster uptake, including rigorous, early interventions that target vaccine-hesitant parents; greater involvement of public health nurses; use of electronic registries to enable reminders and targeted interventions; and a system of school-based, and increasingly daycare-based, checkpoints and prompts that encourage those who fall behind schedule to catch up.