Honourable senators, vaccination is one of the most successful public health interventions ever. Through widespread vaccination, we have eliminated many diseases that were once common in Canada, and up until recently we would have said, with confidence, that Canadian children who once faced illness from infectious diseases now face minimal endemic threat. However, unfortunately, this assurance may be changing.

In 2003, federal, provincial and territorial deputy ministers of health introduced a national immunization strategy which set out five objectives: national vaccination goals, program planning, safety, procurement and an immunization registry network. Honourable senators, we are now more than 15 years out, and we have not come far enough.

We have not reached any of our national vaccination goals. We have failed to develop and implement a consistent national vaccine schedule. We have not been able to put interjurisdictional issues aside and create a national immunization registry network.

We have succeeded in making vaccines safe and accessible. However, many Canadians are not convinced. Parents today are hesitant, worried about the risks of vaccinating their children, even when safe vaccines are readily available.

Honourable senators, I would like to speak to you about the hesitancy toward vaccination. More than just a knowledge deficit, vaccine hesitancy has stemmed from a flood of misinformation, which is making it difficult for Canadians to reach evidence-based conclusions about immunization.

There is no simple fix for vaccine hesitancy. Many dismiss vaccine-hesitant parents as illogical, uninformed or uneducated, but the reality is far more complex. The damaging impact of misinformation arising from our own medical community should not be forgotten.

Andrew Wakefield’s paper linking the measles-mumps-rubella vaccine to autism was published in The Lancet in 1998. Though that article has since been retracted, one cannot underestimate the lasting impact such widely publicized findings have had on public opinion.

Today, arguments against vaccinations are multifaceted. They are often designed to walk the line between truth and fiction, drawing on terminology that stokes fear in parents while creating logical roadblocks for clinicians.

Some arguments we hear all the time include things like, “Vaccinations contain dangerous or toxic chemicals that have been proven to cause chronic health conditions”; or, “Infectious diseases decline on their own due to improved hygiene and sanitation.”

These arguments have slivers of truth to convince the audience of their legitimacy. Yes, vaccines do contain chemicals in small, safe amounts — chemicals such as aluminum — which boosts the immune response to produce more antibodies. Some propose that good hygiene is preventative. While we all know the important role sanitation and hygiene play in public health, even scrupulous efforts to maintain clean hands meet a formidable adversary in the measles vaccine, which can live in the air for up to two hours.

Senators, these arguments are not simple at all. They are not harmless. They certainly are not easy for Canadian parents to dismiss, especially when they come packaged in a flashy new website as so many so often occur.

Many solutions have been proposed. Patient advocates and physician associations are calling on the government to do more to support doctors and clinicians. Some experts have even called to move vaccination out of doctors’ offices and into the realm of the public health world. These arguments suggest that parents and clinicians need more face-to-face time to correct misinformation and to spend time changing minds.

We know that better training and tools beget better interventions and education outcomes. Increasing public support for health professionals is really integral here, but it will take time to overcome the misinformation that fuels vaccine hesitancy. In the interim, I would propose the federal government has the opportunity to take significant action in the fight against vaccine hesitancy and corresponding health concerns. One of these opportunities lies in reforming the patchwork of vaccine schedules which acclaimed health reporter André Picard has described as a “travesty of public policy.”

In contrast to other developed countries such as Australia, where single, harmonized countrywide immunization schedules are the norm, each province and territory here in Canada defines its own vaccine schedule, meaning that Canadians are vaccinated at different times in their life depending on where they live.

Take the example of the diphtheria-tetanus-acellular pertussis vaccine. In Nunavut, it’s provided at Grade 6; in New Brunswick, Nova Scotia and Northwest Territories, in Grade 7; in Saskatchewan, Grade 8; B.C., Alberta, Quebec, P.E.I., Newfoundland, Labrador, Yukon, all in their wisdom provide it in Grade 9. In Manitoba you’re likely to get it between the ages of 13 to 15; and in Ontario, 14 to 16.

This is an issue.

In 2015-16, 277,000 Canadians migrated from one province to another. When each province has a different approach to vaccination, moving at the wrong age may result in some children slipping through the cracks and others receiving duplicate vaccinations.

In 2011, the Canadian Paediatric Society called for a harmonized schedule to improve the health and safety of Canadian children and youth, stating that:

Continuing our disharmonious pathways only compounds the costs, and leaves many of our children and youth at necessary risk.

If that wasn’t enough, some provinces even hold contrary positions on vaccinations.

Up until recently, in Ontario, the HPV human papillomavirus vaccine, was only provided to females, while in other provinces, both males and females were given this vaccine. Discrepancies like these led to questions about the science that informs vaccine policies. They are footholds for those who might argue that this stuff is developed arbitrarily.

I’m sure you can imagine the questions. Why is it different there? Is it unsafe for my child? Which province is doing this right? Maybe we should wait until the science has sorted this out. This is what we call vaccine hesitancy. In this case, it stems from a policy decision. We must strive to build trust through our vaccine policies, not hesitancy.

If we could take Mr. Picard’s advice and simply “lock all the health ministers in a room and not let them come out until there’s one vaccine schedule,” we would solve this problem, and public health in Canada would be better for it.

Although I don’t advocate this approach, I advocate for dialogue that might lead us to an outcome that we would prefer.

The other big challenge we face is that provinces and territories may all maintain their own system for tracking immunization coverage. As a result, the data, methods and even what is considered relevant reporting information differs according to and across jurisdictions.

While many provinces and territories have switched to electronic registries, some are still paper-based, while others use a combination. Electronic databases, in theory, should provide pan-national coverage. But due to lack of interjurisdictional cooperation, information collected in each province is really not accessible outside of the province of origin. This is an important challenge, colleagues, for health authorities who as a result are not able to construct a national picture.

Instead, the information we have on vaccination rates is drawn, believe it or not, from a national survey. Without current and trustworthy data, public health agencies — whom we all rely on to protect our health, the health of our families and our friends — are left largely in the dark.

Yes.

We now know that more and more Canadians are vaccine hesitant. While it is more difficult to change the culture around vaccination, it is far easier to adjust our practices to better protect ourselves. Providing federal and provincial health agencies with access to data on vaccination rates would help them identify problem areas, target support and training, inform health workers and prepare them for the possibility of an outbreak.

Without a national registry, it is difficult to identify which town in Canada might be the next Rockland County, New York — undervaccinated and ripe for outbreak.

Further research is currently under way in areas such as Nunavik, where we already have good information on the gaps that exist. We know that infants in the Canadian Arctic have the highest rate of a potential deadly respiratory syncytial virus, an issue intensified by geographic, systemic and cultural barriers.

Once we have this data coming in, we can achieve better health outcomes, engagement, education and preemptive inoculation.

A national vaccine registry with support and engagement from all provinces would ensure that at-risk populations are identified and addressed. It takes time to build and change the minds of people who are comfortable in their beliefs. However, we must endeavour to stamp out sources of misinformation that confuse Canadians and cause parents to fear the vaccine more than the disease.

Canadians and our health agencies would benefit greatly from improvement in two key areas: a vaccination schedule that is consistent across all provinces and a national database that allows for vaccination rates to be collected, recorded and monitored.

We know that reducing hesitancy toward vaccination will take time as we attempt to address this complex issue. But preparing for the next outbreak should start today. Thank you for your attention.