Vials of AstraZenica's COVID-19 vaccine in a Toronto pharmacy on March 29 (Photo supplied by the Ontario government)

Canada needs a robust vaccine registry, not just a Band-Aid solution

As we grapple with the past year’s fight against the COVID-19 virus and vow never to let Canada find itself in the same vulnerable position it was in last spring, our country must face some important truths about our public health system’s performance in the wake of a deadly pandemic.

Canadians continue to question why we’re lagging behind other countries in distributing vaccines, and why we lack the manufacturing capacity to produce them domestically.

The wide range of outcomes in different countries offers insight into governments that were prepared, governments that were not but took quick action, and jurisdictions with policies that underfunded and de-prioritized preventative health.

Thankfully, the federal government is making major investments for the next pandemic, most recently in domestic manufacturing of personal protective equipment and vaccine capacity.

Novavax, 3M, and Sanofi are all ensuring we have the hardware on hand for the next pandemic, and Sanofi-Pasteur’s recent announcement to boost bio-manufacturing capacity at the formerly named Connaught Labs is a promising sign.

Further investment in bio-manufacturing at academic institutions and research centres will ensure that Canada has a diverse portfolio of vaccine candidates in preparation for the next pandemic. These investments are thoughtful and forward-looking, but won’t bring the same return on investment if they’re not accompanied by updated data collection and monitoring.

A national vaccine registry is one way we could have prepared better. The federal government, facing a logistical challenge unlike any in recent memory, has scrambled to determine how it will collect information on vaccine uptake.

In December, Deloitte was contracted to build an IT system that manages vaccine distribution and reporting, but without consistent systems in the provinces and territories feeding information into this broader platform, data collection is fragmented and incomplete.

Meanwhile, countries around the world have been taking advantage of their existing vaccination systems to monitor vaccine uptake and keep track of which vaccine was administered to which person. Israel has a well-developed national registry of childhood immunizations. This was quickly adapted for COVID vaccines, allowing the government to conduct follow-up, collect data on real-world effectiveness and vaccine uptake, and thoroughly monitor adverse effects. Australia, with a decentralized health-care system like Canada’s, has had a centralized system to track immunizations for years.

A national immunization registry would help us get vaccines to the right people at the right time, in order to increase vaccine uptake and reduce the incidence of infectious respiratory diseases and their associated health-care costs.

For example, Indigenous and racialized communities have the highest rates of influenza and invasive pneumococcal disease in Canada, but are the least likely to be vaccinated.

Understanding where there are holes in our vaccine coverage will help us tailor vaccine education and delivery to the people who need them most. A national vaccine registry will also help build public trust in vaccination, especially in new vaccines, if it’s apparent that Canada has a robust system for monitoring adverse events.

Without adequate funding, provinces are forced to make tough decisions about which vaccines to pay for. Each year, they must decide which influenza, pneumonia, and other vaccines to buy. As a result, different vaccines are available in different jurisdictions.

Establishing a national registry of vaccinations people have received would make it easier to determine which are most effective, and to decide which ones to invest in in future. We wouldn’t have to rely on other countries to tell us which ones work best in different populations and during which seasons. Finding out which ones offer immunity the longest will also be essential to reaching herd immunity in the long term.

So how would it work? Several provinces now use a system called Panorama, but it only tracks childhood vaccinations and has significant limitations. Nor do all health organizations responsible for administering vaccines have access to these registries. Gaps in data are commonplace.

With a well-developed national registry, each patient would get a unique identifier. When receiving a vaccine, his or her bar code would be scanned at the same time the barcode for the vaccine he or she is getting is processed. This information could then be entered into several systems, including provincial registries and the overarching national platform, while protecting the person’s privacy.

While COVID has highlighted the importance of public health and the prevention of infectious diseases, it’s also shed light on significant gaps and inconsistencies across the country. The government should take this opportunity to improve and revamp Canada’s framework for preventative health instead of focusing on quick fixes. COVID-19 is here to stay, and so should our emphasis on preventative health.

Dr. Dawn Bowdish is the Canada research chair in aging and immunity, professor of medicine at McMaster University, and a member of the Lung Health Foundation National Lung Health Advisory. Peter Glazier is executive vice-president of the Lung Health Foundation.

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