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THE JOURNAL OF THE CANADIAN PAEDIATRIC SOCIETYEDITORIAL There is never any shortage of items to be discussed in editorials on immunization. However, this year the Division of Immunization wants to share a speech given at the 1998 National Immunization Conference by Mrs Elinor Caplan, Parliamentary Secretary to the Minister of Health. We are fortunate to have such an informed parliamentarian working among us. Our thanks to Mrs Caplan for all her work in raising immunization awareness in Canada. Speech Given By Thank you, Dr [Philippe] Duclos, for those generous words of welcome. It is a sincere pleasure to be here in Calgary this morning, and I value this invitation to say a few words about the federal government's view of the evolving immunization landscape. First, however, permit me to express, on behalf of the Minister of Health and the Government of Canada, my best wishes for a successful meeting. I have every confidence that, as leaders in this vitally important field, you will continue to advance the cause of public health. On a personal note, I would like to underline my profound faith in the merits of childhood immunization. Our collective experience in recent decades has proven, beyond the shadow of a doubt, that this simple and inexpensive procedure spares thousands of youngsters from catastrophic illnesses, even death. It is, therefore, incumbent on all of us, in government and outside, to work together to ensure our progress does not slow. That is what this conference is about: partnerships, and how governments at all levels can work together with health professionals and public health authorities, to give our youngest, most vulnerable citizens a chance at a long and healthy life.
Two years ago, the former Minister of Health, Mr [David] Dingwall, spoke at this conference. Many positive things have happened since then, although there have also been a few alarming trends. A spectacular success last month [November 1998] was the launch of the first national immunization week. The goal of the week was to raise public awareness of the importance of complete and timely vaccinations for all children in Canada. And signs are that the message got out. There was excellent media coverage in broadcast and print, at both the national and local levels. There was also a great deal of interest on the front lines, as Drs Gold and Delage paid public relations visits to day cares and schools. Since your last conference, it is also gratifying to note the introduction in all provinces of routine hepatitis B vaccinations for infants or school children. Similarly, all provinces have adopted a new acellular pertussis vaccine, known to be safer and potentially more effective than the whole-cell preparation in the shots that children had been receiving previously. I would like to stress the point that all provinces are participating in these programs, because it is the universal, coast-to-coast nature of such initiatives that makes them so effective. It is especially satisfying to note that over time, the provinces are becoming increasingly willing to ensure they are all offering similar and compatible programs. Consider that back in 1992, it took six years for all provinces to implement routine hepatitis B vaccine for adolescents. The second measles dose was universally adopted in 18 months. And now, we are seeing that everyone got onside with the pertussis vaccine within a single year. I suggest that those are the kind of positive results that are fostered by conferences such as these, where participants learn from each other and work with each other toward a common goal. At the federal level, we are also making some exciting headway. Later today, I understand that Dr Duclos will have some extremely positive news to share on the regulatory front. I would encourage you not to miss the rest of this morning's plenary sessions. Another important initiative at the national level are the professional guidelines developed by Health Canada to help health care practitioners enhance immunization delivery for children. Among other things, these guidelines encourage physicians to regularly assess the vaccination status of their patients, and ensure that vaccination programs are accessible and convenient for parents. Given the theme of your conference, I might add that these guidelines - developed by Health Canada in collaboration with professional associations and other stakeholders - are a premier example of the value of partnerships.
And let's not fool ourselves: we need all the collaboration and dedication we can find. For governments and professionals alike, there are some serious and growing challenges in the field of immunization. First and foremost, we must all work together to combat the complacency that is taking root here in the developed world. It is a sad and dangerous irony that we are becoming victims of our own success. As dreadful childhood contagions, like polio, diphtheria, tetanus and rubella, fade from memory, so too does the need for vaccinations slip quietly from our minds. But as everyone in this room knows all too well, those diseases are not gone; they're only an airplane ride away. Our surveillance efforts at Health Canada, for instance, were able to document the importation of the wild polio virus in a child returning from overseas. I think the measles outbreak a few years ago in Canada also offers a sobering example of the need for vigilance. With routine single-dose immunization, most of measles morbidity and mortality was prevented in Canada. But a sudden resurgence that threatened to strike as many as 20,000 people by 1996 prompted all 12 provinces and territories to implement a two-dose vaccination program, and most undertook a catch-up second-dose campaign for school children. The result? There were only 572 cases of measles in 1997, a steep decline from almost 2400 cases in 1995 - and much better than the catastrophe that could have been. And, it might interest you to know, there have been just 11 cases of measles reported so far this year. If that isn't proof of the value of vaccinations, I don't know what is.
I spoke a moment ago of the dangers of complacency - the 'out of sight, out of mind' approach to communicable childhood illnesses. Worse, however, is the misinformation and scaremongering that exploits and feeds on this complacency. It is horrifying to think that people would deliberately spread false messages, discouraging parents from having their children benefit from a simple, potentially life-saving procedure. And yet, this is happening throughout North America, in books and magazine articles, talk shows and the Internet. Vaccinations have been linked to autism, inflammatory bowel disease and multiple sclerosis, without any validating scientific evidence. As a federal government, we take this growing phenomenon very seriously. Through a number of publications, in print and on our web site, we do what we can to set the record straight. In the September 1 [1998] issue of Canada Communicable Disease Report - to give just one example - there is a list of resources to help parents and professionals like you fight ignorance with truth. Once again, there is strength in numbers. Trusted professionals and public health authorities must work together with governments to counter the worrisome trend towards complacency and misinformation. Indeed, it is a pity that our efforts and resources are being diverted in a public relations battle, when they should be aimed at combatting childhood illnesses. Because the next threat is never far away. In the first six months of 1997, for example, there was an outbreak of mumps among adolescents in British Columbia. Manitoba recently experienced a major outbreak of rubella, which brought the number of cases in Canada to nearly 4000 in 1997 from 237 the year before. And pertussis rates are double and triple normal in some provinces right now. Although this is part of the cyclic nature of the disease, we are hopeful that the new pertussis vaccine will have an impact on future trends. If complacency and misinformation are serious challenges for all of us, so too is the need to make the most of our collective resources. Again - in the spirit of partnership and collaboration - it only makes sense to share information and experiences, to make sure that children in Newfoundland and Saskatchewan and Yukon have equal access to the very best vaccination programs. Apart from the simple fairness of it, there is another reason to have a certain level of uniformity in immunization programs across Canada. That has to do with accountability. More and more today, Canadians are demanding to know that their governments are putting in place measures that make sense - from both a financial point of view and a public health point of view. As I said earlier, that is why a conference like this is so worthwhile. It gives all of us a chance to report on our activities, so that, collectively, we can measure our progress and agree on our goals.
When it comes to collaboration, the most promising work currently underway is, without question, the development of a national immunization records network. A national consensus conference, sponsored by Health Canada last March [1998], concluded that all provinces and territories should establish comprehensive immunization tracking systems within five years. The Nationwide Immunization Records Network would support the development and integration of the immunization registries coast to coast. This means, among other things, that:
Throughout the winter and beyond, a national working group sponsored by Health Canada will be putting together the first building blocks of the Nationwide Immunization Records Network. Participants from all provinces and territories, provider groups, consumer associations, privacy interests, professional associations and the federal government will meet to establish common data elements and technical standards, and to plan the first national 'trade show' of immunization tracking systems to be held in 1999. This is an example of how Health Canada can work with its provincial and territorial partners to improve technologies, and as a result improve the health of Canadians.
Throughout my remarks this morning I have tried to convey a sense of the variety of work that is being done to bring us closer to a goal we all share - to control and eliminate vaccine-preventable diseases in Canada. It is a powerfully appealing goal, and one that we all believe is achievable. But we're not there yet. Right now, as most of you know, we are averaging about 80% immunization coverage across Canada. We want to be at 95%. From a financial standpoint, we know it makes sense. It is estimated that every dollar spent on a two-dose measles immunization program brings us $2.61 in benefits. Every congenital rubella case we prevent saves the health care system more than half a million dollars. But some things transcend the impulse toward cold cost-benefit analysis. Giving children a chance at long, healthy lives is one priority that we all share, especially since we can do so with a procedure that is as simple as it is safe. Our basic humanity demands of us that we continue to push hard for universal vaccination. Federal and provincial governments, researchers and public health officials, practitioners and patients - all of us working together toward this most worthwhile of goals. In that context, I wish you much success in this conference, and in your exploration of 'partnerships for health through immunization.'
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