A vocal few Canadians hold anti-vaccine views, but they are not the main reason for insufficient childhood vaccination coverage across Canada, finds a new report from the C.D. Howe Institute. In “In Need of a Booster: How to Improve Childhood Vaccination Coverage in Canada,” authors Colin Busby, Aaron Jacobs and Ramya Muthukumaran, suggest that a much more sensible strategy to reverse falling vaccine rates among Canadian children would be to target parents classified as “fence-sitters” – those who partially but  not fully immunize their children.


“Recent outbreaks of infectious diseases are stark reminders of the dangers they pose and the need for expanded vaccination coverage,” state the authors. “This should also cause public health officials to take pause and look at the alarming status of vaccination coverage among Canadian children,” they add.

Unfortunately, there are many gaps in the provinces’ efforts to monitor childhood vaccination coverage in Canada, which makes it difficult to know where interventions are needed. For example, some provinces, such as Alberta and Quebec, collect but do not report data on child immunization coverage at school age. Ontario, on the other hand, neglects to collect comprehensive data at age 2. As for British Columbia, despite the fact that it collects and reports on comprehensive data for children in most areas of the province, it cannot currently do so in the densely-populated Vancouver region. “We know more about vaccine coverage for children in northern B.C. than we do in Vancouver,” say the authors.

According to the report, there are many reasons parents are failing to fully immunize their children, including complacency, the costs associated with time off work and the effort both to access a provider and to assess vaccination-related benefits and risks. In addition, there appear to be significant misconceptions about the costs and benefits of immunization. Despite scientific evidence to the contrary, more and more parents are concerned about the risks of immunization than in the past.

“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,” note the authors. “Frustration with vocal individuals who hold anti-vaccine views and the wide-ranging reasons for incomplete childhood immunization might lead some to favour compulsory approaches as solutions, such as removing parents’ option to object conscientiously to having their children vaccinated.” Such approaches would be misguided, the authors add, and would lead to further entrenched positions among parents with safety concerns. More important, they ignore the likelihood of accomplishing much higher levels of coverage with stricter voluntary policy measures and more targeted interventions.

The authors urge provinces to pursue a range of voluntary approaches to overcome the various reasons for incomplete childhood immunization:

  1. Target early interventions, like phone calls or emails, at fence-sitting parents.
  2. Public health nurses are vital to increasing vaccine coverage. Provinces need to rely more on them.
  3. Provinces should use electronic registries to track coverage from birth, through childcare and kindergarten, to adulthood – and intervene when necessary.

“With these targeted solutions, Canadian provinces will be able to better ensure that children are protected from future outbreaks,” conclude the authors.

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