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April 24, 2017

From: Colin Busby

To: Provincial and Federal Ministries of Health and Public Health Agencies

Date: April 24, 2017

Re: Who is to Blame for Insufficient Vaccination Coverage among Canadian Children?

In a number of Canadian communities, vaccination coverage among children falls short of what is required to effectively prevent the spread of infectious diseases. As a result, outbreaks may become commonplace.

With clinically and cost-effective vaccines offered at no charge when administered, why are we grappling with this problem?

True, some parents think that the benefits of vaccines are understated relative to some supposed risks, which is why much public discourse has focused on the vocal group of individuals who hold anti-vaccine views. But this group represents a tiny fraction of the population – roughly 2 percent of all children are unimmunized. Further, we also know that these parents are not likely to change their minds.

The bulk of the evidence suggests that most incompletely immunized children are underimmunized, which means they are partially vaccinated against certain infectious diseases. In other words, many parents get some doses of a vaccine but not all, whereas others may get most vaccines but miss one.

The reasons for this are varied, complex and often community specific. I offer some salient examples here.

Although receiving most vaccines is free for families, there are a number of indirect costs. Time is money, as parents know well. Parents are busy; multiple children make life even busier, which is why we tend to see lower coverage among younger siblings in larger households. Taking time off work comes at significant cost, a problem that is compounded when access to physicians after standard work hours is limited in Canada.

Some parents do have safety concerns. These concerns could be about one or many vaccines – perhaps in response to something read online – or they could have to do with potential allergic reactions or proper vaccine handling and storage.

Further, without reminders about the consequences of infectious disease, many parents might not see the need to vaccinate. This could be the biggest difference behind appreciation for immunization benefits between new generations of parents and those who came of age during the depression era, when the consequences of a number of infectious diseases were often dire in communities throughout Canada.

The World Health Organization identifies reasons for “vaccine hesitancy” as a complex, content-specific issue with three main determinants (three “C’s”):

  • Complacency, which speaks to the low perceived risks of contracting an infectious disease relative to other pressing responsibilities.
  • Confidence, such as low trust in vaccines and the decision-makers behind them.
  • Convenience, which covers the physical or economic costs involved in accessing immunization services.

In efforts to improve vaccination coverage, although we should challenge the veracity of information sources among those who hold anti-vaccine views, we should be focussing our efforts on underimmunized children by making it more convenient to get vaccinated and by prompting choice in a manner that discourages complacency.  

For more information on why immunization rates are falling among Canadian children, read, "In Need of a Booster: How to Improve Childhood Vaccination Coverage in Canada."

Colin Busby is an Associate Director of Research at the C.D. Howe Institute. 

To send a comment or leave feedback, email us at blog@cdhowe.org.