An Effective Prescription for an Increasing Problem

Written by: Dr. Jia Hu, Public Health Specialist, Physician, and CEO of 19 To Zero & Dr. Vivien Brown, Family Physician, Author, and Assistant Professor in the Faculty of Medicine at the University of Toronto.

The direct effects of the COVID-19 pandemic have certainly been much discussed and analyzed, including its profound changes to the global economy. Given the breadth of these impacts, it’s no surprise that efforts to combat the COVID-19 virus have led to unintended negative consequences, including massive declines in routine (non-COVID-19) immunizations that have both significant public health and economic consequences.

Evidence is mounting that herd immunity for previously controlled illnesses like measles, mumps, and rubella is no longer being achieved in a larger portion of schools across the country.[1]  In general, routine childhood vaccine coverage has fallen by upwards of 20-40% across the country. Vaccines given in the school setting have fallen most starkly: Uptake of the human papillomavirus (HPV) vaccine, critical in preventing cancers that still kill 1200 Canadians a year, has fallen from ~60-70% to only 0.8% during the pandemic.²

Children are not the only group that has been affected. Coverage for recommended adult vaccines, including those for vulnerable seniors, has always been much lower than for childhood vaccines and has fallen further during the pandemic. Uptake of the shingles vaccine, which prevents a painful illness that 1 in 3 Canadians will develop, fell by half during the pandemic. Influenza vaccine uptake also fell in the second winter of the pandemic, with less than half of Canadians receiving the vaccine.

Adult vaccines are obviously effective at reducing illness, but also have economic implications as they affect the working-age population. Maintaining optimal vaccination coverage could prevent millions of cases of disease in adults and save Canadians >$1 billion in averted health and societal costs.[2]

Why has this happened? There are many reasons, including: difficulty accessing family physicians or public health appointments, school-based immunization programs being cancelled due to school closures or lockdowns, and the fear of contracting COVID-19 while seeking medical care.  The common thread of these reasons is one of access. Canadians want to be immunized and came out in record numbers to receive their COVID-19 vaccine, but vaccines need to be accessible.

When we consider the current crisis in the school system and the dramatic drop in adolescent, in-school, vaccination, we need to acknowledge that while public health is the backbone of the delivery system for this age group, given the school closures and the variability of public health demands at the current time, we need a comprehensive strategy to provide immunization opportunities in all sorts of settings. Pharmacists are an essential part of the immunization team, but currently in Ontario, have no access to publicly funded vaccines – a catch-22 that needs urgent attention. We now have 34 health units in Ontario, all with different plans to immunize in their regions, and we have 3 years of students that have now missed in-school vaccines. The Federation of Medical Women of Canada’s Task Force on this crisis outlined 11 short-term and 6 long-term goals to focus on these issues and tackle this ongoing crisis.[3]

The pandemic demonstrated the indispensable role that pharmacies can play in effectively administering vaccination programs to address public health crises. Pharmacies served as the main pillar of Canada’s COVID-19 vaccine rollout and can do the same for other vaccines so we can at least return to (and hopefully even exceed) our pre-pandemic coverage levels of routine vaccines. A recent study completed by the Neighbourhood Pharmacy Association of Canada, shows that Canadians trust pharmacists as much as doctors and nurses when it comes to their preference of who delivers their vaccination – with both the proximity and client-focused nature of pharmacists cited as key reasons.

Recognition requires awareness and awareness requires effective communication. We need to ensure that the government, public health and health care professionals and, indeed, pharmacists are clearly communicating the importance of these routine immunizations. This will require a shared plan, led by government with input of all stakeholders to tackle the problem.

We also need to understand the challenges better and to build accountability across the health care and pharmacy sectors. This requires the development of vaccination targets and monitoring of these targets to drive improvements. We are also well behind in the development of a centralized and integrated electronic immunization database – one that would help physicians, nurses, pharmacists and especially their patients understand what is needed.

As we move to tackle the huge gaps in routine vaccinations, we must acknowledge the complexity of the problem and bring all our collective resources together to solve it. An “all hands on deck” approach is our best way forward if we wish to catch up on the mountain of missed vaccinations and ensure all Ontarians of all ages are protected, healthy, and thriving.

While funding for the publication of the article was provided by GlaxoSmithKline Inc. and Merck, the article was independently written by the authors and the opinions expressed are the authors’ own. The authors were not compensated by GlaxoSmithKline Inc. or Merck.

[1] https://www.thestar.com/news/investigations/2021/02/22/measles-vaccination-rates-matter-in-the-fight-against-covid-in-ontario-thats-cause-for-concern-check-where-your-childs-school-ranks.html?rf

[2] https://www.sciencedirect.com/science/article/pii/S0264410X21009063?via%3Dihub

[3] HPV Task Force | (fmwc.ca)