How measles outbreak spurred renewed interest in national vaccine registry

As Colin Duggan and his wife were getting ready to take their 18-month-old daughter to get vaccinated, they realized they didn't know their own immunization history.

Over the years, Duggan has moved around, living in Nova Scotia, Ontario and the United States. When it came to finding his vaccination records, he was at a loss.

"We asked our nurse practitioner if that was something we could do again, and she said, 'Better safe than sorry,'" he said.

That day, the entire family rolled up their sleeves and received their shots for measles, mumps and rubella.

A central database

Creating a central place for people to look up their records is just one part of a long list of reasons why public health advocates have spent more than two decades calling for a national immunization registry.

Those calls have been renewed recently with an outbreak of measles in Saint John.

One of those patients had visited a hospital in Halifax for treatment of something unrelated to measles. Because of that, all cleaners, doctors and nurses had to be tested to see if they were immune before they could return to work.

"It's on everybody's mind in public health, in all the provinces and territories, and at the federal government," said Dr. Gaynor Watson-Creed, deputy chief medical officer of health for Nova Scotia.

"I think the big advantage for a national registry is that allows us to see how well we're doing at reaching unimmunized populations and bringing their immunizations up to date. And that gives us a sense as to how protected we are against some of the most serious vaccine preventable diseases."

While Watson-Creed said the desire is there, a national registry would force public health officials to sort through some significant hurdles.

Each jurisdiction follows its own system when it comes to vaccines. There are different types of shots, some are given on different schedules. 

"It would require 13 provinces to have the same approach."

There are, however, hints that it's possible. Eight provinces and territories have opted to use the same program, Panorama, to digitally track their public health records.

Ultimately, it would also require the federal government's involvement to oversee the program.

"The federal government does not necessarily have a stellar track record when it comes to innovation and national registries," said Ian Culbert, the executive director of the Canadian Public Health Association.

Even so, he said the CPHA wants to see the development of a registry to be a priority.

"I think we need to proceed cautiously and make sure that we make solid and sound investments moving forward."

Health Canada points to the work being done under the Pan-Canadian Public Health Network, which helps share information when someone moves to a different province or territory. But the vision of public health advocates goes much further than that. 

Ideally, Culbert said, a registry would offer a database for research purposes without containing identifying information, while individuals could still access their own information that would be safeguarded by health regulations. 

Targeting specific areas

Culbert said there are many situations where people haven't received their vaccines because of logistics. Maybe they don't have a family physician or they can't take time off work to go to an appointment.

"If we had a registry, we would be able to pinpoint perhaps neighbourhoods that have lower immunization rates and be able to go in and do a pop-up vaccination clinic at a convenient time for parents or for whoever is the focus of that particular campaign."

Researchers, too, have also advocated for a national vaccine registry, saying it could be an incredible data source that could shape public health.

Dr. Joan Robinson, a pediatric infectious disease physician at the University of Alberta, said the lack of consistency in recording vaccinations between provinces "is a huge problem."

But she believes it may take a major outbreak for it to become a top priority.

"It's asking the federal government to put money into something that isn't completely their responsibility," she said.

Robinson is a realist when it comes to the likelihood of the registry ever being created, even though she'd be in full support if it did actually happen.

"We could look at … who gets admitted in hospital with influenza. We could use that information to figure out which of the vaccines worked best."

She said it would also help individuals manage their own records, ideally through an app.

"You could access your immunization records and the records of your children. And it could tell you when anyone is due for a vaccine. I mean, wouldn't that be a novel idea?"

Robinson said the priority now needs to be working with parents to make sure children are vaccinated.

Culbert said everything needs to be on the table amid the ongoing vaccine debate.

"Part of the problem is that there are no silver bullets," said Culbert. "There's no panaceas. This is one of a number of initiatives that need to be undertaken."