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From: Daniel Schwanen and Rosalie Wyonch

To: Canada’s ministers of public health

Date: April 27, 2018

Re: Not Just for Kids; Adults Also Need Their Shots

Despite clinical evidence showing the value of immunization, vaccination rates among adult Canadians are dangerously low.

Across the provinces and territories, vaccination rates for preventable diseases like influenza, pertussis (whooping cough) and pneumococcal (pneumonia) infections are well below national immunization uptake targets of around 80 percent. Better and more regular uptake of vaccines could improve health outcomes of Canadian adults and offset some of the economic challenges of an aging society.

The insufficient vaccination coverage is a wake-up call in this national immunization awareness week for public health authorities and Canadian governments can and should address some of the key reasons that lead adult Canadians to be insufficiently vaccinated.

As outlined in the C.D. Howe Institute’s report this week there are general reasons, known as the “Three Cs,” that describe the many, complex reasons for the un- and under-vaccinated among us: confidence, complacency and convenience.

  • Confidence is about one’s trust in vaccine effectiveness and safety;
  • Complacency refers to an individual’s low perceived risks of contracting an infectious disease relative to other pressing responsibilities;
  • Convenience speaks to the challenges – in time, energy, indirect or direct costs – involved in accessing immunization services.

“Policymakers must attempt to overcome complacency and confidence, while building on improvements in convenience – from reviewing  pharmacists’ scope of practice and information tools, to expanding workplace immunization options,” Schwanen says.

Utilizing behavioural economic policy design, the report suggests major changes to the way Canadian provinces and territories monitor and ensure uptake of vaccines among adults.

Key recommendations include:

  • Improving vaccination rates among healthcare workers: ensure that the immunization process is simple and available in the workplace for healthcare professionals, eliminating commuting and planning costs.
  • Building better monitoring infrastructure: an adult immunization database should be a central part of efforts to bolster vaccine uptake for adults because it informs policy and allows for a targeted and cost-effective policy approach to under-vaccinated citizens.
  • Expanded role for pharmacies: policies should build upon many patients’ preference to get their annual influenza shot at their local pharmacy by expanding pharmacists’ access to immunization databases, building greater links to primary care, and expanding pharmacists’ ability to set up immunization reminders for patients upon pharmacy visits, plus encouraging the use of digital apps.
  • Post-secondary entry: making adult immunization more of a routine process could be aided by asking for proof of immunization coverage at entry to post-secondary institutions.
  • Overcoming “confidence” issues: one way to help providers overcome hesitancy among individuals would be to create a national vaccine list for adults, including only cost-effective vaccines for public funding.

With these targeted recommendations, Canadian provinces and territories will be able to boost vaccination uptake among adults and therefore, improve the well-being of many Canadians.

Daniel Schwanen is vice president, research and Rosalie Wyonch is a policy analyst at the C.D. Howe Institute.

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

The views expressed here are those of the author. The C.D. Howe Institute does not take corporate positions on policy matter