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Excellent Care for All

Immunization

Health Care Challenge

Immunization is a cornerstone of keeping children and adults healthy. Historically, the introduction of vaccines – starting with small pox – helped to defeat debilitating and deadly diseases. When the polio vaccine became widely available in the mid-1950s, parents no longer had to dread the polio epidemic. In 1953, at the climax of the polio epidemic, 9,000 Canadians were afflicted and 500 were killed. By the early 1960s polio cases had virtually disappeared.

Similarly, there were approximately 400,000 cases of measles in Canada each year before a vaccine was introduced in the 1960s. In 1996/97, a second dose of the measles vaccine was added to the childhood immunization schedule and the number of measles cases had plunged to relatively few by the mid 1990s. Measles is still a leading cause of death among young children globally.

Countless lives have been saved through the success of mass immunization. Some call it the miracle of public health. “Immunization is really at the heart of our public health system. It protects people from a range of diseases that they may not see, but that remain a risk to public health,” said Nina Arron, Director of the Public Health Policy and Programs Branch, Public Health Division, Ministry of Health and Long-Term Care. “Adequate vaccine coverage means fewer people are getting sick and there are healthier children,” Arron added.

But one of the consequences of the success of mass immunization is that there is a generation of people who sometimes take its importance for granted because they have never witnessed the impact of many of the diseases conquered by vaccines. This has bred complacency among some segments of the public on the value of vaccines. A vocal-minority increasingly questions the safety and efficacy of vaccines.

A 2010 Ontario-based study indicated that :


Vaccines make individuals stronger by boosting their natural immune system to fight off disease. “When a critical percentage of the population is immunized against an infectious disease it creates herd immunity,” Arron explained. Many of the diseases that vaccines protect against seem remote, but they have not vanished. Their spread is just inhibited due to herd immunity. A 95 per cent coverage rate in a population offers a high level of herd immunity, meaning there is less likelihood that the organisms will be circulating and this offers some protection even for those who are not immunized.

“Ontario has got a very robust vaccine program,” Arron noted. Still, despite overall high levels of immunization coverage for children in Ontario, the provincial rate for 7-year-olds continues to fall short of 95 per cent for certain childhood vaccines. Immunization coverage levels also vary by public health unit jurisdictions, with isolated pockets of Ontario falling below adequate coverage levels. “We continue to have to be concerned about breakthrough outbreaks,” Arron said.

In recent years there have been examples of pockets of outbreaks in Ontario and Canada where there has been insufficient immunization coverage. In 2008, there was an outbreak of mumps in Oxford County near London, in an unimmunized community. The same year, the Ministry of Health and Long-Term Care funded a mumps vaccine catch-up program for post-secondary students after outbreaks in the Maritimes and Alberta among university students, who had received only one dose of the vaccine in the past.

Vaccines are not just for children. Immunization is part of a life long process to staying healthy. Adults who are inadequately immunized are at risk of contracting diseases like, pertussis, hepatitis and tetanus. For example, adults have been increasingly recognized as the main source for pertussis infection (whooping cough) in infants and young children. Infected adults and adolescents can pass on the disease to infants who have not yet completed their immunization series against pertussis. These infants will not be fully protected against the disease and are at greater risk of serious complications. A 2006 Canadian Adult National Immunization Survey (NICS) showed :


Vaccines for children and adults are critical in building a resilient population. Healthy people require less health care services. It is crucial to promote and ensure children and adults are routinely immunized for life-saving, vaccine-preventable diseases.

Real Change in Action

In 2011, Ontario expanded the province’s publicly funded immunization program to better protect and make it more accessible to families. Two vaccines were added to the immunization schedule. One protects against the rotavirus infection, which is the leading cause of severe, dehydrating diarrhea in infants and young children. Ontario was the first jurisdiction in Canada to make the rotavirus vaccine publicly funded after the National Advisory Committee on Immunization (NACI) recommended its use for infants in July 2010. The second vaccine, MMRV adds varicella (V) – which protects against the virus that causes chicken pox – to the combined measles-mumps-rubella (MMR) vaccine. The province also expanded the varicella and pertussis (whooping cough) vaccine programs.

“Routine immunization and equal access to vaccines are especially important to families with low socio-economic status, who may not be able to afford the vaccine out-of-pocket”, Arron said. Ontario currently covers the cost of 14 childhood vaccines, compared to nine in 2003-2004. The six additional vaccines that were made available over the past eight years represent a total savings to families of $1,892 per person.

Vaccines have measurable outcomes that contribute tangible savings to the health system. For example, an evidence-based study done in Ontario in 2002 indicated a cost-benefit of funding the rotavirus vaccine. Each child hospitalized for rotavirus costs the province about $2,690, in addition to about $800 for an emergency room visit. These figures do not begin to take into account the cost related to loss productivity from parents’ absence from the work place, increased stress and disruption of family life when a child is ill.

Encouraging uptake of vaccines is essential and not just for children. Since 2000, the province has offered an annual seasonal influenza vaccine free of charge to everyone six months of age and older, who lives, works or attends school in Ontario. The Universal Influenza Immunization Program (UIIP) had had a significant impact on the rate of illness and the burden caused by influenza. Since the introduction of the UIIP, the annual immunization rate of Ontarians has almost doubled from 18 per cent to 33 per cent. This increase has been linked to an overall drop in the incidence of seasonal flu infections by 61 per cent as of 2006 and a 74 per cent reduction in deaths among older Ontarians. It has also contributed to a cost avoidance to the health system of about $27 million over the last 10 years.

The program has made Ontario a national and world leader in the prevention of seasonal flu. But the positive outcomes could be multiplied if flu immunization rates could be further increased. The uptake of the seasonal flu vaccine has remained relatively unchanged in recent years. “People are still hospitalized and die from seasonal flu,” Arron noted. About 1,500 people in Canada die from influenza each year. “So we continue to focus on increasing uptake of the annual flu vaccine.”

Best Quality, Sustainable Care

Investing in vaccine programs and educating the public on the ongoing importance of immunization is key in keeping individuals healthy and building healthier communities. Immunization programs are also critical in making better use of health care resources by avoiding illness and complications from preventable diseases that require hospitalization. Reduced incidence of disease results in fewer doctor and emergency room visits and less use of acute medical services. Vaccines are important tools in the hands of primary care providers to prevent illness. “Immunization makes for a more resilient population and supports system sustainability,” Arron said.

Learn more about Ontario’s immunization program.

Contact Person :
Rohini Busur
Manager Public Health Immunization Policy and Programs
Public Health Ontario
Tel: 416 327-8009
Email: rohini.basur@ontario.ca

For More Information

Call ServiceOntario, Infoline at 1-866-532-3161
In Toronto, 416-314-5518
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