Steps to Improving Adult Vaccination in Canada – Prevention, Access, and Equity

November 2020 blog post written by Megan Acton BA Health Studies and Gerontology, MA Ageing and Society

Influenza and pneumonia combined are the sixth leading cause of death in Canada, accounting for over 8,000 deaths in 2018.[i]  These respiratory diseases can lead to serious complications and illness for older adults and those with chronic diseases who are at higher risk of morbidity, mortality and prolonged recovery due to underlying frailty and changes in immune function.  In turn, this can lead to further declines in health and functional ability.[ii]

Despite the severity of influenza and pneumonia, and the availability of effective vaccines, vaccination is not widely discussed or recommended to prevent serious complications and functional decline of those most at-risk.  To illustrate this, pneumococcal vaccination uptake in Canada hovers around a startling 40 percent for at-risk groups, against the target of 80 percent.

It is IFA’s belief that steps to improving adult vaccination must be underpinned by three main principles – prevention, access, and equity.  In 2019, IFA convened the expert meeting “Adult Influenza Vaccination: Calling Canadian Patient Organizations to Action” where delegates from across disciplines and sectors delved into these principles toward consensus on action needed to improve adult vaccination in Canada:

1. Canadians are faced with complex and mixed messages regarding vaccination that often leads to the spread of misinformation. There is a need for clear, consistent, evidence-based messaging on vaccination targeting the general population and importantly older people and other at-risk groups.
2. Strategies to increase vaccination uptake rates amongst older people and at-risk populations must be aligned with Canada’s health equity principles. Sub populations including those who live in rural and remote settings, migrants, the LGBTQ community, and Indigenous peoples often face systemic barriers and implicit biases within and outside of the healthcare system.
3. Coalitions are integral to building a cohesive voice that raises the awareness and influences action to respond to low influenza vaccine uptake by collaborating and utilizing strengths across disciplines and sectors.
4. In Canada, it is crucial that older adults and at-risk populations have access to more effective vaccines.
5. Evidence must be improved on the burden of infectious diseases including influenza, pneumococcal pneumonia, shingles and pertussis among older adults and at-risk populations to improve communication to the general population, patient and advocacy organizations, health care professionals, public health officials, and all levels of government.
6. Provinces and territories are urged to examine efficacious and realistic methods of accessing existing data on vaccination uptake across the life course to inform and improve policies and practices.

Coinciding with the first point of the consensus statement on the importance of messages surrounding adult vaccination, IFA recently conducted a 10-country study called “Changing the Conversation on Adult Influenza Vaccination” analyzing public vaccination messages.  One in three older Canadians were not immunized against influenza in the 2018-19 season, a finding which is relatively consistent over many years.

Public health campaigns focus largely on the general population, with less emphasis on those who are most at-risk (older people and those with underlying conditions).  The comparative analysis of public health messages showed gaps in the nature of messages and targeting.  Yet, the elephant in the room when talking about Canada’s immunization program is the absence of a harmonized program across provinces and territories.

IFA is eager to explore what lessons can be learned from other countries that have successful immunization programs such as the United Kingdom and Australia.  Watch IFA’s recent Town Hall titled “Strengthening Adult Influenza Vaccination Programs: Learning from International Good Practice” to learn from three champions from the field of adult vaccination in the UK and Australia.

In the current climate of COVID-19 it is more important than ever to ensure the protection of older adults and those with underlying chronic conditions against vaccine preventable diseases.  Maximizing uptake of existing vaccines for respiratory diseases, such as influenza, pneumonia and pertussis reduces the annual burden of disease – including increased mortality, morbidity and healthcare costs – particularly in at-risk populations.

It is for these reasons that the IFA calls on professional, patient and advocacy organizations, together with all levels of government to increase their investment in educating and encouraging older adults and those with chronic diseases to be vaccinated.

[i] https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310039401

[ii] Andrew, M. K., Bowles, S. K., Pawelec, G., Haynes, L., Kuchel, G. A., McNeil, S. A., & McElhaney, J. E. (2018). Influenza vaccination in older adults: rcent innovations and practical applications. Drugs & aging, 1-9