The measles outbreaks this winter in Ontario and Quebec have put more than the latest mutations of the virus under a microscope. Also coming in for close scrutiny is Canada’s patchwork of provincial immunization systems. Public health experts have long called for a national approach to tracking the vaccines Canadians have received—or missed. Starting in 2004, the federal government invested in creating a system, dubbed Panorama, to do that and more. But not all provinces signed on, while those that did adopted only parts of the system, and on disconnected timetables. Asked by Maclean’s about the prospects for finally stitching together a Canada-wide registry, Health Canada answered by email: “The Panorama project is not run by the Public Health Agency of Canada. Please contact the provinces and territories.”
The problem isn’t unique to vaccines. Every debate on what to do about a serious health issue in Canada prompts calls for a national solution, which inevitably run up against the fact that health care is mainly run by the provinces. Doctors’ groups have urged Ottawa to take the lead on everything from setting national emergency-room standards to creating a national drug insurance plan—all to no avail. On vaccines, though, experts haven’t given up, if only because they see such obvious advantages. Dr. Ian Gemmill, a professor of medicine at Queen’s University in Kingston, Ont., and medical officer of health for Kingston, Frontenac and Addington, says a national registry would quickly “demonstrate pockets of susceptibility” to infectious diseases, allowing for targeted responses. And parents, he adds, wouldn’t need to worry about paper records of their children’s shots, especially when moving between provinces.
The federal government, however, is reluctant to spend the money—and assume the political risk—that comes with trying to forge national solutions on health issues. On immunization, Health Minister Rona Ambrose touts Ottawa’s contributions in key but limited areas, such as encouraging the provinces to make sure their separate vaccine registries are compatible enough to share data. Planned federal spending on immunization programs for this year is about $18 million, roughly the same level, with some annual fluctuations, since 2005. Health Canada says its priorities include making sure vaccines are safe, paying for First Nations vaccinations and backing science, notably the cutting-edge National Microbiology Laboratory in Winnipeg.
All that falls short of the national registry envisioned more than a decade ago. Severe Acute Respiratory Syndrome (SARS) first appeared in late 2002 in China, and went on to kill about 800 people around the world, including 44 in Toronto. A post-SARS report headed by Dr. David Naylor, then dean of medicine at University of Toronto, flagged serious failures of national coordination in response to the crisis. One key outcome: Canada Health Infoway—a federally funded agency set up to promote the creation of digital health information systems—was given $135 million to develop what became Panorama. Problems soon arose. Alberta decided not to join at all. The Atlantic provinces saw Panorama as too expensive. Even among provinces that embraced the system, the pace has varied. British Columbia moved quickly, for example, while Ontario only recently switched to Panorama for student vaccination records.
But Jennifer Zelmer, executive vice-president of Canada Health Infoway, says progress shouldn’t be underestimated. About three-quarters of Canadians, she points out, are now at least partly served by Panorama. And making sure vaccination records follow patients as they move within a province, from one town or region to another, was often the first priority for health officials rolling out the system. “The progress has been huge within provinces,” she says. As well, Zelmer says there are promising examples of progress in transferring data between jurisdictions, noting that B.C. and Yukon have worked closely, which made sense since it is quite common for people to relocate between the two.
Zelmer also says critics might be overstating how likely the swift creation of a seamless national registry ever looked in the first place. Naylor’s report created the impetus to try, but Zelmer says follow-up studies that examined ways to implement his recommendations acknowledged from the outset that Panorama “would be a marathon and not a sprint.” Canada Health Infoway has spent only $98 million of the $135 million the federal government earmarked for the project, so work on broadening the system is far from over. “Do I wish that we all collectively had a magic wand? Absolutely,” Zelmer says. “But are we in a very different place now, with Panorama modules covering 75 per cent of the population? Yes. Is there work to do? Of course.”