In Ontario alone, seasonal influenza vaccines eliminate the need for more than 200,000 visits to doctors’ offices, avert approximately 30,000 visits to hospital emergency departments, and prevent approximately 300 deaths each year.1
With stats like these, it is clear that immunization against the flu has a positive effect on people of all ages. But current national and provincial vaccination rates remain far from ideal, despite the human and economic toll of infectious diseases like the flu.
The Ontario Lung Association and its medical societies are working to spread the message that getting vaccinated is one of the most important things that people of all ages can do to protect their lung health, especially if they are at higher risk of serious complications due to their age. Read More
Who is getting vaccinated against influenza, and who is most at risk?
In the 2017/18 season, the Public Health Agency of Canada (PHAC) reports that just 38.3 per cent of Canadian adults reduced their risk of developing influenza by receiving the seasonal flu vaccine. Among seniors who are at heightened flu risk due to their advanced age, vaccine coverage reached 70.7 per cent,2 below the age group’s national coverage goal of 80 per cent3.
Why are Canadians hesitant to arm themselves against the flu and pneumonia?
Overall vaccine hesitancy and stubbornly pervasive myths surrounding the flu vaccine itself are issues to watch closely as we work to find innovative solutions to plateauing uptake rates. In 2017/18, PHAC reports that the most commonly cited reasons for avoiding the flu shot were a fear of getting sick from it and simply believing that the vaccine is not necessary, at 38.3 per cent and 22.4 per cent, respectively.4
Advocating for immunization: our policy recommendations
Seniors are a group for whom vaccination is of paramount importance, since their immune systems are not as well equipped to fight infection.5 What’s more, these older adults are more likely to encounter complications or have difficulty recovering should they become ill.6
Helping Canadians realize the importance of immunization to seniors’ health will necessitate a multi-faceted approach. Therefore, The Ontario Lung Association’s policy recommendations to the federal and provincial governments include:
- Developing a whole life approach to immunization
While Canada has a strong immunization system for children, the same is not true for adults. We need a structural transformation to change Canada’s immunization system to cover the whole of life. Making discussions about immunization a part of regular patient care, along with an immunization schedule for adults, would educate Canadians and provide consistent messaging around which vaccinations are needed and when. A vaccination schedule for older adults, distributed in the same way as the pediatric version, could get the message out and help increase immunization rates.
- Educating healthcare providers on the importance of vaccinations for older adults
Healthcare providers caring for seniors should receive training that vaccination is a fundamental part of good clinical care. If education starts in medical school, it will become a standard of practice. As well, with new vaccines and changing recommendations, regular professional development training of all healthcare workers is also needed.
- Educating Canadians about the importance of vaccinations for all ages
Many Canadians are not aware of what vaccines are available and who needs them and when. One survey found that 88 per cent of adults believed they were up to date on their vaccinations, but only three per cent reported having received the correct number of vaccines for their age/risk group. Some may rely on unreliable sources for information, which leads to vaccine hesitancy. Steps to increase awareness could include engaging religious or community leaders to promote vaccination, promoting and educating about vaccination for older adults through media and social media, as well as literature in healthcare providers’ offices. Reminder systems to notify patients when it is time to be vaccinated could also help.
- Including influenza and pneumococcal vaccinations as a standard part of care for seniors
Influenza and pneumococcal vaccinations should be included as part of practice in clinical guidelines for caring for seniors and people with certain chronic conditions, such as diabetes and respiratory or cardiovascular diseases.
- Reinvesting in the National Immunization Strategy
Funding constraints can influence a provincial government’s decisions regarding which vaccines to offer. The federal government should reinvest in the National Immunization Strategy with a dedicated funding mechanism for transfer payments to the provinces and territories specific to initiating and sustaining immunization programs that include the whole of life approach. Secure, predictable federal funding would help advance immunization in Canada. This would allow the provinces and territories to create immunization programs that are truly for the whole population with the aim to reduce inequities and improve access for patients.
- Universal funding for influenza vaccinations within each province
Three provinces (British Columbia, New Brunswick and Quebec) do not publicly fund influenza vaccine for all residents. Ontario was the first province to implement a universal program, which was associated with decreased mortality, hospitalizations, emergency department use and doctor’s office visits when compared to other provinces.7 A study looking at vaccination rates across Canada found that coverage was higher in provinces with universal funding of influenza vaccines for their residents.8 It is recommended that the three remaining provinces provide universal coverage of the influenza vaccine.
- Providing incentives among healthcare providers for influenza immunization
Research is mixed regarding the effectiveness of financial incentives in increasing immunization rates,9 10 but the strategy is used in many countries. For example, an immunization incentive in the UK offered physicians a certain bonus amount if 70 per cent of their two-year-old population was immunized. The bonus quadrupled if they reached 90 per cent. The incentive was successful, along with other steps including appointing immunization coordinators and using computers to recall patients, in raising immunization coverage to the 90 per cent level.11 In Canada, the fees that general practitioners receive for administering the flu shot vary12. For example, they are about $9.60 in Ontario and about $35.00 in Nova Scotia. Between 2006-2007 and 2013-2014, Nova Scotia consistently achieved the highest flu vaccination coverage rate, which increased by five per cent during that period. During that time, Ontario experienced the greatest drop, from 37 per cent to 33 per cent.13
While other factors may be involved, this does illustrate that incentives may be beneficial and that an incentive strategy is worth investigating.
- Highly recommending influenza vaccination for all healthcare providers and making it mandatory for providers and residents in long-term care homes
A position paper from the Association of Medical Microbiology and Infectious Disease Canada states that healthcare worker immunization in chronic care hospitals and long-term care homes reduces patient and resident mortality by 20-40 per cent during flu season.14
The policy recommendations outlined in this article were drafted as a result of a Breathing Policy Forum session entitled Prevention: The Best Medicine – The Importance of Immunization to the Health of Seniors. To read our full whitepaper, including patient and healthcare provider perspectives, click here. .
1 Kwong, Jeffrey C, Stukel, Thérèse A, Lim, Jenny et al. (2008). The Effect of Universal Influenza Immunization on Mortality and Healthcare Use. PLOS Medicine, 5(10), 1440-1452
2 Public Health Agency of Canada (2019). Seasonal Influenza Vaccine Coverage in Canada, 2017–2018. Available from http://publications.gc.ca/site/archivee-archived.html?url=http:// publications.gc.ca/collections/collection_2019/aspc-phac/HP40-198-2018-eng.pdf
3 Government of Canada (2019). Vaccination Coverage Goals and Vaccine Preventable Disease Reduction Targets by 2025. Available from https://www.canada.ca/en/public-health/services/immunization-vaccine-priorities/national-immunization-strategy/vaccination-coverage-goals-vaccine-preventable-diseases-reduction-targets-2025.html#1.4
4 Public Health Agency of Canada (2019). Seasonal Influenza Vaccine Coverage in Canada, 2017–2018. Available from http://publications.gc.ca/site/archivee-archived.html?url=http:// publications.gc.ca/collections/collection_2019/aspc-phac/HP40-198-2018-eng.pdf
5 McElhaney, J.E., Zhou, X., Talbot, H.K., Soethout, E., Bleackley, R.C., Granville, D., & Pawelec, G. (2012). The unmet need in the elderly: How immunosenescence, CMV infection, co-morbidities and frailty are a challenge for the development of more effective influenza vaccines. Vaccine, 30(12), 2060-2067. Doi: 10.1016/j.vaccine.2012.01.015
6 National Advisory Committee on Immunization (NACI). (2016). Canadian Immunization Guide Chapter on Influenza and Statement on Seasonal Influenza Vaccine for 2017–2018. Available from: https://www.canada.ca/en/public-health/services/publications/healthy-living/canadian-immunization-guide-statement-seasonal-influenza-vaccine-2017-2018.html
7 Kwong, JC, Stukel, TA, McGeer, AJ, Upshur, REG, Johansen, H, Sambell, C, Thompson, WW, Thiruchelvam, D, Marra, F, Svenson, LW and Manuel, DG. (2008). The effect of universal influenza immunizations on mortality and health care use. PloS Med, 5(10), e211.
8 Buchan, Sarah A, Kwong, Jeffrey C. (2016). Trends in influenza vaccine coverage and vaccine hesitancy in Canada, 2006/07 to 2013/14: results from cross-sectional survey data. CMAJ Open, 4(3), E455-E462
9 Fairbrother, G Hanson, KL, Friedman, S and Butts, GC. (1999). The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. American Journal of Public Health, 89(2), 171–175
10 Li, J, Hurley, J, DeCicca, P and Buckley, G. (2014). Physician Response to Pay-for-Performance: Evidence from a Natural Experiment. Health Economics, 23(8), 962-978
11 Fairbrother, G Hanson, KL, Friedman, S and Butts, GC. (1999). The impact of physician bonuses, enhanced fees, and feedback on childhood immunization coverage rates. American Journal of Public Health, 89(2), 171–175
12 Buchan, S.A. & Kwong, J.C. (2016). Trends in influenza vaccine coverage and vaccine hesitancy in Canada, 2006/07 to 2013/14: results from cross-sectional survey data. CMAJ Open, 4(3), E455-E462
14 Bryce, Elizabeth, Embree, Joanne, Evans, Gerald et al. (2012). AMMI Canada position paper: 2012 Mandatory influenza immunization of health care workers. Canadian Journal of Infection Diseases and Medical Microbiology, 23(4), e93-e95