Ontario’s top doctor is calling for a national immunization schedule and registry to address gaps exposed by the resurgence of measles in Canada — but first, he says his own province needs a centralized digital vaccine system.
Dr. Kieran Moore’s annual report, recently tabled with the provincial legislature, says a co-ordinated approach from all levels of government and the health-care system is needed to keep vaccine-preventable diseases at bay amid a rise in vaccine hesitancy.
Each province and territory has its own immunization schedule and data system but for more than 20 years, health-care providers and public health experts have been advocating for a national vaccine registry. The Canadian Paediatric Society has also called for vaccine schedules to be harmonized across the country since 1997.
In his report, Moore said Ontario is lagging behind other provinces who have modernized their vaccine records, including British Columbia, Quebec, Alberta, Manitoba and Nova Scotia.
This patchwork approach has led to confusion for parents who have become record keepers, and left public health officials in the dark when it comes to coverage gaps and inequities in access, making it difficult to respond to outbreaks.
Moore said this has also made it challenging to monitor vaccine effectiveness and safety, critical information as parental skepticism of routine immunizations doubled in Canada between 2019 and 2024. Childhood vaccination rates have also tumbled since the COVID-19 pandemic.
“Vaccine preventable diseases are an ongoing threat that can and will re-emerge if we let our guard down. A recent outbreak of measles in Ontario has unfortunately highlighted how quickly previously controlled diseases can spread,” Moore said in the report.
While B.C. has recorded a little over 100 cases of measles as of July 5, neighbouring Alberta has recorded more cases than the entirety of the U.S. despite having a fraction of the population. Dr. Susan Kuo, a Richmond family physician, said the current outbreak could be prevented with up-to-date vaccinations, and the COVID-19 pandemic had led to an increase in vaccine skepticism and poor disease mitigation.
Dr. Vinita Dubey, Toronto’s associate medical officer of health, said in an interview last month that the process in her jurisdiction is outdated.
Parents keep track of their kids’ immunization records and must submit them to public school boards in Toronto. That information is shared with Toronto Public Health, manually inputted into its own system and then letters are sent to households that have not supplied vaccine records.
“It’s a very, very manual process. Our system itself doesn’t speak to a lot of other systems,” Dubey said. “And so those are some of the ways in which it’s really outdated.”
Moore’s report said the Public Health Agency of Canada is working with provinces and territories to connect existing immunization registries and develop a surveillance system for vaccine coverage.
As of October 2024, five provinces and one territory — Alberta, Saskatchewan, Manitoba, New Brunswick, Nova Scotia and Yukon — have submitted vaccine records, according to the federal government’s website.
Ontario currently stores vaccine records in three separate data systems: one for schools and child-care centres, another for COVID-19 shots, and a third for Ontario Health Insurance Plan billing claims and electronic medical records from doctor’s offices or community pharmacies.
Moore said the Ministry of Health’s efforts to link these data systems are encouraging. A ministry spokesperson said Ontario is working to provide patients with a digital identity tool to access their personal health information, including vaccination records.
Moore said in the report that Ontario has faced challenges with integrating data from various health-care providers without duplicating entries. Routine childhood immunizations are primarily administered by family doctors, unlike in several other provinces where public health nurses take on this role and the information is more easily consolidated.
There’s also an economic advantage to a national vaccine schedule, as centralized procurement would reduce costs through bulk purchasing, reduce duplicate shots, and preventable hospitalizations, the report said.
