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As Canadians clamour for coronavirus vaccine, many aren’t getting immunized against other diseases

As scientists race to develop a vaccine to combat the coronavirus epidemic, many Canadian adults aren’t taking advantage of immunizations that are already available to protect them against other threatening diseases, public health experts say.

A vaccine for the new coronavirus, which causes the illness known as COVID-19, could eventually become part of recommended seasonal vaccinations — like the flu shot.

But it’s “really hard to predict” when that might become a reality, said Dr. Natasha Crowcroft, director of the Centre for Vaccine Preventable Diseases at the University of Toronto.

“Everyone who can is working flat out to make it happen, but there are so many steps to go through to make sure a vaccine is safe and effective,” she told CBC News.

In the meantime, Crowcroft hopes the widespread call for a coronavirus vaccine serves as “a wake-up call” to remind people of the role vaccines play in stopping the spread of illness.

“People can worry about not yet having a vaccine for COVID-19, or they can go get the vaccines we already have to keep them healthy,” she said.

Adults not keeping up with vaccines

Public health authorities and parents tend to focus on getting children vaccinated, largely because there are routine childhood vaccination schedules for measles, mumps and rubella (MMR), polio, petussis (whooping cough), tetanus, diphtheria and other diseases, depending on the province or territory.

But adults often forget that they need vaccinations too — whether it’s their tetanus and diphtheria booster shot every 10 years, getting the HPV vaccine to prevent several forms of cervical cancer, or protecting themselves against increased vulnerability to pneumonia and shingles when they become seniors.

Public health efforts tend to do a better job at making sure children get the vaccinations they need than they do with adults, said Dr. Natasha Crowcroft, director of the Centre for Vaccine Preventable Diseases at the University of Toronto. (Claude Martel)

“Everybody focuses on the kids … and it’s very easy to forget about the adults,” Crowcroft said. “We tend to think, oh, you know, adults are in charge of their own health.

“[But] we’re all much worse at prevention than cure. So we we wait until we get sick and then we think, ‘oh maybe I should have had that flu shot.'”

According to the Public Health Agency of Canada, most adult Canadians believe they are up-to-date with the vaccines recommended for their age group — but few of them actually are.

While 88 per cent of individuals “believed that they received all of the vaccines recommended for someone their age,” only 3 per cent of respondents “reported having received all of the recommended adult vaccines for their age/risk group,” according to the 2016 Adult National Immunization Coverage Survey. The survey, conducted by Environics Research on behalf of the Public Health Agency of Canada, measured interview responses from more than 3,000 adults across Canada.

That rate of immunization among adults is “unbelievably low,” said Dr. Iris Gorfinkel, a family physician in Toronto who has contributed to several clinical research studies on vaccination.

“We’re simply not giving it the time that it needs,” Gorfinkel told Dr. Brian Goldman, host of CBC’s The Dose podcast.

“Patients themselves are not prioritizing vaccinations and doctors clearly are not prioritizing vaccinations as well,” she said. “That’s the conundrum here — that if you’re healthy, you’re probably not even going to go [to the doctor’s office].”

Faced with patients who have increasingly complex health issues, such as diabetes or hypertension, along with a waiting room full of other people wanting to be seen, discussions about vaccine status simply don’t happen — so Gorfinkel recommends dedicating a full appointment for a vaccine review to make sure people are up-to-date.

Vaccinations for seniors critical, doctors say

As people age, their immune systems decline, making illnesses — from flu to pneumonia — much more dangerous, and increasing the need for protection through vaccination, both Crowcroft and Gorfinkel said.

Seniors are also at risk of shingles — a disease that happens when the varicella-zoster virus (which causes chicken pox in kids) reactivates in the body.

People often think shingles is “just a rash,” Gorfinkel said — but for many, it’s a devastating disease.

The virus lies dormant near the spinal cord, so when it reactivates as shingles, “it comes traipsing down the nerve,” she said, causing excruciating pain and nerve damage — which can sometimes be permanent.

“Patients themselves are not prioritizing vaccinations and doctors clearly are not prioritizing vaccinations as well,” said Dr. Iris Gorfinkel, a Toronto-based family physician and vaccine researcher. (Craig Chivers/CBC)

A cruel irony, Crowcroft said, is that as seniors are more healthy and active than those in generations before, they may not think to get the vaccines recommended for their age group.

“They’re busy, out doing things, volunteering … enjoying life,” she said.

But a bad bout of pneumonia or shingles can rob seniors of independence and push them into a “vicious cycle of frailty,” she said.

According to the latest data available from the Public Health Agency of Canada, only 58 per cent of people age 65 and over reported having had the pneumococcal vaccine. Only 28 per cent of adults 50 years of age and over reported having receiving a shingles vaccine.

Crowcroft and her team at the University of Toronto are in the midst of a study to examine whether improving those vaccination rates will help “prevent people who were otherwise healthy from deteriorating and becoming really quite frail.”

What vaccines do I need as an adult?

Make sure you had your childhood shots for:

  • Measles, mumps and rubella (MMR).
  • Polio.

From age nine up to age 45:

  • Human Papillomavirus (HPV): The vaccine prevents several types of cervical cancer. It can be given as early as age nine and up to age 45.

At 24 years of age or younger:

  • Meningococcal (meningitis).

As an adult (all ages):

  • Tetanus and diphtheria: Booster shot every 10 years. Vaccines for both are now given together. Check to make sure your last tetanus vaccination included diphtheria protection.
  • Pertussis (whooping cough): One dose as an adult and during each pregnancy.

Seasonal (every year because the strain of influenza changes):

  • Flu shot.

If you think you’re among the minority of people who didn’t have chicken pox as a child (your doctor can check with a blood test):

  • Varicella (chicken pox).

For seniors:

  • Shingles (vaccine can be given as early as age 50, definitely recommended at age 60 and over): Shingles causes not only a rash, but excruciating pain. Nerve damage is sometimes permanent.
  • Pneumococcal (vaccine recommended for all adults age 65 and over, as well as younger adults with certain chronic conditions or a compromised immune system): Can cause bacterial pneumonia and other invasive infections, including sepsis. Seniors are especially vulnerable.

Other vaccines may be recommended for some adults — talk to your doctor:

  • Hepatitis A.
  • Hepatitis B.
  • Travel vaccines (can include Hepatitis A, Hepatitis B, cholera, meningococcal, Japanese encephalitis, tick-borne encephalitis, rabies, typhoid, yellow fever).                                                                                ​​​​​

(Source: Public Health Agency of Canada)

How to increase vaccination rates for adults

The solution, Crowcroft and Gorfinkel said, lies in a more coordinated approach to tracking vaccinations in a fragmented health-care system, as well as better use of existing technology.

“What we need — and desperately so — are robust provincial and territorial vaccination registries,” Gorfinkel said.

Existing registries are targeted to children, she said, and don’t track adult vaccinations.

In an “ideal world,” she said, such registries could be largely automated.

Health-care providers should be able to scan a patient’s health card, as well as the vaccine, and then transmit that information to the patient’s health record, as well as public health databases, she said.

Electronic technology could also go a step further and send out reminders to people to get their vaccines, Gorfinkel said — whether it’s an email every 10 years to tell patients they’re due for a tetanus and diphtheria booster, or a notification to seniors prompting them to get a shingles vaccination.

Cost is another barrier that needs to be overcome, she said.

Not all vaccines for adults are covered under government health plans — and coverage varies between provinces and territories.

Most provinces and territories don’t cover the cost of shingles vaccinations, which can cost about $200 to $350 — a steep price for many seniors.

Ontario pays for the shingles vaccine Zostavax — but only for seniors between 65 and 70 years of age.

“The 65 to 70 year age range for eligibility is aligned with scientific evidence on the effectiveness of Zostavax and expert recommendations from the National Advisory Committee on Immunization (NACI) and Public Health Ontario,” a spokesperson for Ontario’s Ministry of Health said in an email response to CBC News.

The newer shingles vaccine — Shingrix — is not covered in Ontario.

Gorfinkel and Crowcroft hope that governments at all levels will recognize the value — human and financial — of covering the cost of vaccines for adults.

“Does it make sense to treat [a disease] once you have it? Or does it make more sense to actually provide the vaccination? And the data on this is very clear. The vaccination wins, hands down,” Gorfinkel said.

CBC

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