How to keep up with latest vaccines

Info overload, underfunding blamed for poor coverage

By Jennifer Laliberté

Immunization is hot right now. Staying on top of the dizzying array of new arrivals and changes to the recommended schedule can be a real headache for the busy GP. But it's worth the effort. There are few better ways to stretch our healthcare dollars, and protecting your patients from the diseases the latest vaccines target now will pay you real time dividends in the long run.

NEW KIDS IN TOWN
Last year alone, three new vaccines were licensed with Health Canada. Menactra, the new jab to prevent meningococcal disease in children, got the nod on May 3; the cervical cancer vaccine Gardasil made headlines on July 10; and RotaTeq, an oral vaccine for the prevention of rotavirus gastroenteritis in children, received approval on August 1.

But as you well know, a green light from the regulatory agency means nothing unless patients actually get the shot in the arm. "New vaccines are coming fast and furious," says Dr Monika Naus, chair of the National Advisory Committee on Immunization (NACI). "It's important to have some concerted effort so we don't lose sight of opportunities for prevention."

Immunization is a shared responsibility, adds Dr Greg Hammond, director of the public health branch of Manitoba Health. "We [the health region] make sure the vaccine is available, but it's also up to providers to be aware of opportunities for preventive healthcare and encourage patients to get their shots. We also expect patients to share some of that responsibility themselves," he says.

THE UNCOVERED TRUTH
But even with so many stakeholders involved, the unfortunate reality is that Canadians aren't as well covered as they should be. We're consistently falling short of national targets, even with vaccinations like MMR, diptheria, tetanus and polio that have been around for ages (see "Routine childhood immunization coverage," below). And it only gets worse as kids get older. Your average 17-year-old has less than a 50% chance of being up-to-date on all the shots recommended by the NACI.

Adults aren't much better. "Only 50-70% of seniors get the flu shot each year, as do a mere 50% of healthcare workers," says Dr Kevin Laupland of the University of Calgary who presented a session on adult immunization at the Canadian Immunization Conference in Winnipeg last month. "That's not very good at all."

So if we're doing such a poor job of reaching our national coverage targets with well-established, provincially-funded immunizations, it's easy to see how adoption of hot new jabs like Gardasil could be a little sluggish. "It's usually the funding that's the biggest problem," says Dr Hammond. "New vaccines are substantially more expensive and governments have to measure those costs against all the others driving the healthcare system. It takes time."

FORGET-ME-NOT
While the bean-counters work out the funding, you on the frontline can still do your part to make sure your patients have all the facts. After all, surveys consistently show that the advice of a healthcare provider is the top reason patients get vaccinated (see "What you can do," top right).

Any type of patient reminder or recall system will improve immunization rates in your practice population. The more often you bring up vaccination, and the more personalized the message, the better your patients will fare. The key is choosing a strategy that fits your practice.

Larger offices with a well-established EHR system could see a big improvement with automatically generated letters or postcards. Docs in solo practice, on the other hand, should probably go old-school: you'd be surprised how far a wallet-sized reminder card stamped with the next vaccination date will take you.

That's all well and good, you say, but how do you find the time to administer all these shots? "Some pediatricians open clinics on weekends to immunize kids around flu season," observes Dr Hammond. "Once you're doing a focused delivery like that, you can be quite efficient." For the rest of the year, consider reserving one day every month or so to do nothing but immunizations.

FOR THE RECORD
Of course, implementing new immunization programs — and improving existing ones — takes money. Five years ago, the feds recognized this and pledged $45 million for national immunization programs. But that money dries up in March, and experts fear the funding may not be renewed. "The money has definitely sped things up and provided equity across the country in terms of access to the vaccines," says Dr Naus, "but there's still a long way to go in terms of achieving the outputs."

Among other things, the money is being used to help set up vaccine registries — a critically important tool, says Dr Hammond. "Patients often have no idea what they've received, and that can really complicate things," agrees Dr Laupland.

Five Canadian provinces — Manitoba, NB, Saskatchewan, PEI and BC — currently have vaccine databases, and it's already making a real difference. "It's a valuable record that can be built upon over time," says Dr Hammond. "It tells us how well we're doing, but it can also raise red flags and let us know when we're not getting through to a certain population." Case in point: Manitoba's coverage rates, though still not perfect, are higher than the national average.