Canada Needs a National Vaccination Registry

Measles is the most contagious virus on earth. It creates scenarios that could have been ripped from science fiction—for example, a woman walks into a room where someone coughed two hours earlier and catches a virus that could permanently damage her brain. As an immunologist, scientist and professor of medicine, my life’s work is understanding how vaccinations can prevent situations exactly like that one and protect health in the long term. You could say I’m the opposite of an anti-vaxxer.

After measles broke out in New Brunswick last October, I was hit with a sinking feeling. Its rapid spread either meant that Canada’s health-care system didn’t have the resources it needed to control it, or our MMR vaccine uptake wasn’t as high as it should’ve been—or both. Uptake rates for most childhood vaccinations have been dropping in Canada for years; in the case of MMR, they fall way short of the threshold required for herd immunity. People have blamed the misinformation that ran wild during the pandemic—say, that vaccines are linked to fertility issues—but that’s only part of the problem. In many provinces, kids are still required to be vaccinated for a range of diseases, including measles, before they’re allowed to attend public school. But enforcement for showing proof of vaccination has dwindled. Most provinces also recently added “conscience exemption” to the list of non-medical reasons to opt out of vaxxes—no doctor sign-off required. 

One of the biggest barriers to vaccinations, however, is tracking. Thanks to the family doctor shortage, many families simply miss their jab appointments without realizing it; they don’t have a medical office to remind them. They struggle to independently navigate Canada’s complex vaccine schedule, which mandates 12 different shots for kids in the first year and a half of their life. It’s no coincidence that we now rank in the top 10 countries globally for measles outbreaks, alongside countries like Yemen and Afghanistan. We’re the only G7 country without a national vaccination registry—and we need one stat.

During the pandemic, the provinces created short-term digital portals that allowed people to easily check and download their COVID-19 vaccination statuses: how many shots they received (and when), and which drug companies made them. That system provided clarity and gave us a glimpse of what’s possible. But beyond COVID, we never expanded those portals to include historical vaccines or other boosters and shots administered outside of medical settings, like in workplaces, at private pharmacies, on reserves or in prisons.

A national vaccination registry, managed by the federal government, that tracks Canadians’ entire immunization histories would be a big leap forward. Ideally, it would log every vaccination from childhood to adulthood, any optional vaxxes (like flu shots), the dates they were administered, their brand names and a minimal amount of identifying information, like the postal code of the recipient. It would also allow Canadians to track their immunizations even if they’ve lost their flimsy yellow card—still a standard recording method, believe it or not—and no matter where the shots were delivered. Right now, that information is scattered. If you’ve moved provinces or changed doctors, there’s a strong chance your records haven’t followed you. Many parents only learn that their kids are missing vaccines if or when a letter is sent home from school. And some adults—even colleagues of mine—wrongly assume they’re up-to-date because they’re waiting for their family doctors to call and nudge them to get the next one. 

A universal registry wouldn’t just minimize inquiring calls to the country’s already slammed family clinics. It could also flag geographic areas with low vaccine coverage to improve our response to outbreaks. Live vaccines require refrigeration and can have limited shelf lives, which means rural areas with smaller populations tend to have fewer of them on hand. If our registry showed low vaccine-uptake rates, however, public health would have a better idea of how many would need to be mobilized for pop-up administration sites, or where to focus outreach, like vaccine-education initiatives.

Several other countries have successfully kept outbreaks at bay since the ’90s with the help of registries. One example is the Australian Immunisation Register, or AIR, originally introduced as the Australian Childhood Immunisation Register in 1996. Everyone enrolled under Australian Medicare is automatically registered, and a doctor or vaccine provider enters every vaccine administered from birth through adulthood into a central system. If the patient receives vaccinations overseas, they can provide documentation to have them logged, too. AIR automatically notifies users when they’re due for another dose and tracks any adverse reactions. Parents and child care facilities can also incur hefty fines if kids in their care miss a jab, a penalty that’s helped increase rates of full childhood immunizations among Aussie children aged five to seven. 

Even the U.S. has a robust share of vax registries, which help prevent miscommunication and missed doses. The California Immunization Registry, rolled out in 1994, is amazingly comprehensive. It consolidates records from hundreds of interstate providers into one unified record per patient. To date, 610 million vaccines have been logged, and there have been only 17 cases of measles in California this year. In Ontario, we’ve had roughly 4,200. 

Just about everyone in my field agrees that a national registry is much-needed, but plenty of Canadians are uncomfortable with the idea. They worry about cyberattacks or the potential for private companies to access their records for profit. Others simply view it as an invasion of privacy or an infringement on their bodily autonomy. Even a neutral tool like this registry can become a flashpoint for ideological battles over freedom and state control, but Canada has some of the strictest privacy laws in the world. (Scientists have to adhere to a slew of guidelines and protection to access virtual health data for research purposes.) 

As with any centralized database, a leak of contact information or health history is possible, but unlikely. Our vax registry would, by law, be designed with deep respect for Canadians’ security. It should require explicit consent from the user, offer users optional “lockbox” instructions that prevent health-care providers from sharing specific parts of patients’ records, and require regulators to directly notify users of any breaches. Encryption systems and extensive audit logs that monitor suspicious activity are also already industry standard for any electronic medical records accessed by doctors and researchers. Plus, the vax registry would only collect the essentials: vaccine type, date, location and patient ID. 

For those still worried about government overreach, I’d ask: what’s the cost of doing nothing? Even without symptoms, measles can persist in brain neurons. Over time, it can mutate to hide itself from the immune system as it spreads. We’ve seen some patients develop a degenerative brain condition called SSPE, a complication that can surface more than a decade later and result in death. And if a mother contracts measles early on during her pregnancy, babies exposed in utero may never reach their full intellectual potential, if they live at all. We have the power to prevent these tragedies—and ensure Canadians are prepared and cared for before the next health crisis.

Dawn Bowdish is a professor of medicine at McMaster University and the executive director of the Firestone Institute for Respiratory Health.