Vaccine registry still vacant

Seven years after a post-SARS study recommended that Canada establish a national immunizations registry to better react to infectious disease outbreaks, it will be another year before implementation of the registry even begins in most provinces.

Originally planned to be fully operational by the end of 2009, the registry, called Panorama, is set to be implemented by 2016. One province, Alberta, has already opted out of the national plan completely due to frustrations with the delay.

The Public Health Agency of Canada says communicable diseases can be controlled by the regular vaccination of children.

“When you think, that’s 13 years later [than the post-SARS 2003 recommendations] and you have to think if it’s even being taken seriously by this government,” says Liberal MP and health critic Carolyn Bennett.

Bennett, a doctor and the Minister of State for Public Health when the plans for Panorama were put in place, says it’s very surprising it hasn’t been more of priority for Prime Minister Stephen Harper’s government.

“I’d be more than happy to put questions on the order papers for the government to see if the delay is from the provinces or from the government,” says Bennett.

Panorama was developed after some health experts criticized Canada for its ineffective reaction to SARS in 2003. One of these experts, Dr. David Naylor, the former dean of medicine and current president of the University of Toronto, completed a report on the subject for the Public Health Agency of Canada.

“The single largest impediment to dealing successfully with future public health crises is the lack of a collaborative framework and ethos among different levels of government,” stated his 2003 Report.

In response to this report, the federal government assigned Canada Health Infoway the task of developing a country-wide communicable disease surveillance system in partnership with the provinces and territories. Infoway is a not-for-profit organization funded by the federal government that develops and facilitates the adoption of pan-Canadian electronic health records systems.

“Germs don’t respect borders,” says Bennett about the importance of having pan-Canadian immunization data-sharing capabilities.

No provincial consistency

While Panorama was supposed to be a national registry, health care remains a provincial responsibility in Canada. The delayed implementation of Panorama could be linked to this jurisdictional dichotomy. “Germs don’t respect borders”

One reason why it has encountered jurisdictional conflict is that a national database such as Panorama must adhere to differing provincial privacy laws. Furthermore, jurisdictions can choose whichever functions of the program they want to implement, says A. G. Klei of Canada Health Infoway. Along with picking and choosing functions of Panorama to implement, provinces can opt-out completely.    

“The original vision was that it would be a national database,” says Dr. Jeff Kwong, a scientist at the Institute for Clinical Evaluative Sciences in Toronto.

“It’s unfortunate, but you try to do one thing for the country and it comes out 13 different ways, I don’t understand why it’s hard to come to an agreement.” 

In a 2009 report, Toronto Public Health stated that although the system would be a good improvement for Ontario’s internal vaccination records, a unified national immunization registry wouldn’t occur.

“[It is] unclear whether the provincial Panorama registries will be able to interface with each other to transfer out-of-province records and consolidate information nationally,” it stated. "You try to do one thing for the country and it comes out 13 different ways"

There’s no reason why Panorama couldn’t work, says Dr. Kwong. While it’s an ambitious project, he says, it’s technologically possible. When each province puts its own stamp on the program though – if it chooses to participate at all – that’s what complicates and delays things.

 Even though it seems Panorama is taking a long time, people should understand that this is normal for implementing national health programs, says Dr. Michael Finkelstein, Associate Medical Officer of Health for the City of Toronto.

“The federal government can’t tell the provinces they have to use Panorama. They have no authority to,” he says. 

Where to go from here

Once Panorama is developed and a few provinces start using it, provinces not using it or all its functions may change their minds, Dr. Finkelstein says.

“The next door neighbour provinces may say, ‘Hey that looks pretty good over there’ and by 2020 we may get there,” he says. “I know it sounds like a long time . . . but these implementations projects do take some time.  They’re complex.”

Once implemented, Panorama will record information on vaccinations, keeping it in one database.

According to Canada Health Infoway, British Columbia, Ontario and Quebec are set to begin implementation of Panorama this year. Northwest Territories is starting its implementation planning. Prince Edward Island and Nunavut are on-board with the project but have no implementation plans yet.

The remaining jurisdictions – Manitoba, Saskatchewan, Yukon, New Brunswick, Nova Scotia and Newfoundland and Labrador – should implement Panorama sometime by 2016 if they’re following Canada Health Infoway’s plan but they don’t have firm target dates yet.

Panorama shouldn’t have become a jurisdictional issue, says Dr. Bennett. Canadians should realize the importance of working together on this national-minded project.

“There’s no question that the health of Canada is a shared responsibility of all levels of government,” she says, “and in the Naylor Report there was a real prescription of co-operation and collaboration of sharing data, and without this we won’t attain our goals.”