National vaccine registry needed amid measles resurgence, Canada's outgoing top doctor says
As Dr. Theresa Tam retires as Canada's top doctor, she's calling for a national vaccine registry.
Tam says the COVID-19 pandemic, which began in early 2020 and killed at least 60,000 Canadians, showed how badly one is needed to track vaccines and protect vulnerable communities.
A national vaccine registry, she says, could help prevent and manage crises like the resurgence of measles that the country now faces.
Tam says she's in favour of a "nationally interoperable network of vaccine registries" that connects all of the provincial and territorial health systems and helps identify pockets of the population where there is poor vaccine coverage.
While the majority of measles cases so far have occurred in communities that are historically under-vaccinated, she told Dr. Brian Goldman, host of CBC's White Coat, Black Art, "we don't actually know exactly where the situation with vaccine coverage lies."
Tam spoke to Goldman from Ottawa for a feature interview reflecting back on her career as the country's chief public health officer.
The pandemic proved that the technology for a registry is there, she says, given that almost all provinces and territories made COVID-19 vaccine records available electronically during that time.
Although it was the pandemic that made her both a household name — and a target for hate — Tam came to the role of top doctor three years earlier, in June 2017, after occupying a series of other leadership positions within the Public Health Agency of Canada (PHAC), including deputy chief. She has also served as an expert on a number of World Health Organization committees.
WATCH | Dr. Theresa Tam on facing personal attacks during the pandemic:
Leading Canada's public health response to COVID-19 was as much a personal challenge as it was a professional one, given Tam was also on the receiving end of racist and sexist vitriol during that time.
"What I try to do, certainly at the time and even now, is just to focus on the job that I'm trying to deliver," she said.
Those attacks were even harder on her staff — those monitoring the channels where the messages would come in, and who tried, as much as possible, to shield her from the worst of it, Tam says.
"And one member of my staff used to also read me the incredibly lovely cards and messages that the public sent to encourage me to carry on. It was like the antidote to the other messages as well. So that really helped."
One of Tam's provincial counterparts, Dr. Robert Strang, chief medical officer of health in Nova Scotia, says he has "huge respect for Dr. Tam."
"Certainly working with her during COVID, we were all kind of in this kind of team together. Having her leading us as chief medical officers was a real pleasure and a privilege."
Getting cross-Canada support for registry
The challenge with getting a network of vaccine registries operating to help with measles and other infectious disease crises in future, Tam says, lies in getting all of the jurisdictions to sign on and co-operate to make their systems speak to one another.
"There's in fact quite a lot of work on the way right now to develop those agreements with the provinces, as well as the more technical aspects of this," she said.
A national registry, she says, will make things "so much easier" for public health departments, doctors, patients and parents.
"That's the most important thing, that you will know whether your kids got the vaccine and that your health provider can have that information as well."
Strang says there's agreement on the principle, but "the devil is always in the details."
There are a number of groups, including PHAC, working to get the federation to do a better job of sharing health data, he says.
"There's certainly support and agreement amongst the chief medical officers and public health leaders of this being a priority," Strang said.
But Dr. Iris Gorfinkel, a Toronto family physician and researcher, says she suspects political considerations are behind some of the provinces "literally hoarding their medical data."
"When politics stands in the way of science moving forward or health being prioritized, it becomes a serious, potentially life-threatening problem," said Gorfinkel, who is also the founder of PrimeHealth Clinical Research.
Some provincial governments may be afraid voters will dislike sharing their health data, she says.
But that shouldn't be a factor, given how easy it is to remove identifying details from the information so no one apart from an individual and their health-care provider knows their vaccine status, Gorfinkel says.
We're already paying a heavy price — in lives and dollars — for not having a national registry, she says.
"First, there's a tremendous waste of vaccines," Gorfinkel said. We saw that during COVID-19, she says, when Canada over-bought vaccines and struggled to administer them before they expired, eventually drawing international criticism for doing so while other parts of the world went without.
In the case of the measles outbreaks, she says, "if we don't know where those are happening and we can't ship vaccines to where they're most needed, then what that means is we're not going to make the best use of the vaccines we have."
And, of course, people and health systems pay when hospitals fill with people who have become ill from vaccine-preventable illnesses, Gorfinkel says.
Looking abroad
Other countries have made this work, among them Sweden, France, Finland, Germany, the Netherlands and Spain.
In Norway, for example, a national registry that began in 1995 and at first tracked only routine childhood vaccinations, was expanded in 2011 to require mandatory reporting for all vaccines and age groups.
Gorfinkel says some of these countries better embrace the sentiment that "what happens to my neighbour does affect me."
Public health expert Amir Attaran, a vocal critic of Tam and PHAC during the pandemic, says far more could have been done at the federal level to get a national registry in place in this country, too.
WATCH | Tam on why Canada needs better real-time health data:
A professor in the faculties of law and school of epidemiology and public health at the University of Ottawa, Attaran says infectious disease experts like Tam have known since the SARS outbreak in 2003 that the country was woefully unprepared to properly track and respond to an outbreak due to poor data sharing.
"And because of the experience of SARS in Canada, we should have been very switched on about this," said Attaran, who holds both a law degree and a PhD in biology.
He says Canada's Statistics Act empowers the federal government to "require the provinces to cough up statistics," and that's exactly what public health data is.
Canada's public health culture is self-defeating, Attaran says, because it recognizes the necessity of accurate and timely data but proceeds "under this false assumption that you can't get those data unless everybody agrees and everybody's happy with it. And then you fail to put in the political energy to bring about that consensus by agreement or coercion."
Masking controversy
While the pandemic highlighted the need for a national vaccine registry to manage outbreaks better, it also exposed challenges in public health communication.
One of the most debated issues was masking.
Attaran was among those who said Tam bungled the advice around masking in the earlier stages of the pandemic, for example.
"Early in the pandemic, she told people, 'No, you don't need to mask,'" he said. Yet by then the virus had been identified as SARS-CoV-2, and we'd already learned from the 2003 SARS crisis that it required masking, he says.
But in Nova Scotia, Strang says, the information scientists were working with early on suggested the virus behaved like an influenza, which spread through droplets, not aerosols. "We don't recommend widespread masking, necessarily, for everybody for influenza."
Tam says public health leaders "need to do a better job in explaining to people how the scientific information are coming through, how we analyze it and how we turn them into guidance."
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