In January 2006, Canadian Family Physician published a guide for family doctors that detailed male and female preventive health care checklists.1 These recently updated checklists2 are comprehensive and include notations to help busy practitioners remember to ask about various issues, ranging from flossing to noise control programs and from seat-belt use to nonflammable sleepwear. All well and good.
However, given the vast number of issues, maneuvers, and demands on the list, it is possible (and perhaps even likely) that the issues at the bottom of the list might not get much attention. After discussing smoking and drinking and diet and gum disease, as well as doing a full physical assessment and deciding on laboratory tests, bone density testing, sigmoidoscopy, and so on, what is the very last thing on the list? Immunizations. While we can appreciate the importance of the many health care maneuvers in family practice, in the past 100 years (with the exception of clean, safe drinking water) no treatment has rivaled immunization in reducing morbidity and mortality rates worldwide.
Yet immunization comes last. And that is just how Canadians are being treated—or in this case, undertreated. For whatever the immunization—whether given by public health staff or family physicians, whether a simple tetanus shot or a more complex varicella zoster or human papillomavirus vaccine—Canadian adults are underimmunized. The data on immunization are sobering: the Canadian Adult National Immunization Coverage Survey in 20063 found that less than 47% of adults were properly immunized for tetanus, a vaccine covered in every province and territory. Worse still is the track record for pneumococcal vaccine, recommended for those older than 65 years of age and those with chronic underlying conditions. Physician use of this vaccine has an abysmal record, with fewer than 39% of those older than 65 and about 17% of those with chronic diseases other than asthma receiving it.
What can we conclude from this? Adult Canadians are not being immunized routinely for vaccine-preventable diseases. In a recent Canadian publication by Parkins et al, we are reminded that despite providing excellent vaccination for the pediatric population, we neglect adult immunization—and as a result a high burden of vaccine-preventable disease and death is now seen within the adult population.4 In some ways, we are victims of our previous successes. As noted in a white paper spearheaded by BIOTECanada, which provides a composite overview of the Canadian vaccine landscape, vaccines continue to be (mistakenly) undervalued and underused throughout the world.5 In industrialized countries, the underuse of vaccines is caused in part by underestimating the seriousness of vaccine-preventable diseases, underestimating the benefits of vaccination, and concerns about the side effects of vaccines. Those who witnessed the dreadful disabilities and deaths caused by smallpox and polio often viewed vaccines against these diseases as nothing short of miracles. However, much of today’s population has never experienced the devastation caused by these and other vaccine-preventable diseases—thanks to immunization programs. In addition, when there is no longer an imminent fear of contracting a disease, the public tends to forget about the limitations of cures and can become apathetic toward available prevention strategies, including vaccination.5