Iris Gorfinkel is a family physician and founder of PrimeHealth Clinical Research in Toronto.
It’s a dubious distinction, but Ontario now has the most measles cases in North America. Having surpassed 1,200 confirmed cases, it is by far the worst measles outbreak Canada has seen in decades. Provincial and territorial vaccine registries might have prevented untold cases. They’re a critical but missing warning system that could have given clinicians advanced notice of who needs to get immunized once vaccine-preventable diseases begin to spread.
Most patients I see don’t know which vaccines they’ve had. An occasional one manages to save their aging yellow card, but most don’t have one. Chasing down vaccine records involves patients signing an authorization form to release the information from the place where their immunizations had been provided. A second appointment is then booked to review this. It often fails because records aren’t kept forever, doctors retire and clinics frequently close.
Patients are understandably upset when they learn that I’m unable to directly access the records showing which vaccines they’ve had. It’s a frustration I share at having wasted both their time and mine. Not knowing also means postponing vaccine administration and increasing the cost to health plans. Everyone loses.
The provinces and territories rely on outdated record keeping that’s siloed in clinics, pharmacies, hospitals and local public health units. These systems weren’t designed to share health information but to protect it, including from clinicians working outside those systems. Vaccine information is too often hidden from clinicians at a time it’s most needed, when a patient is being assessed in a clinic, urgent care setting or an emergency room.
The consequences of not having an accessible provincial vaccine registry extend beyond inconvenience. An appointment slot used to track down a patient’s vaccines is one less appointment that’s available to assess acute problems. It partly explains why only one in four Canadians can get a same-day or next-day appointment. Longer wait times for appointments puts more pressure on over-extended emergency rooms.
A 2022 report from the Ontario auditor-general lamented that “Ontario lacks a central registry to track the complete vaccination history for all Ontarians, limiting the ability to adapt to new outbreaks and emerging diseases.”
Canada is also seeing a resurgence of familiar vaccine-preventable diseases. There have been over 130,000 confirmed cases of influenza since August. Canadians also endured over 19,000 confirmed cases of whooping cough in 2024. These figures are gross underestimates because most cases never get tested.
As a family doctor, I witness the devastation of these illnesses with a mix of concern and dread. Because most of these illnesses are caused by viruses, antibiotics don’t work. We have treatments, but these are diseases without cures. How much more preventable misery must there be before the provinces and territories respond by creating vaccine registries?
The solution is quite literally one beep away. Barcodes have been used by retailers for over half a century. Barcodes have also been on Canada’s vaccine labels for 10 years, yet ministries of health have neglected to use them to their full extent. Clinicians have to manually enter individual vaccine lot numbers and expiry dates. It’s a time-wasting and mind-numbing task that’s error-prone. It also adds to our administrative load.
The solution is simple.
Scanning a barcode could simultaneously complete three records – the patient’s personal record, their local public health unit’s records, and the provincial vaccine registry. A given clinic’s vaccine needs could be matched in real-time to what’s been administered, thereby reducing vaccine wastage. It’s basic supply chain management.
This is especially critical when vaccine supplies are low, as they were early in the COVID-19 pandemic. Knowing who was vaccinated, where and when was invaluable to helping flatten the curve.
A future pandemic isn’t a question of “if” – only of “when.” A national vaccine registry would allow for comparisons of vaccination rates and test positivity within specific zones. Such comparisons could help reveal how effective new vaccines are in Canada’s distinct populations. A centralized registry would also simplify the detection of rare vaccine side effects. Canada would become less reliant on research from other countries to guide health policies. This is of key importance now that the U.S. can no longer be relied on for its health research, given its recent drastic funding cuts.
Using bar codes would save time, improve users’ experiences, simplify documentation, reduce transcription errors, and create robust and comprehensive provincial and territorial vaccine registries. If the provinces and territories were to adopt this strategy, their shared data could be anonymized to form a national vaccine registry, a long-sought-after goal of public health.