Peer-reviewed article
Improved vaccine coverage for First Nations children receiving first dose on-reserve: a retrospective cohort study in western Canada.
MacDonald SE, Graham B, King KD, Huang L, Svenson LW et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This study examined childhood vaccine coverage among First Nations children in Alberta, Canada between 2013 and 2019. Researchers linked administrative data from on-reserve and off-reserve vaccination records to measure immunisation rates. Children who received their first vaccine dose at the on-reserve community health centre had significantly higher vaccine coverage rates compared to those who started their vaccine series elsewhere. The findings suggest that community-based vaccine delivery improves immunisation uptake in First Nations populations.
Key points
- Children receiving first vaccine at on-reserve health centre had higher coverage: pneumococcal vaccine coverage at age 2 was 55.7% vs 33.3% for those vaccinated elsewhere
- Coverage advantage at age 7 years persisted: pneumococcal coverage was 75.6% for on-reserve first dose vs 55.5% for off-reserve
- Data-sharing agreements between First Nations and provincial health systems enabled linking vaccine records across providers
- Fragmentation in immunisation reporting systems previously prevented accurate measurement of vaccine coverage in First Nations communities
- Results support transfer of health funding and service delivery to First Nations to improve childhood immunisation
Limitations
The study is observational and cannot establish causation; other factors beyond location of first dose (such as parental health literacy, socioeconomic factors, or community engagement) may explain differences in vaccination completion between groups.
Abstract
Introduction Fragmentation in immunisation reporting systems pose challenges in measuring vaccine coverage for First Nations children in Canada. Some Nations have entered into data-sharing agreements with the province of Alberta's health ministry, enabling novel opportunities to calculate coverage. Methods Partnering with a First Nations community in Alberta, this retrospective cohort study calculated routine childhood vaccine coverage. Administrative data for vaccines delivered within and outside the community were linked to calculate partial and complete immunisation coverage in 2013-2019 at ages 2 and 7 years for children living in the community. We also compared vaccine coverage each year for (a) children who were and were not continuous community residents and (b) children who received or not their first vaccine at the on-reserve community health centre. We also calculated the mean complete coverage across all study years with 95% CIs. Results For most vaccines, coverage was higher (p<0.05) at ages 2 and 7 years for children that received their first vaccine at the First Nations health centre, compared with those who received their first dose elsewhere. For example, for pneumococcal vaccine, the mean level of complete coverage in 2-year-olds was 55.7% (52.5%-58.8%) for those who received their first vaccine in the community, compared with 33.3% (29.4%-37.3%) for those who did not; it was also higher at 7 years (75.6%, 72.7%-78.5%, compared with 55.5%, 49.7%-61.3%). Conclusion Initiating the vaccine series at the on-reserve community health centre had a positive impact on coverage. The ability to measure accurate coverage through data-sharing agreements and vaccine record linkage will support First Nations communities in identifying individual and community immunity. The findings also support the transfer of health funding and service delivery to First Nations to improve childhood immunisation uptake.