From the Fraser Institute

By Nadeem Esmail and Mackenzie Moir

Alberta’s health-care system may be set for another positive move away from the failed Canadian model. According to leaked draft legislation by the Smith government, Albertans may soon be able to access physician care in a parallel private sector, with physicians permitted to work in both the public and private systems.

The defenders of the status quo were of course quick to frame the approach as unique in Canada, arguing it would harm our universal system. While this potential change may put Alberta’s policies at odds with those of other provinces, it would more closely align with universal health-care systems everywhere else in the developed world. And most importantly, it will make for better access to health care for all Albertans.

First, it’s important recognize just how unusual Canada’s approach to privately-funded health care is compared to other high-income countries with universal health care.

In every one of the 30 other developed countries with universal health care, patients are free to seek services on their own terms with their own resources when the universal system is unwilling or unable to satisfy their needs. One reason may be to avoid long waiting lists, while others simply want to receive more personalized health-care services, meet a personal health need or access newer medical technologies and procedures.

In the majority of these countries, including those with high-performing systems such as Switzerland, the Netherlands, Germany and Australia, physicians are also permitted to work in both the public and private sectors.

Canada’s deviation, and Alberta’s, from this international norm has not served patients well. Despite having the highest health spending among the provinces in one of the most expensive universal health-care systems in the developed world, Albertans endure some of the worst access to health care and wait in some of the longest queues for treatment.

A central explanation for why Canadians spend more and get much much less is the lack of a private competitive alternative to the universal public system.

Again, a private option gives patients an option to select care the government is unwilling to provide, either in terms of timeliness or in ways that may be personally important to them. Faster access could allow some people to expedite a return to work and support their family, or to re-engage in important activities without needing to leave the province or the country as they currently must.

By moving people willing to pay for services out of the public queues, the government can help reduce the wait times for patients in the public queues. It’s not surprising that Canada has the longest waiting lists in the developed world given we’re the only country that prohibits privately-funded health care.

Arguments that the private sector will starve the public system of resources (including doctors and nurses) misunderstand what’s actually happening in Alberta today.

Currently, surgeons spend a good deal of time waiting for access to operating rooms or hospital beds for patients. Meanwhile, nurses are leaving the profession in large numbers. Canada also has unemployed medical specialists who could be employed if new opportunities arose. Allowing private access to care or previously unavailable medical resources would increase the total volume of services available to Albertans.

Even beyond this, the opportunity to earn more by working extra hours in a private clinic could encourage physicians to use some of their now non-working hours to treat patients privately. In this regard, the focus on allowing physicians to work in both public and private sectors is a well-informed policy choice that makes better use of Alberta’s existing medical workforce.

Finally, a private parallel option creates incentives for better service in the universal system through competition. Shackling patients to a government monopoly with no alternative choices results in a more expensive system and lower standard of care than would be available otherwise. When no one is permitted to deliver timelier patient-focused care, there’s no pressure created to do so anywhere else in the system. The outcome is obvious just from looking at how poorly the public system in Alberta performs despite its world-class price tag.

While this new leaked draft legislation may have the defenders of the status quo frantically racing to defend the current Canadian model, it promises a better health-care system for Albertans. This change will more closely align Alberta’s policies with those of every other universal health-care country in the developed world. More importantly, it will improve access to health care for all Albertans, and provide Albertans currently stuck with poor service an option to choose differently for themselves without a plane ticket.

Nadeem Esmail

Director, Health Policy, Fraser Institute

Mackenzie Moir

Senior Policy Analyst, Fraser Institute

 Nicolas Hulscher, MPH

Across countries on three continents, a 1% increase in vaccine types before age one corresponded to a 0.47% increase in autism prevalence.

A new cross-national study from Italy’s National Research Council, spanning multiple developed countries across three continents, has identified a remarkably strong association between early-life vaccine intensity and autism prevalence. The number of vaccine types and doses administered before 12 months showed exceptionally high correlations with national autism rates.

A 1% increase in vaccine types before age one corresponded to a 0.47% increase in autism prevalence.

The correlation is enormous — r = 0.87 for vaccine types and r = 0.79 for vaccine doses. In regression models, vaccine intensity alone explained 81% of the variance in autism prevalence across nations.

This is not an isolated signal. It directly corroborates earlier U.S. state-level data from DeLong (2011) — and aligns with the 107 positive-association studies catalogued in the McCullough Foundation’s Landmark Autism Report.

Key Findings

Coccia used cross-national 2021 autism incidence data paired with WHO-reported infant vaccine schedules. Countries were grouped into relatively comparable healthcare and surveillance systems (North America, Europe, and advanced Asian nations) to reduce detection and reporting bias. The primary exposures were:

• number of vaccine types given ≤12 months, and
• total number of doses delivered ≤12 months.

Autism prevalence per 100,000 children served as the outcome, and general vaccination coverage rates were statistically controlled so only vaccine intensity and timing were isolated.

The results were striking but unfortunately expected:

• Countries such as the U.S., Canada, Australia, Japan, South Korea, and Singapore give ~15 vaccine types and 20 doses before age one — and have the highest autism prevalence (~1,273 per 100k).
• Countries like Norway, Finland, Denmark, Italy, and the UK give ~8 vaccine types and 9 doses — and have significantly lower autism rates (~834 per 100k).
• A 1% increase in vaccine types before age one corresponded to a 0.47% increase in autism prevalence.
• The regression model (log–log) explained 81% of the variance.

Coccia then used quadrant mapping to classify nations:

• Critical Risk Zone: high vaccine intensity + high autism (U.S., Canada, Australia, Japan, South Korea, Singapore)
• Protection Zone: low vaccine intensity + low autism (Nordic countries)
• Transitional Zone: countries on track to move upward as vaccine intensity rises (Italy, UK)

The conclusion is clear: Early-timed and compound vaccination strongly tracks with rising autism rates.

How DeLong (2011) Fits In

DeLong’s analysis of CDC data found that each 1% rise in U.S. childhood vaccination coverage was associated with ~680 additional cases of autism and speech/language impairment nationwide.

Where DeLong examined state-level associations between how many children were fully vaccinated and subsequent autism/SLI prevalence, Coccia provides the first true cross-national dose–response analysis — showing that the number of vaccine types and doses given before age one powerfully predicts national autism prevalence.

Both studies point in the same direction:
more vaccination in early life → higher autism prevalence.

How This Strengthens the McCullough Foundation’s Landmark Autism Report

Our Autism Report reviewed 136 vaccine-related studies:

• 107 studies inferred positive associations between vaccination or vaccine components and ASD/NDDs.
• All 12 vaccinated vs unvaccinated studies found better neurodevelopmental outcomes in completely unvaccinated children, including far lower rates of autism.
• Found strong, consistent increases in cumulative vaccine exposure during early childhood and the reported prevalence of autism across successive birth cohorts.

We concluded:

Combination and early-timed routine childhood vaccination constitutes the most significant modifiable risk factor for ASD, supported by convergent mechanistic, clinical, and epidemiologic findings, and characterized by intensified use, the clustering of multiple doses during critical neurodevelopmental windows, and the lack of research on the cumulative safety of the full pediatric schedule.

Coccia independently arrived at a highly similar conclusion:

This study offers a critical contribution to the ongoing discourse on vaccine safety and neurodevelopment by identifying a statistically significant association between early-life vaccine intensity and national autism rates.

All evidence points to the same conclusion:

Early, clustered vaccination is the strongest modifiable driver of rising autism rates.

Nicolas Hulscher, MPH

Epidemiologist and Foundation Administrator, McCullough Foundation

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