VICTORIA -- Physicians who fail to counsel parents to have their children vaccinated are leaving themselves open to legal action, the group that insures most Canadian doctors is warning.

In its December newsletter, the Canadian Medical Protective Association tells physicians the standard of care in Canada is to vaccinate against a dozen childhood illnesses.

That means doctors have an obligation to talk to parents about the benefits and risks of these vaccines, including three costly new vaccines that are not offered free of charge in most of the country.

"This is creating a real ethical dilemma for pediatricians who want to do what's best for the kids, but know that many parents cannot afford the vaccines," said Marie-Adèle Davis, executive director of the Canadian Pediatric Society.

She said the fact that some provinces offer vaccines against chickenpox, meningococcal disease and pneumococcal disease, while others do not undermines the principles of medicare, and discriminates against poorer children.

The CPS wants governments to make all childhood immunizations free of charge from coast to coast.

"There should be no economic barriers to health care for children," Ms. Davis said.

The growing inequities in the availability of vaccines in Canada is dominating discussion at the Canadian National Immunization Conference in Victoria, and fuelling calls for a national strategy.

Across the country, children are vaccinated against nine common infectious agents: diphtheria, tetanus, pertussis, measles, mumps, rubella, polio, Haemophilus influenza b (Hib), and hepatitis B.

All those vaccines are free of charge, and with almost universal coverage, these once-deadly diseases have virtually disappeared from Canada. While it is not yet on the schedules, most provinces will also cover the cost of vaccinating children against influenza.

However, most provinces and territories have been slow to embrace new vaccines.

These include a vaccine for varicella (commonly known as chickenpox), one that protects against seven strains of pneumococcal bacteria (which are the leading cause of earaches, meningitis and childhood pneumonia) and another that protects against meningococcal group C bacteria (which can cause deadly meningitis). There is also a growing debate about adding a booster shot against pertussis (whooping cough) in adolescence.

Monika Naus, associate director of epidemiology at the B.C. Centre for Disease Control in Vancouver, presented a series of maps that highlighted the inequities between provinces and territories. According to her findings:

The chickenpox vaccine, called Varivax, is offered free of charge to children in Prince Edward Island, Alberta, Nunavut and the Northwest Territories. In other provinces and territories, it can be purchased, but parents must pay $75 or more.

The meningococcal vaccine, called Menjugate, is part of the basic immunization schedule in Quebec and Alberta. In other provinces, parents can purchase it, but the cost can be as high as $200.

The pneumococcal vaccine, called Prevnar, is free of charge for children in Alberta and Nunavut. Elsewhere in the country, it can cost up to $150.

The adolescent pertussis vaccine, called Adacel, is paid for by governments in Newfoundland, Nunavut and the Northwest Territories. Other provinces are hesitating, even though it costs only about $10.