Evaluation of the Vaccination Program
Final Report – Executive Summary and Management Response and Action Plan
March 2025
Prepared by the Office of Audit and Evaluation
Health Canada and the Public Health Agency of Canada
Note: The complete evaluation report is available upon request. Please send an email to oae-bae@phac-aspc.gc.ca.
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Executive summary
Context and evaluation scope
The goal of Public Health Agency of Canada’s (PHAC) Vaccination Program is that people living in Canada have timely and equitable access to safe and effective vaccines. It also works to reduce the rates of vaccine preventable diseases (VPDs) by increasing vaccination coverage.
PHAC’s vaccination activities are carried out by the Infectious Diseases and Vaccination Programs Branch (IDVPB). The evaluation assessed a portion of overall program activities from April 2018 to June 2024, namely the guidance, education, procurement, and grants and contribution activities of the Centre for Immunization Programs (CIP), the Centre for Immunization Surveillance (CIS)’s Transfer Payment Program, the Centre for Vaccine and Therapeutics Readiness (CVTR), and the Communications and Public Affairs Branch (CPAB).
The evaluation assessed the extent to which the evaluated subset of the Program was structured to enable evidence-based decision making. It also assessed the clarity of roles and responsibilities in communicating vaccination information to people living in Canada, and the extent to which the evaluated Program subset has achieved its intended outcomes. Several lines of evidence were reviewed as part of the evaluation, including documents, performance and financial data, a Vaccine Injury Support Program (VISP) case study, and interview data.
Of note, this evaluation period spans the unprecedented COVID-19 pandemic, which was declared on March 11, 2020, by the World Health Organization (WHO) and no longer considered a public health emergency of international concern by the WHO as of May 5, 2023. PHAC received significant financial and human resources to carry out its leading role in Canada’s COVID-19 pandemic response which will sunset as of March 2025. In addition, the functions of these centres have operated within various organizational structures throughout the evaluation period, including expansion of federal roles and activities during the COVID-19 pandemic, and they continue to evolve. For example, CIP and CIS merged and became the Centre for Immunization Surveillance and Programs (CISP) on August 5, 2024, after the scope of this evaluation was finalized.
Findings
Reviewed evidence shows that PHAC has made significant progress towards achieving its expected outcomes. The evaluated vaccination activities are organized to support the generation of evidence-based outputs, which are, in turn, used to inform PHAC’s program activities. These outputs are also used to develop information and tools that are shared with partners and stakeholders including provinces and territories (PTs) and health care practitioners to support them in the delivery of their own vaccination activities.
PHAC also has a mandated role to communicate vaccination information to people living in Canada. Available data shows that PHAC’s communication and public education campaigns are reaching their targeted audiences. Overall, PHAC’s activities that were evaluated under the umbrella of the Vaccination Program provided evidence-based information to partners, stakeholders and people living in Canada to make informed choices about vaccinations. Some of these activities include the Immunization Partnership Fund (IPF) and its Community of Practice meetings, the work of the Vaccination Behaviour and Confidence Team, who shares best practices and knowledge products, as well as innovative practices for enhancing vaccine acceptance and uptake, and addressing misinformation and disinformation (MIDI), and PHAC’s plain language summaries of National Advisory Committee on Immunization (NACI) vaccine guidance, among others.
While delivering vaccinations to people living in Canada is a PT responsibility, PHAC supported timely and equitable access to vaccines and vaccination information through various initiatives such as the Bulk Procurement Program, IPF funded projects, NACI guidance, FPT committees, and funded research. Despite PHAC’s dedicated efforts, vaccination coverage is below target and PHAC, like other public health authorities around the world, is facing the significant challenges of rising vaccine skepticism and widespread vaccine MIDI. This highlights a need to continue prioritizing work in this area, especially in the context of a growing and increasingly complex vaccine pipeline, noting that many drivers of these challenges are outside PHAC’s sphere of control and require coordination and collaboration with other entities and jurisdictions.
Moving forward, PHAC will need to continue focusing its efforts on addressing evolutions in the vaccination landscape. In addition to the challenges brought by MIDI and the decreases in vaccine uptake, PHAC will need to adapt its tools and guidance to manage the significant increase in new vaccines anticipated to enter the Canadian market in the coming years. The additional financial and human resources received by PHAC to respond to the COVID-19 pandemic are sunsetting in March 2025. These resources enabled the Program to increase the scope of its activities. In a context of more limited resources and a recurring demand, PHAC will need to prioritize its activities going forward.
Recommendations
Four recommendations emerged from the evidence reviewed for this evaluation.
Recommendation 1: The Centre for Immunization Surveillance and Programs (CISP) should explore opportunities to share IPF best practices and lessons learned.
Evidence demonstrated that IPF-funded projects enhanced vaccine confidence and uptake, especially among populations facing barriers to equitable access to vaccines and vaccination information and who experience increased vulnerability to serious illnesses from vaccine preventable diseases. These projects provided a valuable source of information to support program development. While IPF project information is available on PHAC’s website and the Program runs a community of practice that brings together IPF recipients, little information on project results has been shared outside of this community. Internal and external interviewees expressed an interest in learning more about IPF best practices and lessons learned as this could help inform their own programs.
Recommendation 2: PHAC should explore opportunities to clarify roles and responsibilities with PTs in communicating with the public.
Communication roles expanded during the pandemic. PHAC took on additional communication activities, including in areas that it did not cover before the pandemic. Since communicating vaccination information to people in Canada is a shared responsibility with PTs, with the end of the pandemic comes the need to coordinate with PTs and to clearly articulate the division of roles and responsibilities in this space. This will help all parties clearly understand roles and responsibilities and to prioritize its communication activities moving forward.
Recommendation 3: IDVPB should revisit the Vaccination Program’s priorities in a post-pandemic climate.
The significant influx of funding received during the pandemic allowed PHAC to take on more activities and responsibilities in the vaccination area. With the end of this funding, the Program will have to reprioritize activities within its available resources to meet its mandate, while also addressing the increased expectations from pandemic activities, and tackling ongoing vaccination challenges.
Recommendation 4: IDVPB should update its Performance Information Profile for the Vaccination Program.
The Program’s current performance measurement framework is outdated and does not fully reflect its structure and activities. Updating the PIP would help the Program focus its expected outcomes to track its performance in line with its key areas of activities and responsibilities.
Management Response and Action Plan
Recommendation 1
The Centre for Immunization Surveillance and Programs (CISP) should explore opportunities to share Immunization Partnership Fund (IPF) best practices and lessons learned.
Context
IPF project information is available on PHAC’s website; however, little information on project results is shared. Internal and external interviewees expressed an interest in learning more about IPF best practices and lessons learned.
| Action Plan | Deliverables | Expected Completion Date | Accountability | Resources |
|---|---|---|---|---|
| 1.1 Immunization Partnership Fund (IPF) stakeholder engagement | 1.1.1 Host IPF Recipient Community of Practice (CoP) Session | March 31, 2026 | Director General, CISP | Existing budget and full-time equivalents (FTEs) |
| 1.2 Knowledge Translation and Dissemination | 1.2.1 Dissemination of results and findings to internal and external stakeholders | March 31, 2026 | Director General, CISP | Existing budget and FTEs |
Recommendation 2
PHAC should explore opportunities with PTs to clarify roles and responsibilities in communicating with the public.
Context
Communication roles expanded during the pandemic. With the end of the pandemic comes the need to clearly articulate PHAC’s roles and responsibilities, as well as those of the provinces and territories (PT).
| Action Plan | Deliverables | Expected Completion Date | Accountability | Resources |
|---|---|---|---|---|
| 2.1 The Communications and Public Affairs Branch (CPAB) is to work with IDVPB to clarify how best to communicate about PHAC’s role and responsibilities, along with those of provinces and territories in regard to vaccination for stakeholder, media, and public communications products. | 2.1.1 IDVPB and CPAB will collaborate to develop key messages on federal and provincial/territorial roles and responsibilities concerning vaccination that will be used to support coordination and complementary communications on a range of communications products (e.g. correspondence, website content, social media). | December 2026 | Director General, CISP Executive Director, CPAB |
Existing budget and FTEs |
Recommendation 3
IDVPB should revisit the Vaccination Program’s priorities in a post-pandemic climate.
Context
The significant influx of funding received during the pandemic is ending and the Program will have to prioritize activities and resources needed to deliver on mandates, meet enhanced expectations as a result of pandemic activities, and continue to address the evolving challenges related to the vaccination space.
| Action Plan | Deliverables | Expected Completion Date | Accountability | Resources |
|---|---|---|---|---|
| 3.1 Once funding decisions through PHAC Renewal are made, IDVPB will bring internal senior leaders together to identify Branch priorities and identify program activities that can be resized, divested, or transferred. | 3.1.1 Revise program operational plan to align with refreshed branch priorities and available resources | March 2026 | Director General, CISP | Existing budget and FTEs |
Recommendation 4
IDVPB should update its Performance Information Profile for the Vaccination Program.
Context
The current performance measurement framework does not fully reflect the current program structure and activities.
| Action Plan | Deliverables | Expected Completion Date | Accountability | Resources |
|---|---|---|---|---|
| 4.1. IDVPB will strengthen the performance measurement framework for its Vaccination Program to align with its current structure and activities. | 4.1.1 Develop a new Performance Information Profile for the Vaccination Program. | December 2026 | Director General, CISP | Existing budget and FTEs |
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