COVID-19: How provinces and territories make decisions about how, who and when to vaccinate

Provinces and territories decide how, who and when to vaccinate populations living in their region. They consider advice from a number of expert sources as well as their unique situations to vaccinate the people in their region.

On this page

• Provincial and territorial vaccination programs
• Health Canada
• Public Health Agency of Canada
• National Advisory Committee on Immunization
• Council of Chief Medical Officers of Health

Provincial and territorial vaccination programs

Provinces and territories are responsible for vaccination programs for all individuals living in Canada. They also allocate and distribute vaccines to on-reserve communities, which put in place local vaccination programs.

Decisions by provinces and territories on vaccination are aimed at achieving the maximum protection for populations living in their region.

When making these decisions, provinces and territories consider their unique situations, which include:

• at-risk populations
• vaccine supply
• transmission rates in communities
• access in different communities and regions
• the ability to prepare their health systems and health professionals for vaccination as it relates to:
  • storing
  • delivering
  • allocating
  • distributing
  • administering
  • monitoring and reporting

They also consider all the latest vaccine and COVID-19 evidence. Evidence can come from different trustworthy sources. Provinces and territories make decisions based on the evidence and data available, adapting as the situation and evidence evolves.

The following organizations and groups help inform provincial and territorial vaccination programs.

Health Canada

Health Canada is the federal regulator of health products, including vaccines. This means they approve products so they can be used in Canada. They review the scientific evidence for COVID-19 vaccines from clinical trials, as well as other information, before approving them for use in Canada.

These clinical trials test the effectiveness and safety of:

• number of doses
• time between doses
• giving the vaccine to different age groups

Health Canada will only approve a vaccine if the evidence clearly demonstrates that the:

• vaccine meets their high standards for safety, effectiveness and quality
• benefits outweigh the risks

After approval

After a vaccine is approved by Health Canada for use in Canada, other expert groups make recommendations for its optimal use. Recommendations for use are updated and may change as needed if new research and evidence emerges.

Working with the Public Health Agency of Canada, Health Canada continues to monitor each vaccine product for safety, effectiveness and quality. This is because there's always new information that only becomes available after a larger number of people start using a vaccine.

When monitoring, Health Canada looks for any signs that there may be a problem based on:

• safety reports received from manufacturers
• reports of serious side effects and reactions received from health professionals and consumers
• reports from other international organizations
• research studies

Depending on how serious the safety issue is, they may:

• review the product's benefits and risks
• ask the manufacturer to conduct further studies or change the labelling, such as:
  • directions for use
  • warnings about side effects when used alone or when used with other products
• send out an advisory or warning for health care professionals, hospitals and consumers
• continue to monitor the product
• remove the product from the marketplace

Some reports of possible side effects may not be linked to a vaccine, but they need to be reviewed to determine this. Based on these reports, a province or territory may decide to pause distribution of, or access to, a certain vaccine while it's under investigation.

Learn more about:

• Clinical trials for COVID-19
• COVID-19: How vaccines are approved
• Vaccines: Role of government, health authorities and health care providers
• Approved and types of COVID-19 vaccines
• Vaccines and treatments for COVID-19: Safety after approval
• COVID-19: Vaccine safety and side effects
• COVID-19 vaccine safety: Weekly report on reactions following vaccination
• Vaccine regulatory details

Public Health Agency of Canada

The Public Health Agency of Canada (PHAC) is the federal agency responsible for public health.

PHAC coordinates the distribution of COVID-19 vaccines. Provinces and territories determine the number of vaccines needed to cover eligible populations. They may request additional shipments where necessary.

Provincial and territorial governments plan and adapt their rollout plans based on:

• supply
• timing
• distribution requirements of vaccines and related products, such as:
  • needles
  • syringes
  • alcohol pads
• how vaccine coverage is progressing in their populations

Working with Health Canada

Health Canada and PHAC work together to monitor for possible side effects and serious reactions from COVID-19 vaccination. Health professionals and local public health units report to PHAC when patients inform them of a serious reaction.

Some of these reports may not be linked to a vaccine, but they need to be reviewed to determine this. Based on these reports, a province or territory may decide to pause distribution of, or access to, a certain vaccine while it's under investigation.

Learn more about:

• NACI statements and recommendations
• COVID-19 vaccine distribution
• Procuring vaccines for COVID-19
• Vaccines and treatments for COVID-19: Safety after approval
• Population vaccinated against COVID-19
• COVID-19: Vaccine safety and side effects
• COVID-19 vaccine safety: Weekly report on reactions following vaccination
• COVID-19: Support to provinces and territories
• COVID-19 immunization: Federal, provincial and territorial statement of common principles

National Advisory Committee on Immunization

The National Advisory Committee on Immunization (NACI) is an independent, volunteer committee of Canadian health experts. The committee provides advice to PHAC on the optimal use of approved vaccines in Canada.

NACI reviews evidence as it evolves, which is why recommendations may change. It's not uncommon for NACI to make recommendations that are broader or narrower than the conditions of use approved by Health Canada.

When developing recommendations, NACI considers:

• how best to use an approved vaccine to achieve the greatest public health and population benefits
• transmission rates of the disease in Canada and the risks for different populations, including those who are more at-risk for severe disease
• clinical trial and real-world evidence on the safety and effectiveness of vaccines
• availability of other vaccines in Canada
• how vaccination program recommendations will impact equal access to vaccines for all populations
• the possibility or ease of making changes to vaccine programs based on recommendations
• public trust in the vaccine and willingness to get vaccinated

NACI's guidance helps provinces and territories plan their vaccination programs. Provinces and territories consider NACI's advice and their regions' unique circumstances when making their program decisions.

Working with PHAC

One of PHAC's responsibilities is to give NACI necessary data and support to inform and publish their guidance, such as:

• reports on serious side effects and reactions
• scientific evidence on vaccine effectiveness and safety
• modelling of transmission trends and potential outcomes
• monitoring data for COVID cases, hospitalizations and deaths
• web publishing resources to post their recommendations online

PHAC also helps to distribute and communicate NACI recommendations to provinces, territories and health professionals.

Council of Chief Medical Officers of Health

The Council of Chief Medical Officers of Health (CCMOH) is made up of chief medical officers of health from federal, provincial and territorial governments. The council collaborates on technical and scientific matters of mutual interest.

The council:

• shares knowledge, experience and best practices on public health in Canada
• reviews evidence on all aspects of the COVID-19 pandemic (including information from Health Canada and NACI, elsewhere in Canada and internationally)
• provides public health advice, guidance and recommendations to inform a unified national approach and provincial and territorial decision making

This is currently done as part of the Special Advisory Committee on COVID-19. This committee is the main federal, provincial and territorial process for emergency support related to the public health response to COVID-19.

Evidence considered by the council includes the evolving situations of all Canadian regions to inform advice on vaccination, including:

• transmission rates
• community spread
• at-risk populations
• variants of concern
• capacity of hospitals and ICUs
• number of cases per population
• deaths and hospitalizations due to the disease
• Canadian and international studies of vaccine safety and effectiveness

The CCMOH can issue statements to communicate a national public health approach for the use of COVID-19 vaccines. This approach informs provincial and territorial vaccination programs based on their unique circumstances.

Learn more about:

• Special Advisory Committee on COVID-19
• Pan-Canadian Public Health Network