National Advisory Committee on Immunization (NACI): Workplan
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Preamble
The following list represents policy questions for the National Advisory Committee on Immunization for 2022-2024. When combined with the added work of COVID-19 related topics, it is acknowledged that not all of these topics will be addressed over these two years, so some will be carried forward to subsequent years. This list however represents priority selections to be undertaken by NACI as capacity is freed up from COVID-19 vaccine issues over time.
The priority selections below have been informed by consultations with NACI and Provincial and Territorial stakeholders. As new products and indications are authorized in Canada or new information becomes available, workplan items may be added for consideration and priorities may change. This is particularly true in the pandemic environment, where workplanning outside of COVID-19 vaccines continues to be unpredictable.
The following triggers may drive items for the NACI workplan:
- New vaccine or new indication
- New Canadian recommendations (e.g., CATMAT, CPS, SOGC, P/Ts, etc.)
- Recommendation adopted by other reputable organizations
- P/T programmatic concerns
- New safety signal detected
- Vaccine supply issue
- Changes in disease epidemiology
- CIG chapter review
- Publication of key trials
- Internal inconsistency
- Update to product monograph
- Public health emergency
- Work already in progress that was interrupted by the COVID-19 pandemic work
2022-2024 workplan
| Initiative | Policy / Program issues | Trigger(s) |
|---|---|---|
| Work currently underway | ||
| COVID-19 | Updated guidance on priority immunization strategies and associated target populations based on current evidence and authorized COVID-19 vaccines. | Public health emergency |
| Updated recommendations on the use of authorized COVID-19 vaccines as they are approved for use in Canada, and as evidence on these vaccines and COVID-19 evolves | New vaccines | |
| CIG COVID-19 Chapter reviews | CIG chapter reviews; new Statement content |
|
| High-Consequence Infectious Diseases (HCID) | Update smallpox vaccine guidance for lab workers and outbreak situations, including consideration of other orthopox viruses (e.g. monkeypox) | Recommendation adoption by reputable organization Public health emergency |
| Pneumococcal | Recommendations for new adult pneumococcal vaccines (PCV15 and PCV20) relative to existing options, dependent on regulatory decisions | New vaccine |
| Seasonal influenza | Repeated seasonal influenza vaccination | P/T programmatic concerns |
| Optimal timing of seasonal influenza programs (including intra-season waning) | P/T programmatic concerns | |
| Guidance on seasonal influenza vaccination in the context of COVID-19 | Public health emergency | |
| 2023-2024 Seasonal Influenza Statement | P/T programmatic concerns | |
| Review of safety and effectiveness of influenza vaccine in pregnancy | P/T programmatic concerns | |
| Review of product choice for 65+ | P/T programmatic concerns | |
| 2024-2025 Seasonal Influenza Statement | P/T programmatic concerns | |
| Supplemental statements or Addenda for new products and/or NACI opinions related to new or existing products | New vaccine | |
| Canadian Immunization Guide (CIG): Part 1 (Key Immunization Information) |
Blood products, human immunoglobulin and timing of immunization - completion of revision | CIG chapter review |
| Communicating effectively about immunization - due for revision | CIG chapter review | |
| Updates to various chapters related to COVID-19 vaccine content | CIG chapter review | |
| CIG: Part 3 (Special Populations) |
The following chapters will be due for revision: 1) Immunization of Adults; 2) Immunization of persons with inadequate immunization records; 3) Immunization of infants born prematurely; 4) Immunization of patients in healthcare institutions; 5) Immunization of persons new to Canada; 6) Immunization of workers | CIG chapter review |
| CIG: Part 4 (Active Vaccines) |
Part 4 chapters requiring updates are those withnplanned NACI statements | CIG chapter review |
| Next projects | ||
| Human Papillomavirus (HPV) | Consider 1-dose HPV vaccination schedule, and consider 2-dose/3-dose schedules among persons 15+ | Recommendation adoption by reputable organization |
| Pneumococcal | Recommendations for new pediatric pneumococcal vaccines (PCV15 and PCV20) relative to existing options, dependent on regulatory submission and decisions | New indication |
| Future projects, depending on trajectory of COVID-19 pandemic and associated vaccines (in order of prioritization) | ||
| Respiratory Syncytial Virus (RSV) | New active RSV vaccines or prophylactic monoclonal antibodies, dependent on regulatory submission and decisions | New vaccine |
| Rabies | Updated guidance on rabies vaccine pre-exposure prophylaxis (PrEP) and post-exposure prophylaxis (PEP) in context of new guidance from WHO | Recommendation adoption by reputable organization Work already in progress that was interrupted by the COVID-19 pandemic work |
| Hepatitis A | Consider a universal hepatitis A vaccine schedule, including 1-dose option | Recommendation adoption by reputable organization |
| Herpes Zoster | Recombinant Zoster Vaccine (RZV) use in immunocompromised populations (new indication for those under 50 years old at high risk of disease) | New indication |
| Meningococcal | Recommendations on use of new Meningococcal (Groups A, C, Y, W) Polysaccharide Tetanus Toxoid Conjugate Vaccine | New vaccine |
| Hepatitis B | Recommendations on use of 3-antigen Hepatitis B Vaccine Candidate | New vaccine |
Abbreviations
NACI |
National Advisory Committee on Immunization |
CATMAT |
Committee to Advise on Tropical Medicine and Travel |
CIC |
Canadian Immunization Committee |
CIG |
Canadian Immunization Guide |
CPS |
Canadian Paediatric Society |
HPV |
Human Papillomavirus |
P/Ts |
Provinces and territories |
PEP |
Post-exposure prophylaxis |
PrEP |
Pre-exposure prophylaxis |
RSV |
Respiratory Syncytial Virus |
RZV |
Recombinant Zoster Vaccine |
SOGC |
Society of Obstetricians and Surgeons of Canada |
WHO |
World Health Organization |
Previous workplans
2020-2021
| Initiative | Issue(s) | Triggers | Expected date of completion* |
| COVID-19 | Updated guidance on priority immunization strategies and associated key populations based on current evidence and authorized COVID-19 vaccines. | Public health emergency | Q3 2020-2021 |
| Updated recommendations on the use of authorized COVID-19 vaccines as they are approved for use in Canada, and as evidence on these vaccines and COVID-19 evolves. | New vaccine | 2021 for final guidance, pending clinical trial progression | |
| Hepatitis A | Consider a universal hepatitis A vaccine schedule, including 1-dose option. | Recommendation adoption by reputable organization | On hold for COVID-19 |
| Measles, Mumps, Rubella (MMR) | Additional dose of mumps-containing vaccine in outbreaks | Changes in disease epidemiology | 2021 |
| Full CIG Chapter Update for Measles, Mumps and Rubella due | CIG Chapter reviews due | 2021 | |
| Pertussis | Optimal timing of adult and adolescent Tdap boosters, inlcuding Td intervals | New indication | On hold for COVID-19 |
| Pneumococcal | Consider recommendations for PCV10 in light of new indications and practice | New indication | On hold for COVID-19 |
| Rabies | Updated guidance on rabies vaccine PrEP and PEP in context of new guidance from WHO | Recommendation adoption by reputable organization | 2021 |
| Full CIG chapter review due | CIG Chapter review due | 2021 | |
| Smallpox | Update smallpox vaccine guidance for lab workers and outbreak situations, including monkeypox | New vaccine | On hold for COVID-19 |
| Seasonal Influenza | Seasonal Influenza statement | New vaccine | 2020-21 |
| Consider dose-sparing strategies, including intradermal administration | Prevention of vaccine supply issues | Q2 2020-2021 | |
| Minimum observation time following influenza vaccination, in context of COVID-19 | Recommendation adoption by reputable organization | Q2 2020-2021 | |
| Optimal timing of seasonal influenza vaccine programs (including intra-season waning) | P/T programmatic concerns | 2022 | |
| Analysis of product choices for adults 65+ | P/T programmatic concerns | 2021 | |
| Repeated Vaccination | P/T programmatic concerns | 2020 | |
| Review of safety and effectiveness of influenza vaccine in pregnancy | Publication of key studies | 2021 | |
| CIG: Part 1 (Key immunization information) | Routine chapter updates (5): Benefits of Immunization, National Guidelines for Immunization Practices, Communicating Effectively about Immunization, Principles of Vaccine Interchangeability, Blood Products, Human Immune Globulin and Timing of Immunization | CIG Chapter reviews due | 2021 |
| CIG : Part 2 ( Vaccine Safety) | Routine Chapter updates (3) | CIG Chapter reviews overdue | 2019-20 |
| CIG: Part 4: Active Vaccines | Routine chapter updates (13): BCG, Diphtheria, Hep A, Hib, MMR, Polio, Pneumococcal, Rotavirus, Rabies, Smallpox, Tetanus, Varicella, Yellow Fever | CIG Chapter reviews due and some overdue | On hold for COVID-19 |
| Evidence-based methods | Transition to GRADE methodology | Recommendation adoption by reputable organization | On hold for COVID-19 |
| NACI economics framework | Incorporation into NACI process: economics framework | Recommendation adoption by reputable organization | 2021 |
| Economic guidelines | Incorporation into NACI process: economic guidelines | Recommendation adoption by reputable organization | 2022 |
| Abbreviations: | |
| NACI | National Advisory Committee on Immunization |
| BCG | Bacillus Calmette-Guérin |
| CATMAT | Committee to Advise on Tropical Medicine and Travel |
| CCDR | Canada Communicable Disease Report |
| CIC | Canadian Immunization Committee |
| CIG | Canadian Immunization Guide |
| CPS | Canadian Paediatric Society |
| EEFA | Ethics, Equity, Feasibility, Acceptability |
| FY | Fiscal year (April 1 - March 31) |
| JE | Japanese encephalitis |
| NoC | Notice of compliance |
| P/Ts | Provinces and territories |
| QIV | Quadrivalent influenza vaccine |
| SOGC | Society of Obstetricians and Surgeons of Canada |
| TIV | Trivalent influenza vaccine |
| TOR | Terms of reference |
| WG | Working group |
| WHO | World Health Organization |
| YF | Yellow fever |
2019-2020
| Initiative | Issue(s) | Triggers | Expected date of completion* |
|---|---|---|---|
| Ebola Virus Disease | Interim pre-market guidance on domestic use of stockpiled investigational vaccine for ring vaccination strategy in event of imported cases, post-market guidance to follow in later years | New vaccine | Q2 2019 for interim guidance |
| Hepatitis A | Consider a universal hepatitis A vaccine schedule, including 1-dose option | Recommendation adoption by reputable organization | 2021 |
| Measles, Mumps, Rubella (MMR) | Consider additional dose of mumps-containing vaccine in outbreaks | Changes in disease epidemiology | 2019-20 |
| Full CIG chapter update for Measles, Mumps and Rubella due | CIG chapter reviews due | 2019-20 | |
| Pertussis | Optimal timing of adult and adolescent Tdap boosters, including Td intervals | P/T programmatic concerns | 2020 |
| Pneumococcal | Evaluation of preferential PCV13 recommendation for routine infant programs | Recommendation adoption by reputable organization | 2020 |
| Rabies | Updated guidance on rabies vaccine PrEP and PEP in context of new guidance from WHO | Recommendation adoption by reputable organization | 2020 |
| Full CIG chapter review due | CIG chapter review due | 2020 | |
| Respiratory Syncytial Virus (RSV) | Review/update NACI guidance on Palivizumab | Recommendation adoption by reputable organization | 2019-20 |
| CIG - chapter creation | 2019-20 | ||
| Seasonal Influenza | Seasonal influenza | New vaccine | 2020-21 |
| New Products: quadrivalent influenza vaccines | New vaccine | 2020-21 (dependant on NOC) | |
| Repeated vaccination | P/T programmatic concerns | 2020 | |
| CIG: Part 1 (Key immunization information) | Routine chapter updates (6): Immunization in Canada. Benefits of Immunization, National Guidelines for Immunization Practices, Communicating Effectively about Immunization, Principles of Vaccine Interchangeability, Blood Products, Human Immune Globulin and Timing of Immunization | CIG chapter reviews due | 2019-20 |
| CIG : Part 2: Vaccine Safety |
Routine chapter updates (3) | CIG chapter reviews overdue | 2019-20 |
| CIG: Part 3: Special Populations | Routine chapter updates (6): Immunization of Adults, Immunization of Persons with Inadequate Immunization Records, Immunization of Infants Born Prematurely, Immunization of Patients in Healthcare Institutions, Immunization of Persons New to Canada, Immunization of Workers | CIG chapter reviews overdue | 2019-20 |
| CIG: Part 4: Active Vaccines | Routine chapter updates (12): BCG, Diphtheria, Hib, MMR, Polio, Rabies, Smallpox, Tetanus, YF, JE | CIG chapter reviews due and some overdue | 2019-20 |
| Ethics, Equity, Feasibility, Acceptability (EEFA) | Incorporation into NACI process: EEFA | Recommendation adoption by reputable organization | 2019 |
| NACI economics framework | Incorporation into NACI process: economics framework | Recommendation adoption by reputable organization | 2020 |
| Economic guidelines | Incorporation into NACI process: economic guidelines | Recommendation adoption by reputable organization | 2021 |
*Please note that this workplan is evergreen. As new products and indications are authorized or new information becomes available, workplan items may be added for consideration and priorities may change.
| Abbreviations: | |
|---|---|
NACI |
National Advisory Committee on Immunization |
BCG |
Bacillus Calmette-Guérin |
CATMAT |
Committee to Advise on Tropical Medicine and Travel |
CCDR |
Canada Communicable Disease Report |
CIC |
Canadian Immunization Committee |
CIG |
Canadian Immunization Guide |
CPS |
Canadian Paediatric Society |
EEFA |
Ethics, Equity, Feasibility, Acceptability |
FY |
Fiscal year (April 1 - March 31) |
Hib |
Haemophilus influenzae type b |
JE |
Japanese encephalitis |
NoC |
Notice of compliance |
PCV13 |
Pneumococcal conjugate vaccine |
PEP |
Post-exposure prophylaxis |
PrEP |
Pre-exposure prophylaxis |
P/Ts |
Provinces and territories |
QIV |
Quadrivalent influenza vaccine |
SOGC |
Society of Obstetricians and Surgeons of Canada |
Td |
Tetanus and diphtheria vaccine |
Tdap |
Tetanus, diphtheria and pertussis vaccine |
TIV |
Trivalent influenza vaccine |
TOR |
Terms of reference |
WG |
Working group |
WHO |
World Health Organization |
YF |
Yellow fever |
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