Immunization in Canada: Canadian Immunization Guide
For health professionals
Updated: September 2015
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The objectives of immunization programs are to prevent, to control, to eliminate or to eradicate vaccine-preventable diseases by directly protecting vaccine recipients and indirectly protecting vulnerable individuals who may not respond to vaccines or for whom vaccines may be contraindicated. These objectives are dependent upon the epidemiology of the diseases, the effectiveness of available vaccines, and the ability to achieve good immunization coverage. In Canada, the low incidence of vaccine-preventable diseases and their associated morbidity and mortality have been a result of comprehensive Federal, Provincial and Territorial (F/P/T) immunization policies, and the ongoing monitoring and evaluation of vaccines and immunization programs. Refer to the Benefits of Immunization in Part 1 for information about the impact of immunization on the epidemiology of vaccine preventable diseases and the benefits of immunization.
This chapter provides an overview of immunization programs in Canada and discusses the various F/P/T immunization committees and mechanisms that support policy development. In doing so, it describes the National Immunization Strategy which serves as the principle framework that guides the work of F/P/T advisory bodies, stakeholders, networks and key decision making processes.
Immunization Policy and Program Development
In Canada, the responsibility for health care, including immunization, is shared by the federal, provincial and territorial (F/P/T) governments. While each jurisdiction has a distinct mandate and unique operating context, their activities are complementary and collaborative. Collaboration is a key component of immunization policy and program development as provinces, territories and the federal government benefit from sharing data, knowledge, expertise and best practices that help provide the necessary information for their respective programs.
National Immunization Strategy
Since its adoption in 2003, the National Immunization Strategy (NIS) has been a platform for collaboration between F/P/T stakeholders and has facilitated the development of consistent and equitable approaches to immunization planning, vaccine purchasing, program delivery and education. The NIS provides mechanisms for enhanced collaboration on issues such as vaccine safety, surveillance, immunization registries, research, vaccine supply and immunization program planning. The NIS enables collaboration of policy recommendations made at the national level with immunization program development at the provincial/territorial level.
Key Federal/Provincial/Territorial Stakeholders
Through health departments, advisory bodies and other public authorities, all F/P/T governments engage in different aspects of immunization program planning, delivery and evaluation. Key stakeholders are described below:
- Federal Government
The Public Health Agency of Canada (Agency) is the federal agency responsible for immunization. To help provide leadership, advice and support for timely vaccine recommendations and sustainable immunization programs, the Agency is supported by two scientific advisory committees whose members are recognized experts in multiple fields including pediatrics, infectious diseases, immunology, medical microbiology, internal medicine and public health.
- National Advisory Committee on Immunization (NACI)
NACI provides expert and evidence-based recommendations regarding the use of vaccines authorized for use in Canada, advises on the need for national vaccination strategies, and makes recommendations for vaccine development research. NACI is also responsible for producing the Canadian Immunization Guide. Created in 1964 and originally reporting to the predecessor of Health Canada, the Department of National Health and Welfare, and later to Health Canada, NACI has reported to the Agency since it was created in 2004. Refer to NACI Recommendation Development for additional information about the national immunization guideline development process.
CATMAT makes evidence-based recommendations relating to tropical infectious diseases and health risks associated with international travel, suggests mechanisms for the widespread dissemination and utilization of such information, and advises on priorities for epidemiological research and other activities related to travel or tropical medicine. Some CATMAT recommendations for the use of authorized immunization products for travellers may extend beyond recommendations developed by NACI for Canada due to differences in disease prevalence internationally. CATMAT recommendations are available on the PHAC website.
Health Canada (HC) Biologics and Genetic Therapies Directorate (BGTD) is the federal authority responsible for regulation of vaccines for human use under the Food and Drugs Act and Food and Drugs Regulations. HC reviews the clinical and manufacturing information of vaccine submissions and authorizes the sale of vaccines in Canada. Together with PHAC, it is responsible for monitoring vaccine safety and effectiveness throughout the life cycle of the product. HC also promotes immunization initiatives and ensures that First Nations, Inuit and Métis receive appropriate immunization services.
Other federal departments and bodies with immunization related interests and activities (that is, research, policy and operational considerations) include: Citizenship and Immigration Canada, Correctional Service of Canada, National Defence and the Canadian Armed Forces, Canada Border Services Agency, Public Works and Governments Services Canada, Foreign Affairs, Trade and Development Canada, Statistics Canada, Veterans Affairs Canada, Department of Indigenous Services Canada, Patented Medicine Prices Review Board, Canadian Institutes of Health Research, National Research Council Canada, and Industry Canada.
- National Advisory Committee on Immunization (NACI)
- Provincial and Territorial Governments
The provincial and territorial (P/T) governments are responsible for the administration and delivery of health care services, including immunization-related programs. Immunization policies and schedules are developed by P/T governments or their expert immunization advisory committees, based on jurisdiction-specific needs, other immunization recommendations (such as NACI), program resource availability and constraints, and identified priorities. In addition, P/T governments are responsible for: purchasing vaccines for publicly funded programs; the design and maintenance of immunization registries; disease and safety surveillance and program monitoring; and public and professional education and engagement (such as immunization campaigns, information services, and professional training, education and guidance). Each jurisdiction has its own process and mechanism for setting immunization targets and planning, designing, implementing and evaluating immunization programs. P/T governments typically initiate their vaccine and immunization program assessment processes following, or in tandem with NACI and, where applicable, the Canadian Immunization Committee (CIC).Evidence and recommendations developed by NACI and CIC are often used by P/T governments to inform their local immunization policy and program decisions.
- Pan-Canadian Public Health Network
The Pan-Canadian Public Health Network (PHN) was established by Canada's F/P/T Ministers of Health in 2005 as a key intergovernmental mechanism to:
- strengthen and enhance Canada's public health capacity,
- enable F/P/T governments to enhance day-to-day business of public health, and
- anticipate, prepare for, and respond to public health events and threats.
The work of the PHN is governed by a 17-member Pan-Canadian Public Health Network Council (PHNC) composed of senior F/P/T government officials responsible for public health, including the Chief Public Health Officer of Canada. The PHNC is accountable to the Conference of F/P/T Deputy Ministers of Health, which provides direction and approves common immunization policies and program priorities including the implementation of PHNC vaccine recommendations.The PHNC has three Steering Committees reporting under it: the Healthy People and Communities Steering Committee, the Public Health Infrastructure Steering Committee, and the Communicable and Infectious Diseases Steering Committee.
- Canadian Immunization Committee
The Canadian Immunization Committee (CIC) consists of F/P/T government representatives who review and provide recommendations on immunization program planning, which are provided to the F/P/T Deputy Ministers of Health through the PHN.
- Council of Chief Medical Officers of Health
The Council of Chief Medical Officers of Health (CCMOH) may provide further guidance and recommendations on technical issues relating to immunization. Its members are the Chief Medical Officers of Health from each P/T, the most senior public health physician of the First Nations and Inuit Health Branch of HC, and the Chief Public Health Officer of Canada. The CCMOH reports to the Conference of F/P/T Deputy Ministers of Health through the PHNC.
Development of Recommendations by NACI
In developing recommendations, NACI relies on its working groups. The working groups consist of NACI members, liaison members and other vaccine experts who systematically review and synthesize the available scientific and other technical information (i.e. disease burden, vaccine characteristics, unpublished study data) pertaining to specific questions or issues raised by NACI. Recommendations from other groups (e.g., World Health Organization [WHO], Canadian Paediatric Society, Advisory Committee on Immunization Practices [United States]) are also considered. This information is then presented in form of a draft Statement or Statement Update to the full NACI committee for review, discussion and adoption. Once adopted, NACI recommendations and the reviewed evidence are made available to P/T governments, to health professionals and to the general public in both official languages on the NACI website. NACI recommendations are summarized for easy use by vaccine providers in the Canadian Immunization Guide.
- Ismail SJ, Langley JM, Harris TM et al. Canada's National Advisory Committee on Immunization (NACI): Evidence-based decision-making on vaccines and immunization. Vaccine 2010;28S:A58-63.
- National Advisory Committee on Immunization. Evidence-based recommendations for immunization – Methods of the National Advisory Committee on Immunization. Can Commun Dis Rep 2009;(ACS-1):1-10.
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