ARCHIVED: Section B.4: National Immunization Strategy (NIS): Final report 2003 – Vaccine procurement
The objectives for the vaccine procurement component of the NIS are to ensure the best value for vaccines, the long-term security of supply for vaccines, the quality of supply, and improvements in accountability.
b) Existing System
Most vaccines in Canada (i.e., over 75% of the total dollar value of vaccines in 2001/02) are purchased through direct contract with vaccine suppliers by individual provinces/territories. The remaining 25% of vaccines are purchased through the existing F/P/T procurement process, which is coordinated by Public Works and Government Services Canada (PWGSC).
The F/P/T Committee on Group Purchasing of Drugs and Vaccines, led by PWGSC, has representation from P/T ministries of health, Health Canada, and National Defense, but does not report to the CDMH. This F/P/T procurement process is low cost ($100K annually, shared equally among the participating jurisdictions) and vaccines are generally purchased at a price equal to or lower than the lowest prices in Canada. Vaccine contracts issued through this process are generally issued on a one-year basis, to the lowest bidder.
c) Gaps/Limitations of Existing System
The current mix of F/P/T bulk purchasing of vaccines, combined with purchase through direct contract by individual jurisdictions, has resulted in differential vaccine prices across Canada.
Without full support and participation in the F/P/T bulk purchase process, the ability to address concerns regarding rising prices or supply issues (described below), using a coordinated national approach, is reduced.
- Escalating vaccine prices
As illustrated in the following table, based on data collection from each P/T, P/T vaccine expenditures have increased substantially. Although much of this increase is due to the introduction of expensive new vaccines, the prices of existing vaccines have also increased in recent year. (figures for 2002-2003 are not available).
Total P/T Vaccine Expenditures
* includes one-time catch-up meningococcal program in Quebec and Alberta
- Concerns regarding security of supply The supply of vaccines in Canada has generally been quite stable, as vaccines needed for immunization programs have usually been available in the quantities required. However, in recent years, supply problems have begun to occur in Canada, and are attributable to a variety of causes, including product changes, lot testing failures, and increased demand. Supply problems are also occurring in the United States. According to the United States General Accounting Office, incidents of vaccine shortages in the United States began in fall 2000 and, by fall 2001, the Centers for Disease Control and Prevention (CDC) reported shortages of five vaccines used for childhood immunization: tetanus and diphtheria booster (Td); diphtheria, tetanus, and acellular pertussis (DTaP); pneumococcal conjugate vaccine; measles, mumps, and rubella (MMR); and varicella vaccine16.
The existing F/P/T bulk purchase process could be improved to address the following:
- P/Ts currently lose some individual control, particularly with respect to value-added products/ services.
- The current process is not always timely.
- Current funding and infrastructure may not be able to sustain required activities.
- The current process is "winner takes all".
- The current process often awards one-year contracts.
- The current process does not report to an F/P/T governing body.
d) Proposed Approach
To address any limitations of the existing system, the following enhancements to the existing F/P/T procurement process could be made:
- Increase the capacity to ensure security of supply (e.g., multi-year contracts).
- Improve the ability to respond to escalating vaccine prices (e.g., proactive planning of longer-term vaccine needs/orders, use of multi-year contracts).
- Develop a mechanism to include value-added products/services as part of the process and to redistribute these funds as part of the NIS.
- Collaborate with vaccine regulator to ensure timely communication on newly developed or released vaccines.
- Improve information-sharing regarding P/T contracts.
- Improve the administrative process, including development and use of the following:
- Standardized forms and communication tools to streamline process
- Standards for specifications concerning vaccine products and delivery processes
- Clear contract parameters and bid evaluation criteria before the tendering process
- Performance evaluation standards for contracts
B.5 Immunization Registry Network
The key objectives of this component of the proposed NIS are to:
- Enhance national surveillance of immunization coverage rates (i.e., percentages of the recommended population who received the vaccine).
- Facilitate the transfer of and access to individual immunization records.
- Measure progress towards national immunization goals and objectives.
- Facilitate linkage of surveillance data of vaccine preventable diseases and vaccine-associated adverse events (VAAEs).
b) Existing System
Each province and territory maintains their own system for tracking immunization coverage. In most provinces and territories, immunization information is collected primarily on children, and there is variability between jurisdictions with respect to the type of data being collected. The collection of childhood immunization data often begins at the time of enrollment in licensed daycare facilities or schools. Some jurisdictions have electronic databases to track this information, whereas others use paper-based systems.
Most provinces and territories are currently establishing electronic immunization registries, which would be consistent and compatible with standards established in a national network. As part of an existing F/P/T initiative, work is being conducted to develop a long-term strategy for the surveillance of communicable diseases, which includes developing data standards and data definitions for immunization, communicable diseases, and vaccine associated adverse events17.
c) Gaps/Limitations of Existing System
Program planning, evaluation, and research, at a national level, could be improved with a national network of immunization information. For instance, a registry network could provide better access to vaccine coverage data, thereby reducing the need for coverage surveys, which have limitations in terms of timeliness, quality, and cost. It could also provide data to support program planning, such as the identification of populations who are under-immunized and could benefit from targeted efforts. Furthermore, an immunization registry network could provide better access to denominator data on the number of persons immunized, which would support assessments of vaccine safety.
Improvements in the standardization of data across jurisdictions would facilitate the transfer of immunization records when a child moves from one jurisdiction to another, and would help to ensure that immunizations continue on schedule.
d) Proposed Approach
Health Canada is currently funding a project to establish a network of provincial/territorial registries. It is proposed that this work continue as a component of the NIS, as follows:
- Development of a minimum (core) data set to be collected by each province/territory.
- Development of business, technical, and functional standards for use by each province/ territory.
- Development and provision of tools and software to interested jurisdictions by Health Canada, to assist in achieving the technical capacity to establish an electronic registry.
- Establishment of a national profile for immunization registries, in respect of laws regarding confidentiality of and access to data.
- Development of strategies to populate immunization registries, including bar coding immunization agents.
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