An analytical framework for immunization programs in Canada
Introduction
At an ever-increasing pace, new vaccines are being developed, licensed, and commercialized in Canada due to initiatives of pharmaceutical companies. New products are evaluated by the National Advisory Committee on Immunization, which determines the optimal conditions of use of the vaccine in the epidemiological context of Canada [1]. Other expert committees such as the Canadian Task Force on the Periodic Health Examination [2] or the Committee to Advise on Tropical Medicine and Travel [3] may also produce recommendations or guidelines for health professionals. Integration of a new vaccine into a publicly-funded immunization program is the responsibility of provinces and territories, and each jurisdiction decides which products will be purchased and offered free of charge to certain target groups. Decision-making structures and processes for immunization vary greatly between Canadian provinces and territories, and it has been observed that decision-making criteria may vary between different vaccines in the same jurisdiction [4]. This lack of standardization and reproducibility in the vaccine evaluation process has negative consequences on the homogeneity and equity of immunization programs across Canada [5]. To help improve this situation, in the context of the development of a National Immunization Strategy [6], [7], an analytical framework has been developed to allow comprehensive and systematic evaluation of all factors which should be considered before making decisions regarding the pertinence of new immunization programs.
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Development of the framework
The first step in the framework development was to contact key scientific and public health experts involved in the planning of immunization programs across Canada. A series of names were provided by the Chief Medical Officers of Health or their equivalents in all Canadian provinces and territories. A questionnaire was sent to these persons asking what factors were important in recent decisions regarding publicly-funded immunization programs in their jurisdiction. They were also invited to
Burden of disease
In a public health perspective, the burden of disease is an important factor to set priorities. Vaccines were first developed to prevent frequent and deadly diseases such as smallpox, diphtheria, tetanus, infant pertussis, poliomyelitis, or measles, and the relevance of the programs implemented during the 20th century cannot be questioned. However, new vaccines developed during the last ten years are targeting less frequent or less severe conditions, and investments for their prevention have to
Use of the framework
In Quebec, the framework has been used to structure the reports on the pertinence of control programs against varicella [40], pneumococcal [41], and serogroup C meningococcal disease [42]. The framework was also used in consensus-building and prioritization conferences that were carried out with the Health Canada Population Health Immunization Subcommittee, on February 25, 2002, in Toronto, and with the “Comité sur l’Immunisation du Québec” on March 14, 2003, in Longueuil (Quebec). First, the
Conclusion
Starting from published material and the experience of Canadian scientists and public health professionals, a series of essential questions has been developed and the elements which should be analyzed in the planning of publicly-funded immunization programs are presented. The proposed analytical framework may be utilized to structure a report or a presentation on the pertinence of a new program, or can structure discussions and consensus-building activities in expert committees. It can also
Acknowledgements
Lonny J. Erickson received a training grant (Ph.D.) from the Canadian Institutes of Health Research. Financial support for developing the framework was provided by the Subcommittee on Immunization of the Advisory Committee on Population Health.
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A framework for the systematic consideration of ethics, equity, feasibility, and acceptability in vaccine program recommendations
2020, VaccineCitation Excerpt :Within the PHECG Framework, the principle of distributive justice (i.e. related to the fair deployment of resources) is included as a core ethical dimension (under justice) to consider for public health interventions [31]. Within NACI’s Core Ethical Dimensions Filter, the Feasibility Matrix is used to ensure the principle of distributive justice is addressed by answering the following question from Erickson et al.’s Analytic Framework, “Is implementation feasible given existing resources?” [2]. The Technical Lead, with input from the relevant Working Group and consultation with the CIC and Vaccine Supply experts within PHAC, reviews the matrix to identify potential issues that may arise with respect to feasibility of implementation of a recommendation.