Elsevier

Vaccine

Volume 23, Issue 19, 31 March 2005, Pages 2470-2476
Vaccine

An analytical framework for immunization programs in Canada

https://doi.org/10.1016/j.vaccine.2004.10.029Get rights and content

Abstract

Recent years have seen an increase in the number of new vaccines available on the Canadian market, and increasing divergence in provincial and territorial immunization programs as jurisdictions must choose among available health interventions with limited funding. We present an analytical framework, which we have developed to assist in the analysis and comparison of potential immunization programs. The framework includes 58 criteria classified into 13 categories, including the burden of disease, vaccine characteristics and immunization strategy, cost-effectiveness, acceptability, feasibility, and evaluability of program, research questions, equity, ethical, legal and political considerations. To date this framework has been utilized in a variety of different contexts, such as to structure expert presentations and reports and to examine the degree of consensus and divergence among experts, and to establish priorities. It can be transformed for a variety of other uses such as educating health professionals and the general public about immunization.

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.

Section snippets

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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