B. Description of Each Strategy Component

A summary of each component of the NIS is provided below. For each NIS component, objectives of that component will be outlined, followed by a description of the existing system as it relates to that component, a summary of the gaps and limitations of the existing system, and an overview of the proposed approach.

B.1 National Goals and Objectives

a) Objectives

The purpose of having national goals and objectives for immunization programs would be to support the following:

• Reductions in vaccine-preventable diseases
• Improved vaccine coverage rates
• Objective measurement of progress/ program evaluation

b) Existing System

In the current system, national goals and objectives for immunization have been developed by Health Canada-sponsored "consensus conferences", with broad stakeholder participation, including representation from each province and territory. National goals and objectives have been developed for many vaccine preventable diseases, including poliomyelitis, measles, mumps, rubella and congenital rubella syndrome, tetanus, diphtheria, pertussis, invasive Haemophilus influenzae type b (Hib) infections, and hepatitis B. These goals involve either achieving or maintaining the elimination of disease (e.g., polio), or reducing morbidity and mortality (e.g., pertussis), as well as identifying proper handling of vaccines and good delivery programs⁷. At this time, the national goal to eliminate measles by the year 2005 is the only national goal which has been endorsed by the Conference of F/P/T Deputy Ministers of Health.

c) Gaps/Limitations of Existing System

Without the official F/P/T endorsement of national goals and objectives, their full integration into immunization program planning and delivery efforts, and associated effects on vaccine coverage and disease rates, may not be maximized.

Furthermore, Canada's ability to commit and contribute to international health initiatives could be improved if we had a mechanism to effectively endorse recommended national goals and objectives. As an example, in 1990, Canada, along with 70 other countries, participated in the World Summit for Children at the United Nations, and was a signatory to a declaration establishing a number of child health goals with respect to disease reduction or elimination and immunization coverage. One such goal was to reduce measles cases by 90% (compared to pre-immunization levels) by 1995, as a major step towards the global eradication of measles in the long term⁸. As described in the 1996 Canadian National Report on Immunization³, "in 1995, with only 3.6% of the population in the Americas, Canada accounted for 40% of all reported cases of measles and nearly 80% of all confirmed cases." That same year, the Conference of federal, provincial, and territorial (F/P/T) Deputy Ministers of Health (CDMH) endorsed the national goal of eliminating measles by 2005, which was subsequently endorsed by the F/P/T Ministers of Health. National data show that the number of measles cases decreased from 523 cases in 1994⁹ to 7 cases in 2002 (Dr. P. Varughese, Centre for Infectious Disease Prevention and Control, Ottawa: personal communication, 2003). Despite this success, measles elimination is the only national goal which has been officially endorsed.

d) Proposed Approach

The long-term vision of this component of the NIS is to develop national goals and objectives for immunization, and the recommendation of these national goals and objectives for endorsement by all F/P/T governments, where appropriate.