A. Introduction

Immunization programs have had a major impact on the health status of the population, as many diseases are prevented through immunization. Since the introduction of mass immunization efforts, infectious diseases which used to be common, are now rare. For instance, smallpox was globally eradicated in 1977 and paralytic poliomyelitis was eliminated from the western hemisphere in 1994, as a result of immunization¹. Such immunization programs resulted in substantial savings to the health system and improvements in length and quality of life. Newer immunization programs, where cost savings can be more difficult to demonstrate, still remain among the most cost effective (cost per life saved and/or serious disability prevented) interventions available², and the net benefit to society in terms of wellness and disease prevention is substantial.

In Canada, immunization is a shared responsibility between federal, provincial and territorial governments. Nevertheless, national collaboration on immunization issues could be improved in the current system. The large majority of costs are borne by the provinces and territories, as each province and territory plans, funds, and delivers their respective immunization programs to their populations. In planning their immunization programs, provinces and territories adjust their recommended schedules and selection of vaccines based on the National Advisory Committee on Immunization (NACI) or other expert advisory committee recommendations, as well as on local epidemiological, program, and financial considerations³.

Unlike Canada, other countries (United States⁴, Australia⁵ and the United Kingdom⁶) have structures with central mechanisms for immunization planning and funding which contribute significantly to the quality of the overall immunization program, including the procurement process.

Canada would benefit from a national mechanism to move from discussion and recommendations to national collaboration and coordinated provincial/ territorial policy decisions within a comprehensive national plan. Such a mechanism would support the following:

• Equitable access to recommended vaccines
• More efficient use of public health human and other resources
• Timely introduction of new immunization programs across Canada
• Commitment to international health initiatives
• Intersectoral collaboration on immunization issues

The proposed goals of a national immunization strategy (NIS) are to

1. Provide high, achievable and measurable coverage of publicly funded immunization programs for all Canadians.
2. Provide complete coverage of all children with routine childhood vaccines recommended by the proposed national immunization committee.
3. Ensure equitable access to these routinely recommended vaccines - among jurisdictions and in special populations - while considering jurisdictional program implementation differences.
4. Promote public and professional acceptance of recommended programs.
5. Provide optimal program safety, effectiveness and acceptance.
6. Improve coordination and efficiency.
7. Provide optimal cost-effectiveness and affordability of programs.
8. Ensure security of vaccine supplies.
9. Provide national intervention when required.

This strategy has been designed so that all five components and related support activities are interconnected and work together to achieve these goals