Pathways to Immunization Policy in Canada

Size: px

Start display at page:

Download "Pathways to Immunization Policy in Canada"

Bethany Webster
6 years ago
Views:

1 Pathways to Immunization Policy in Canada hollygrahamwikispaces.com Noni MacDonald MD, MSc, FRCPC 1 Rhonda Kropp BScN, MPH 2 Karina Top MD, MS, FRCPC 1 1. Dalhousie University, Canadian Centre for Vaccinology, Halifax, Canada 2. Director general, Public Health Agency of Canada Nov 3,2017

2 Presenter Disclosure NM Relationships with commercial interests: No financial conflicts to declare Grants/Research Support: Canadian Institute for Health Research, Canadian Immunization Research Network Nova Scotia Health Research Foundation Public Health Agency of Canada Consultant: World Health Organization Other: employee of Dalhousie University RK- employee of Government of Canada KT- grants from: GSK, CIHR, PHAC, IWK Health Centre, WHO; research support and consultancy fees from Pfizer 2

3 Canada: Geography and Health 2 nd biggest country in world by land hollygrahamwikispaces.com mass million sq km Population: 35.1 million (2016) most live < 100 km southern border 4 ½ time zones Climate extremes : <-40 o C to + >30 o C Federation: 10 provinces + 3 territories Health care is a prov/terr responsibility > variation in size and population ONT=13.4 M, Nunavut & Yukon = 36,000 each Nunavut -2.1 M sq km, 8x land mass UK Pathways to Immmunization Policy in Canada: Not Simple

4 Federal Minister of Health responsible for maintaining and improving the health of Canadians Supported by Health Portfolio Health Canada: helping Canadians maintain and improve their health, while respecting individual choices and circumstances. Public Health Agency of Canada: help protect the health and safety of all Canadians; focus on preventing chronic diseases, like cancer and heart disease, preventing injuries and responding to public health emergencies and infectious disease outbreaks. Canadian Institutes of Health Research: premier federal agency for health research Patented Medicine Prices Review Board: quasi-judicial body that protects consumers and contributes to health care by ensuring that the manufacturers' prices of patented medicines are not excessive. Canadian Food Inspection Agency. In collaboration and partnership with industry, consumers, and federal, provincial and municipal organizations, continues to work towards protecting Canadians from preventable health risks related to food and zoonotic diseases. consists of approximately 12,000 FTE employees The Honourable Ginette Petitpas Taylor annual budget of over $3.8 billion.

5 Responsibilities for Immunization: Federal Government Canada is a federation Prov/ Terr deliver health programs Feds: Guidance and Standards Health Canada -Biologics and Genetic Therapies Directorate NRA: 3 Centres Centre for Vaccine Evaluation Centre for Evaluation of Radiopharmaceuticals and Biotherapeutics Centre for Blood and Tissues Evaluation Public Health Agency of Canada : Surveillance: vaccine preventable diseases vaccination coverage vaccine safety Canadian Immunization Monitoring Program Active (IMPACT) Pandemic planning Outreach to improve vaccination coverage Vaccine supply management National Advisory Committee on Immunization (NITAG) Vaccine review, recommendations Can Imm Guide

Responsibilities for Immunization: Provinces and Territories Delivery of health programs Immunization Program Who, what, when, where, how 17 immunization schedules Prov + Terr = 13 Fed (FNIHB) +

6 Responsibilities for Immunization: Provinces and Territories Delivery of health programs Immunization Program Who, what, when, where, how 17 immunization schedules Prov + Terr = 13 Fed (FNIHB) + Armed Forces Imm/Refugee, Gov t employees oversees Delivery site immunization: Prov & Terr PH clinics Primary care offices Pharmacies School based programs all varies Surveillance and reporting serious AEFI May share materials * * 2007 Nova Scotia, Alberta

7 Links Between Feds and Prov/Terr National Immunization Strategy CIRN: Canadian Immunization Research Network ( $10M /5 years)

National Immunization Strategy (NIS) 2003 First Ministers (F/P/T) Accord on Health Care Renewal Push to persue a national immunization strategy 2004: National Imm Strategy developed by precursor to

8 National Immunization Strategy (NIS) 2003 First Ministers (F/P/T) Accord on Health Care Renewal Push to persue a national immunization strategy 2004: National Imm Strategy developed by precursor to PHNC 03/pdf/nat_imm_strat_e.pdf Components: National Goals and Objectives Immunization Program Planning Vaccine Safety Vaccine Procurement Immunization Registry Network In 2007: Feds support HPV vaccine purchase $300 M In 2016 Fed Budget $25M to improve coverage rates: NIS focusses on three areas: 1. Update the national vaccination coverage goals and vaccine preventable disease (VPD) reduction targets 2. Improve Canada s ability to identify under and un-vaccinated Canadians 3. Implement a program to improve vaccine access and uptake No appetite for one immunization schedule

9 National Immunization Strategy: #1: Canada has evidence-based goals for vaccine preventable disease rates and immunization coverage #2: Canada is better able to identify under and un-immunized populations and has an enhanced understanding of the determinants of vaccine acceptance and uptake #3: Canadians have timely and equitable access to immunization #4: Canada has the evidence needed to develop and implement evidence-based interventions, to improve immunization coverage rates #5: Canadians have the information and tools needed to make evidence-based decisions on immunization #6: Canada understands the key barriers to, and best practices in, improving immunization coverage and invests in addressing them *More information available at: canada/services/publications/healthy-living/national-immunization-strategy-objectives html 9

10 Immunization Partnership Fund: Fed to Partners $2-3 M/ year over five years ( ). improve vaccination coverage by supporting health partners in 3 priority areas: 1. enabling healthcare providers to vaccinate patients identifying under- and unvaccinated people and increasing vaccination 2. increasing demand for vaccination addressing gaps in knowledge attitudes beliefs raising awareness about benefits requirements where to get vaccinated 3. enhancing access to vaccination services removing barriers to developing programs and in accessing vaccination services

11 Immunization Partnership Fund: Examples To Prov/Terr : 5 projects creating an automated reminder system for vaccination appointments (British Columbia & Alberta) identifying under- and unimmunized districts and developing ways to increase vaccinations in children living there (Manitoba) training to healthcare providers in maternity wards to help them to talk effectively with parents hesitating to vaccinate (Quebec) helping healthcare providers to better identify under- and unimmunized adults to talk effectively with them about vaccination. (Prince Edward Island) To Other Partners expanding and improving the CANImmunize app (Ottawa Hospital Research Institute) studying vaccination issues during pregnancy and developing tools and resources to help healthcare providers and women (Society of Obstetricians and Gynecologists of Canada) reviewing immunization policies and best practices across Canada (C.D. Howe Institute) supporting an online national immunization resource centre to increase ease access evidence-informed tools and strategies relevant to CAD context (Canadian Public Health Association)= CANVax monitoring the effectiveness of the annual flu vaccine for the season (British Columbia Centre for Disease Control)

12 Health Canada Public Health Agency of Canada Public Health Network Council Prov /Terr Approves vaccine for use in Canada (NRA= BGTD) Based upon evidence manufacturer, literature Coordinates, supports National Advisory Committee on Immunization (NACI) recommendations on vaccine use in Canada since 1964 evidence based, context relevant, cost effectiveness, expanding to cover more; recommendations may be off label Coordinates distribution and knowledge translation of NACI recommendations to Prov/Terr and health care providers (Canadian Immunization Guide Coordinates vaccine bulk purchase based on Prov/Terrs decisions Funds Canadian Immunization Research Network FPT governance structure for public health in Canada NIS deliverables =workplan items, including setting of vaccination goals and targets NACI s workplan is reviewed and influenced by this structure Make decision on if, when, where, how specific vaccines will be used Each jurisdiction makes their own decision on vaccination programs and schedules, based on the NACI recommendations 12

13 Pathways to Policy Health Canada PHAC /NACI Public Health Network Council Prov/Terr Regulator : can only approve a vaccine if manufacturer submits application NITAG (NACI): evidence driven links to academe and NGOs e.g. professional societies; does make off label recommendations but only on approved vaccines Vaccine Goals and Purchase: ++ input Prov/Terr- maybe influenced by general public and political decisions Varied relationship with academe, maybe influenced by general public and political decisions

Influencing Policy Decision Makers: Embeddedness Academe CSOs including professional societies General public etc Reputation Quantity of connections Environment Decision Makers

14 Influencing Policy Decision Makers: Embeddedness Academe CSOs including professional societies General public etc Reputation Quantity of connections Environment Decision Makers Legislation other Enabling Factors Capacity Quality of connections Koon et al. Health Research Policy and Systems

15 External Pathways to Immmunization Policy Academe: research evidence new vaccine benefit; change in risk profile old vaccine, new target group, new strategy for program delivery etc In via: NACI, F/P/T- Problem: not well organized, not well embedded General Public: vocal demand new vaccine, change in older etc In via: influence political leaders Fed, Prov, Terr Problem: not well organized, not well embedded

UK: Men B Vaccine example general public pressure > 800,000 signed petition Stimulated by death of child from Men B Sarah Wollaston, a doctor and senior Tory MP, said there was a case to review the

16 UK: Men B Vaccine example general public pressure > 800,000 signed petition Stimulated by death of child from Men B Sarah Wollaston, a doctor and senior Tory MP, said there was a case to review the way vaccines for children were assessed but cautioned against letting patient pressure groups have too much say in how resources were spent. The Guardian UK

NACI, F/P/T (CIC), in Province/Territory Can Imm Conf 2002 Well organized, often

17 Pathways to Immmunization Policy NGOs/ CSOs: research evidence new vaccine benefit; change in risk profile old vaccine, new target group, new strategy for program delivery In via : NACI, F/P/T (CIC), in Province/Territory Can Imm Conf 2002 Well organized, often influential: NIS 2003 Problem: not always prioritize requests, often not understand political implications

The Good, The Bad and The Ugly: Fed/Prov/Terr Try different regimes living lab HPV

2013;309:1793-1802 PCV 2+1 vs 3 +1: PIDJ 2010;29:546-9 Pharm sites delivery: CMAJ

18 The Good, The Bad and The Ugly: Fed/Prov/Terr Try different regimes living lab HPV 2 doses vs 3 doses: JAMA. 2013;309: PCV 2+1 vs 3 +1: PIDJ 2010;29:546-9 Pharm sites delivery: CMAJ 2017;189:E In school vax education: 2014 CMOH Ontario Vaccines: The best Medicine orts/cmoh_14_vaccines/default.aspx Mandatory vs not Compensation Delays intro pressure other provinces / territories Tailor fit epidem locally in Prov/ Territory

A Parent s Guide to Vaccination Available to order for free in English & French and the following languages: http://canadaimmigrants.

19 A Parent s Guide to Vaccination Available to order for free in English & French and the following languages: Arabic Chinese (simplified) Chinese (traditional) Farsi (Persian) Korean Punjabi Russian Spanish Tamil Tagalog Urdu Find these and many other resources at Canada.ca/vaccines

20 The Good, The Bad and The Ugly

21 The Good, The Bad and The Ugly HPV vaccine Steenbeek A et al.ill informed consent. A content analysis of physical risk disclosure in school-based HPV vaccine programs. Public Health Nurs. 2012;29(1):71-9. Development immunization materials: Parents Patients 13 + variations duplication effort +/-confusion for parents/ patients

The Good, The Bad and The Ugly Training HCW Not standardized nor is imm emphasized in national licensing exams RN, LPN, MD etc Curriculum Professional schools Time varies by profession, school <1 hr

22 The Good, The Bad and The Ugly Training HCW Not standardized nor is imm emphasized in national licensing exams RN, LPN, MD etc Curriculum Professional schools Time varies by profession, school <1 hr to > 50 hr Lack formal learning objectives Limited topics covered Response to Anti Vaccine Efforts Often CSOs not F/P/T Pelly LP et al THE VAXED PROJECT: an assessment of immunization education in Canadian health professional programs. BMC Med Educ Nov 26;10:86

23 The Good, The Bad and The Ugly Canada Nunavut Thyroid Melanoma Cervix Last Province or Territory to implement HPV vaccine: Nunavut

24 Australia, Canada and selected countries Immunization Uptake rates ( 2017 JRF = 2016 data ) DTP1 DTP3 DTP4 Hib3 HBV3 MCV1 MCV2 PCV3 Polio3 Rota Rubella Aus (2015) Can 96 (2015) (2015) * Cuba / Fin ? U K? ? USA ?

Immunization Competencies Education Program

Immunization Competencies Education Program Adapted by: Michael Boivin, B Pharm Susan Bowles, BSc Phm, PharmD, MSc Danielle Grenier, MD, FRCPC Ian Gemmill, MD, CCFP, FCFP, FRCPC Alex Henteleff, BN, Med