National Immunization Strategy: Objectives 2016 – 2021

Immunization: A shared responsibility

In Canada, immunization is a shared responsibility among the federal, provincial, and territorial (F/P/T) governments. The National Immunization Strategy (NIS), established in 2003 by F/P/T Deputy Ministers of Health, provides a framework for effective inter-jurisdictional collaboration that improves the relevance, effectiveness, and efficiency of immunization programing across Canada.

At the time of its creation, the NIS was designed to address a number of immunization challenges in Canada.  Work under the NIS by all jurisdictions continues to this day, through F/P/T engagement and collaboration under the Public Health Network (PHN)^Footnote1 structure, particularly via the Canadian Immunization Committee.  The result is that jurisdictions today are better connected, helping ensure immunization program design and delivery is evidence-based and sustained by a safe and secure vaccine supply chain, which benefits all Canadians.

The NIS priorities – A recent history

In 2011, F/P/T governments undertook a review of the strengths, weaknesses, and gaps of the NIS to date, and highlighted areas where ongoing work could be focussed.  Priority areas for the NIS identified in 2013, following this review, included:

• NIS Direction and Coordination
• Programmatic Research 
• Programmatic Evaluation
• Surveillance
• Immunization Registries Coordination
• Common Vaccine Guidance 
• Outbreak and Adverse Events
• Vaccine Acceptance and Uptake
• Security of Vaccine Supply
• Vaccine Research, Innovation, and Development
• No-Fault Compensation
• Coordinated Immunization Schedules and Programs

Since then, advances have been made in many areas and while some elements are considered complete, others have evolved with time. Consequently, the objectives and work underway as part of the NIS, and any strategy, must be reviewed regularly, to ensure Canada’s immunization experts are working collectively to improve immunization program delivery in ways that are relevant to all Canadians. 

Furthermore, while all of these priorities remain important, it is not possible to address them all at the same time. Regular review of progress against the NIS objectives and activities is required. The approach also allows for transparent reporting to Canadians on progress against those concrete objectives. To this end, the NIS priorities and developments in immunization were reviewed in 2016 in order to develop key objectives and associated activities that will be carried out under the NIS for the next five years.

Our next steps: NIS objectives 2016 – 2021

While immunization coverage in Canada today is good, we are not reaching any of the coverage goals set in 2005, leaving Canadians vulnerable to preventable illness.  Furthermore, while rates of vaccine preventable diseases in Canada are low, recent measles and pertussis outbreaks demonstrate that Canadians are still at risk.

In its 2016 Budget, the Government of Canada committed $25M over five years to increase immunization coverage rates. While all NIS priorities are important, given the shared responsibility for immunization in Canada, and respectful of the collaborative, ongoing work of the NIS, F/P/T partners have worked together to establish a set of short term objectives that can capitalize on this new investment, leverage momentum and build from the 2013 priorities to provide F/P/T focus for the next five years.

Objective #1: Canada has evidence-based goals for vaccine preventable disease rates and immunization coverage

Activity: Update Canada’s national vaccine preventable disease reduction and immunization coverage goals

Most of Canada’s national vaccine preventable disease (VPD) reduction and immunization coverage goals were developed between 1994 and 2005.  Updating these goals will ensure that Canada’s targets are in line with recent evidence, will improve our ability to set immunization priorities, and will allow Canada to monitor progress towards increasing immunization coverage and reducing rates of VPDs.

Objective #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

Activity: Enhance Canada’s approach to identifying under and un-immunized populations and for understanding the reasons underlying immunization decisions

Immunization registries^Footnote2 and their ability to identify under and un-immunized individuals and populations varies across the provinces and territories (P/Ts). While national immunization coverage surveys and complementary studies are conducted on a regular basis, current methods to determine where the under and un-immunized populations are in Canada, and the reasons underlying their immunization status, should be enhanced. This will allow Canada to have a greater understanding of vaccine acceptance and uptake in our country, produce more reliable immunization coverage estimates and inform initiatives designed to improve immunization coverage.

Objective #3: Canadians have timely and equitable access to immunization

Activity: Expand the mandate of the National Advisory Committee on Immunization to enhance the timeliness and scope of its recommendations

Scientific guidance on vaccine use from the National Advisory Committee on Immunization (NACI) assists jurisdictions in making decisions about immunization program investments and vaccine purchases.  More integrated and timely NACI guidance, combining both scientific and economic evaluation, will accelerate immunization program decision-making and will help protect Canadians from VPDs.  Furthermore, differences in immunization schedules and program availability across jurisdictions can impact equitable access to immunization in Canada.

Objective #4: Canada has the evidence needed to develop and implement evidence-based interventions, to improve immunization coverage rates

Activity: Continue to support immunization research in Canada

Jurisdictions rely on research and other evidence to understand the issues impacting immunization in Canada so that they may develop targeted interventions to improve our coverage rates.  Ongoing support for research will be aimed at improving immunization coverage rates to ensure Canadian immunization programming is based on the most up-to-date scientific findings.

Objective #5: Canadians have the information and tools needed to make evidence-based decisions on immunization

Activity: Develop and enhance tools and approaches that support Canadians in making evidence-based decisions on immunization

A growing number of Canadians are using the internet and mobile technology tools to improve and maintain their own health and that of their families.  Governments should work together to ensure Canadians have easy access to tools that provide reliable information on immunization and help them to monitor their personal immunization status so they can make evidence-based immunization decisions for themselves and their families.

Objective #6: Canada understands the key barriers to, and best practices in, improving immunization coverage and invests in addressing them

Activity: Develop a grants and contributions opportunity that aims to better understand and improve Canada’s immunization coverage

Canada has a number of excellent programs and interventions in place aimed at protecting Canadians through immunization. They include interventions that support health care providers and the public health system to provide immunizations, and tools that support Canadians in getting immunized. There is however work to be done and best practices to be applied in both areas. A grants and contributions stream that is focussed on learning more about barriers to immunization and on implementing or scaling up best practices that will help to improve immunization coverage in Canada.

Conclusion

As we continue to work together under the NIS to improve immunization coverage and enhance immunization program delivery in Canada, our collective objectives and short term goals must regularly be assessed and reported on.  Information on this website will be updated annually, documenting key milestones achieved, and objectives will be re-evaluated and revised every five years.