VACCINATION PROGRAMS IN CANADA:

VACCINATION PROGRAMS IN CANADA:

A Report on the Administration of Vaccination Programs and the Control of Communicable Diseases in Canada, October 1989.

This summary of a study conducted by Info-Lynk Consulting in October 1989 provides an account of how the Canada's federal / provincial system of government manages infectious diseases - while so much has changes, so much remains the same.

Executive Summary

This report has been prepared to explain, to a largely no-Canadian audience, how the people of Canada are protected against communicable diseases. It is based on structured interviews conducted between May and August 1989 with health care professionals who are involved in the administration of vaccination programs at the federal, provincial and municipal levels of government across Canada as well as a review of the pertinent literature.

In Canada the vaccination programs are an integral part of provincial health programs. As a confederation of ten provinces and two territories where the responsibility for health is constitutionally recognized as residing with the provincial and territorial governments, Canada does not have a “national” health care system. Each provincial government organizes the delivery of its health services in accordance with its historical, cultural and political outlook.

The Health Protection Branch of Health and Welfare Canada which oversees the regulation of drug approval, including the approval of vaccines for use in Canada, is also responsible for monitoring the incidence of infectious diseases. These two functions of government: the regulatory, licensing function and the disease surveillance function report to the Assistant Deputy Minister, Health Protection. However, their respective missions and operations are quite separate. The regulatory function is a jurisdictional responsibility of the government of Canada. The surveillance function is a voluntary agreement among the provinces and the government of Canada to participate in such an activity.

The Laboratory Centre performs the surveillance of communicable diseases at the national level for Disease Control (LCDC). LCDC is serving a major function in providing a forum for the development of national guidelines on the administration of vaccination programs at the provincial level. Two advisory committees accomplish this work: the National Advisory Committee on Immunization (NACI) and the Advisory Committee on Epidemiology (ACE).

NACI periodically publishes, under the authority of the Minister of National Health and Welfare, a set of guidelines entitled “Canadian Immunization Guide”. The third edition of these guidelines was published in 1989. The voluntary Boards of Directors of the Canadian Medical Association, Canadian Paediatric Society, and the College of Family Physicians of Canada endorsed the 1989 edition of the guidelines.

In December 1988, the Advisory Committee on Epidemiology (ACE), through its sub-committee on Communicable Diseases, published a report that outlines an infrastructure for the development of a national approach to the operation and surveillance of communicable diseases in Canada. The same report also published the draft criteria for formulating a point system that would serve to assist in prioritizing notifiable diseases. Case definitions have been developed for each of the diseases identified by the above criteria. Objectives for surveillance, and an optimum surveillance system have also been developed. This protocol, when adopted by the provinces, holds great potential for establishing a basic national common database and the accurate monitoring of communicable diseases in Canada.

In discussions held with provincial officials about their management of hepatitis B viral infection and their general administration of the vaccination programs, the political milieu of the jurisdiction was presented as justification for why the prevailing situation existed. During these discussions, consistently, the same issues emerged that centered on the management of hepatitis B infection surveillance in Canada; the need for more well directed public educations programs; the political will to recognize and cater to the needs of high risk groups; the organizational relationships between provincial governments and their regional health units; the relative roles of the private, fee for service, physician and the public health nurse; the use of suitable software for support in communicable disease management; the need for a permanent vaccination record; the need to monitor adverse drug reactions resulting from the administration of vaccines.

This study serves to provide an overview of the diversity that exists in the way Canadians are protected against communicable diseases. The reference to hepatitis B has provided a focus for assessing how the mosaic, that constitutes the health care delivery system in Canada, serves to protect its citizens in demonstrating the need for systems that monitor and provide surveillance of a disease that exhibits a variety of forms: acute, chronic and carrier state and which can be difficult to diagnose.

Tim Lynch
Info-Lynk Consulting Services
Toronto

October 1989

Postscript: The full report of this Executive Summary was prepared for Snith Kline and French Canada Ltd., as a basis to a marketing intelligence survey for its sister company Smith Kline Biologics, Belgium, regarding the sale of their recombinant DNA hepatitis B vaccine in Canada. Smith Kline French has undergone several corporate mutations since 1989 and is currently part of Glaxo Smith Kline (GSK), which has its Canadian headquarters in Mississauga Ontario. For a more updates version of the situation on Canada go to the Health Canada link to the Center for Emergency Preparedness and Response.