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Wednesday, 16 November 2011

Vaccine Policy in Canada - progress on a province to province basis

Vaccines are now the backbone of public health.  Rightly or wrongly, communicable disease control has become the prime indicator of public health programming.  Outbreaks are seen by professionals, public and media as a failure of the public health system and the one time public health is held accountable.  We have responded by increasingly directing scare public health resources to supporting immunization programs and the concomitant individual services, the opportunity costs for other health improvements that have not been implemented are enormous. 
BC has become one of the first provinces out of the starting gate in announcing rotavirus vaccine coverage and second dose varicella BC vaccince announcement Nov 2011 . The announcement also includes Hepatitis A vaccine for Aboriginal populations where an ongoing outbreak remains unchecked.  Kudos to them, the announcement includes $3.1M in funding for purchase and avoids any discussion of the costs for delivery.  If typical of many provincial vaccine funding announcements, it may be seen as occurring within the “routine immunization program”.
What does that mean? for public health provided services, no extra money and a further dilution of stretched programs.  For physician delivered vaccine services, incremental vaccine payments on a fee for service basis which are just as mysteriously disbursed without comment. 
The vaccine programs are warranted.  Several other good vaccines are in the pipeline and will need to be funded in the next few years.   However the infrastructure to support their delivery is taxed and crumbling.  Health care professionals are challenged to remain current with new schedules, adjust to new vaccines, update vaccine safety programs and modernize documentation.
Why do we still not have a national immunization registry and common electronic platform? – was this not a deliverable of Health Infoway?  or has decades of information neglect in public health resulted in such disarray that common IT systems are not even possible?  Have we in public health become our own worst enemy in resisting implementing modern information systems which are conversable with electronic health records and accessible at the multiple points of contact (and de facto immunization delivery points)?  Why is scanning technology which is mainstay of pharmaceutical delivery, beyond the reach of the front line public health practitioner? 
There is political currency in announcing vaccine programs, so expect to continue to see such program expansion.  Will it take a disaster or breakthrough outbreak to acknowledge the system vulnerabilities?  Will expert opinion go the way of SARS recommendations? 
Canada has a great vaccine infrastructure with Health Canada approving vaccine licensure, NACI leading on recommending vaccine use, Canada immunization committee sometimes recommending standardization of programming – however too often this step is undermined. Shared purchasing and large scale public contracts substantially reduce the cost of vaccines, and corporate profits are minimized while public dollars wisely spent. 

Residents like to hear they are the first to receive a benefit, not the last – hence the political currency of early announcements.  Vaccine programs should be evidence based, standardized, portable and consistent.  On a national basis, most of these criteria are lacking – and that is an indefensible public health flaw.  

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