ARCHIVED - Recommendations on a Human Papillomavirus Immunization Program

1. Background

The Canadian Immunization Committee (CIC) is the federal/provincial/territorial (F/P/T) body that provides leadership in immunization by giving advice and recommendations on implementation of the National Immunization Strategy (NIS) and issues affecting immunization. The CIC is part of the Pan-Canadian Public Health Network (PHN), which reports to the Public Health Network Council through the Communicable Disease Control Expert Group.

F/P/T immunization programs need to assess key vaccines coming onto the Canadian market and the feasibility of introducing them in the publicly funded system. The CIC's mandate includes national collaboration on immunization program planning, one of the 10 components of the NIS. The objectives of a national process for immunization program planning are to minimize duplication of effort and to move towards harmonization of immunization schedules across the country. In December 2005 the PHN identified human papillomavirus (HPV) vaccine as a priority in program planning. It agreed to move forward on the overall evaluation of a candidate immunization program for the HPV vaccine using the analytical framework for immunization programs in Canada developed by Erickson, De Wals and Farand(1). Consensus was reached on the need for F/P/T collaboration and consistency in the assessment of new and future immunization programs and the development of business cases to be proposed in Canadian jurisdictions.

Vaccines are authorized for sale in Canada after rigorous scientific review and testing for their quality, safety and effectiveness. Health Canada, the federal regulator, approved the first HPV vaccine on 10 July, 2006, for females 9 through 26 years of age. In February 2007, the National Advisory Committee on Immunization (NACI) published its recommendations on HPV vaccines taking into account the burden of disease and vaccine characteristics. NACI's recommendations are considered by F/P/T jurisdictions as they develop and implement their immunization programs.

A multidisciplinary joint CIC-NACI HPV Vaccine Expert Working Group was established in May 2006 to develop comprehensive recommendations for HPV vaccine programs using the analytical framework(1). It included members from the CIC and NACI, as well as disease experts and representatives from the Cervical Cancer Prevention and Control Network, College of Family Physicians of Canada, Society of Obstetricians and Gynaecologists of Canada, Society of Gynecologic Oncologists of Canada, First Nations and Inuit Health Branch of Health Canada, and Biologics and Genetic Therapies Directorate of Health Canada. Broad representation from public health, vaccinology, sexual health, gynecology, cancer, aboriginal health, nursing and family medicine ensured that multiple perspectives were discussed and that the group's mandate was met. The resulting analysis and recommendations were forwarded to the CIC for consideration in the development of their recommendations on the HPV vaccine program and options.

This report summarizes the components of the analytical framework on HPV immunization programs and presents the recommendations for the implementation of a publicly funded HPV immunization program across the country, aiming for a harmonized approach towards the introduction of the vaccine in Canada. A worksheet table summarizing the responsibilities of NACI and CIC for the components of the analytical framework is included as Appendix 4.

Following the NACI recommendations, the Federal Budget 2007 provided $300 million to provinces and territories through a third-party trust fund to launch HPV vaccine programs. The HPV Vaccine Trust, distributed on a per capita basis, is intended to support the purchase of the HPV vaccine by the provinces and territories. The vaccine will be used in a publicly funded HPV immunization program for residents, including all First Nations and Inuit residents both on and off reserve, over 3 years. There is flexibility provided in the use of a trust mechanism such that provinces and territories can use this money as appropriate within their jurisdictions. The Government of Canada will work with the P/Ts to facilitate access to the funding so that the vaccine is available equitably across Canada. The provinces and territories are responsible for the delivery of immunization programs and will consider their own set of circumstances in decisions about the implementation of HPV immunization programs.