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We would like to thank the national and international experts and program specialists who participated in the consensus conference, the conference co-chairs, the planning committee members, those who donated their time to ensure the evidence presented in the discussion guides was the most current and relevant, and the staff of the Immunization and Respiratory Infections Division of the Public Health Agency of Canada (PHAC) for making the conference a success.
Since its inception in 2003, the National Immunization Strategy (NIS) has facilitated a cohesive approach towards immunization program planning in Canada and has assisted in bringing immunization issues to the forefront of the Canadian public health agenda. The Canadian Immunization Committee (CIC), within the Pan-Canadian Public Health Network, is responsible for overseeing its implementation. The 2003 Federal Budget provided $45 million over 5 years to assist in the continued pursuit of the National Immunization Strategy.
To further support the implementation of the NIS, the federal government provided $300 million over 3 years to the provinces and territories to support the introduction of four newly recommended childhood and adolescent vaccines. Following the 2004 funding announcement, a significant number of provinces and territories launched new publicly funded programs for these vaccines which have enabled Canada to move toward harmonization of immunization programs across the country.
A key component of the NIS is the development of national goals for all vaccine-preventable diseases (VPDs) and their recommendation for endorsement by all federal, provincial and territorial (FPT) governments, where appropriate. The purpose of having national goals for immunization programs is to support reductions in all VPDs, improve immunization coverage, measure progress and evaluate programs. Official F/P/T endorsement of national goals for VPDs is a complex process because of differing priorities and funding levels for immunization programs within each jurisdiction. Currently, the goal to eliminate measles by the year 2005 is the only official national goal that has been endorsed by the FPT Council of Deputy Ministers of Health (1995).
In 2005, a National Consensus Conference for Vaccine-Preventable Diseases (NCC-VPD) was held in Quebec City. The purpose of the conference was to review and assess the current status of the existing disease reduction goals and immunization coverage targets for six selected VPDs, to achieve consensus on the recommendations and to outline the essential requirements to facilitate national adoption and implementation of the recommendations. The 2005 national goals and recommendations were agreed to while acknowledging that provinces and territories would need to develop their own programmatic objectives.
The CIC has reviewed the 2005 national goals and recommendations and has approved their publication and has forwarded the goal to eliminate indigenously transmitted cases of rubella and congenital rubella syndrome (CRS) from Canada by 2010 to the Pan-Canadian Public Health Network for national endorsement. CIC believes that the recommendations from the conference establish a national vision and at the jurisdictional level provide a standard towards which to strive. The World Health Organization (WHO) in collaboration with UNICEF has created similar guidelines for immunization coverage, summarised in the Global Immunization Vision and Strategy (2006-2015)(1). This document outlines goals which countries should aim for, but which are not enforceable. National goals and recommendations also serve to create a measurement against which future improvements of immunization programs can be evaluated. The 2005 national goals and recommendations will be re-evaluated in 2010.
The CIC recommended that all jurisdictions assess the relevance of 2005 national goals and recommendations based upon jurisdictional capacity and priorities. Provincial and territorial responses were reviewed to assess the feasibility, measurability and priority of each goal and recommendation in order to gain a jurisdictional perspective of their impact on immunization program delivery. Several limitations were noted, among which were inadequate surveillance data, and the lack of resources available to develop new data collection tools and monitoring systems. Respondents also suggested changes to recommended targets concerning dates and rates, which were thought to be unrealistic within the given time frame. The limitations noted by each province and territory will affect their ability to fully implement the 2005 national goals and recommendations. They can therefore only act as guidelines for the PTs to use as deemed appropriate.
Despite these current limitations, there are benefits at the jurisdictional level of adopting the 2005 national recommendations. As provinces and territories aspire towards the national vision, their immunizations programs will invariably improve resulting in increased coverage; these improvements can in turn be used to justify additional funding for immunization programs as well. Establishing national goals and recommendations provides a method of accountability at the jurisdictional level.
Based on the process developed for the 2005 consensus conference, future conferences are planned to review, develop and update recommendations for national goals for immunization coverage and disease reduction for all vaccine-preventable diseases.
Drs. T. Tam and G. Hammond
Co-Chairs of the Canadian Immunization Committee