Canada’s vaccine policy needs to be revamped, says expert panel

In a recent review, an expert panel of health professionals said Canada’s vaccine policy needs better economic justification for its decisions.

Conducted by health care researchers from across the country, the review studied a number of economic evaluations of vaccines in Canada and concluded that such evaluations need to play a larger role in Canada’s public health decision-making processes concerning vaccines.

“Given the increased complexity of economic studies evaluating vaccines and the impact of results on public health practice, Canada needs improved, transparent and consistent processes to review and assess the findings of the economic evaluations of vaccines,” say the review’s authors.

When it comes to immunization policy, Canadian governments both federal and provincial have traditionally been focused on the twin lodestones of efficacy and safety, the only relevant question on the table being, If we immunize against this disease, will we save lives?

But with the rise in drug costs over the past two decades and the emergence of newer, more sophisticated (and more expensive) vaccines, governments the world over have had to contend with concerns both epidemiological and budgetary.

Health care professionals in Canada have started to put pressure on the Canadian government to involve more health care economics in its decision-making…

For its part, the World Health Organization (WHO) launched its Global Immunization Vision and Strategy in 2006, emphasizing that countries need to make “rational, evidence-based decisions about the choice of new vaccines and technologies.” Thus, health care professionals in Canada have started to put pressure on the Canadian government to involve more health care economics in its decision-making, which in the case of vaccine economic evaluations would typically involve considerations of cost-effectiveness, affordability and the potential economic and social impact of a disease on the health care system and the country at large.

A November 2013 workshop involving the committee serving the vaccine manufacturers industry of Canada (BIOTECanada), the Public Health Agency of Canada, academic vaccine researchers, economists and modelers agreed with the move toward more cost analysis, urging that Canada needs to look at ways of “increasing the capacity to conduct and interpret economic evaluation through shared resources and common guidance.”

Canada’s immunization programs are provincially run with input from the National Advisory Committee on Immunization (NACI), which makes recommendations on vaccines and vaccine programs, including the targeting of immunization strategies to at risk populations.

According to the expert panel review, although the NACI currently does not systematically include economic evaluations in its immunization decision-making, it would benefit from doing so.

But how dominant a role should economic considerations be in determining Canada’s vaccine policy?

According to Phillip Jacobs of the Institute of Health Economics in Edmonton, Alberta, cost-benefit analyses play a role in decision-making but they aren’t front and centre, mostly because the factors impacting immunization decisions are multifarious and messy, involving political, moral and social issues particular to different times and places. “More complex models may emerge from academia and elsewhere that will include a wider variety of considerations than just economics. However, it is unlikely that the use of these complex models will replace the informal judgement of politicians and their advisors,” Jacobs says.

The new panel review is currently available online in the journal Human Vaccines and Immunotherapeutics.

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