Question Period Note: Vaccination - General

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• Routine immunization programs remain one of the most effective measures to protect Canadians against vaccine-preventable diseases (VPDs), such as measles, mumps and tetanus. Many common infectious diseases that were once a major cause of morbidity and mortality in Canada are now preventable with vaccines. Nevertheless, VPDs remain a public health concern in Canada, and it is important to achieve the highest possible levels of vaccination.
• As Canada and the world return to broader socio-economic activity following the acute phase of the COVID-19 pandemic, the risk of VPDs is increasing. Monitoring uptake of routine childhood vaccinations and ensuring that Canadians of all ages are up-to-date with their routine vaccinations remain important ways to minimize outbreaks and prevent further spread of VPDs.
• Routine vaccination programs prevent illness, save lives and are critical in supporting the health of Canadians.
• When enough people are vaccinated, we protect ourselves and those around us. Children, immunocompromised individuals, the elderly, and those who do not have up-to-date routine vaccinations, as outlined in the Provinces’ and Territories’ recommended immunization schedules, are at greater risk of contracting vaccine preventable diseases.
• When outbreaks occur, vaccine preventable diseases can have a profound impact on access to and operations of all areas of our health services. This prospect is especially concerning as health systems across Canada are already operating beyond capacity due to the ongoing response to COVID-19.
• The federal government is working with provinces, territories and health professional partners to promote, strengthen and support “catch up” within routine vaccination programs that have been disrupted due to the pandemic to increase individuals’ and communities’ protection from vaccine preventable diseases.

If pressed
• The Government of Canada is committed to supporting routine vaccination, as a vital means of preventing disease, disability, and death, and reducing pressure on healthcare systems.

Immunization is a shared responsibility among federal, provincial and territorial (FPT) governments. Health Canada leads the regulatory approval of vaccines. This involves rigorous scientific review and testing to assess the quality, safety, and efficacy of vaccines before they are approved for use. Once a vaccine is authorized, Health Canada, together with the Public Health Agency of Canada (PHAC), conducts post-market surveillance to monitor vaccine safety, detect and respond to possible adverse events.
The provinces and territories (PTs) administer vaccines within their jurisdictions, which includes all policy and program decision-making, design and implementation required to determine which public programs to offer, which vaccines to buy, where to administer vaccines, and priority populations and eligibility criteria for vaccination.
PHAC supports PTs in delivering their immunization programs by: leading FPT engagement and coordination; bulk purchasing vaccines for all jurisdictions; conducting vaccine confidence research, policy, and programming; managing vaccine coverage, effectiveness and safety surveillance; facilitating immunization research; enhancing domestic manufacturing capacity; and supporting the delivery of the Vaccine Injury Support Program (VISP).
FPT Engagement
To support FPT engagement on immunization policies and programs, the Canadian Immunization Committee (CIC) is a key national forum that brings together PT representatives and federal departments responsible for immunization programming, including Health Canada, Indigenous Services Canada, and Correctional Service Canada, among others. Under the direction of the Communicable and Infectious Diseases Steering Committee of the Pan-Canadian Public Health Network Council, the CIC provides a platform to implement the objectives of the National Immunization Strategy, foster FPT collaboration, engage with non-governmental stakeholders, and discuss and provide strategic operational and technical advice and best practices on issues related to vaccination in the interest of coordinating and improving immunization policies and programs in Canada.

Vaccine Supply and Assurance
PHAC works with PT partners and Public Services Procurement Canada (PSPC) to lead vaccine supply management. This includes routine immunization and influenza vaccine procurement and maintaining a national state of readiness by securing pandemic influenza vaccine preparedness contracts. Through the Bulk Procurement Program, PHAC works with PSPC to lead and advise on vaccine acquisition and allocation for FPT programs. The team coordinates jurisdictional needs, seeks to enhance the security of supply, and manages challenges and disruptions that could impact immunization program delivery.

Vaccine Confidence
The World Health Organization (WHO) identified vaccine hesitancy as one of the top ten risks to global health in 2019, threatening to reverse the progress that has been made in addressing VPDs. Vaccine hesitancy is complex and can be more common in certain populations, including marginalized or underserved communities who have historically experienced systemic racism and often do not trust the government. PHAC acts as the focal point for vaccine confidence policy, research and behavioural analysis to inform development of evidence-based awareness and outreach campaigns and tools and training to support healthcare providers communicate credible information about vaccine effectiveness and safety to Canadians.

A core part of federal vaccine confidence efforts, the Immunization Partnership Fund (IPF) supports public health actors, trusted partners, and communities across Canada to increase vaccine acceptance and uptake through grants and contributions. The IPF provides funding to local, regional and national organizations, and PTs to develop evidence-based approaches designed to improve vaccination coverage rates and combat mis- and dis-information. Supporting trusted representatives from within communities is proven to be an effective way to deliver programming, communicate information about vaccines, and increase vaccine confidence and uptake.

Vaccine Surveillance
High levels of vaccination coverage for VPDs are required to help ensure the ongoing health and safety of Canadians, particularly children, immunocompromised (weakened immune system) individuals, and the elderly. PHAC monitors and leads surveillance of national vaccine coverage and effectiveness for the general population as well as vulnerable populations. Updated vaccination coverage goals and VPD reduction targets were agreed to by PTs in 2017, in line with current evidence. Coverage goals range from 80-95% depending on the age group and the VPD. The most recent Childhood National Immunization Coverage Survey (CNICS), which is a longstanding study that measures the immunization coverage among children in Canada, showed that while the majority of the vaccine coverage estimates are below the set goals, gains were made in some areas since earlier iterations of the survey. The most up to-date results are available from CNICS 2019 (pre-pandemic). Results from CNICS 2021 will be released in spring 2023, and we will shed additional light on the impact of the pandemic on routine childhood vaccine uptake and changes that may have occurred towards achieving vaccine coverage targets. Therefore, there is a need for ongoing vaccine coverage surveillance through CNICS.

After a vaccine is authorized for use in Canada, post-market safety surveillance is conducted to monitor and understand how vaccines behave in the entire population and their real-world impact. This is critical for rapidly detecting and responding to safety issues, ensuring that the benefits of a vaccine continue to outweigh the risks, and supporting vaccine uptake by building public confidence in Canada’s immunization programs. Canada has a well-established vaccine safety surveillance system that is a collaboration between PTs, PHAC, Health Canada, and vaccine manufacturers. Manufacturers are required to report serious adverse events to Health Canada as the national regulatory authority, as well as submit regular summaries of global safety information. Health Canada reviews these reports and takes appropriate regulatory actions should new safety issues be identified. In addition, PHAC receives and reviews reports of adverse events following immunization from FPTs immunization programs and two active surveillance networks through the Canadian Adverse Events Following Immunization Surveillance System. Adverse events following immunization reports are continuously assessed and potential safety issues are flagged immediately for further investigation.

Immunization Research
Emerging, real-world research is a critical component of immunization program evidence-informed decision-making. PHAC works with the Canadian Institutes of Health Research (CIHR) to support public health research. The Canadian Immunization Research Network (CIRN) is an example of this; a multi-disciplinary network that addresses diverse immunization research requirements in Canada on topics related to vaccine safety, immunogenicity and effectiveness, vaccine hesitancy, and immunization program implementation and evaluation. Knowledge translation activities are also supported by PHAC to promote the communication of key research findings to decision-makers, academia and relevant stakeholders.

Biomanufacturing
Recognizing the importance of a resilient and innovative biomanufacturing and life sciences sector, in July 2021, the Ministers of Innovation, Science and Industry and Health launched, and share joint accountability for the Biomanufacturing and Life Sciences Strategy (the Strategy). The Health Portfolio is working with the Department of Innovation, Science and Economic Development to advance the Strategy, which outlines a coordinated approach to grow Canada's domestic capacity to rapidly develop and produce vaccines, therapeutics and other lifesaving medicines to improve readiness for future pandemics or other health emergencies.

Recognizing the evolving technology and the advantages of leveraging newer, more rapidly adaptable vaccine platforms. On November 7, 2022, the Prime Minister, Justin Trudeau, took part in the ground-breaking of vaccine developer Moderna’s new state-of-the-art mRNA vaccine manufacturing facility in Laval, Quebec. When completed, this new facility will be able to produce up to 30 million mRNA vaccine doses per year in non-pandemic times and up to 100 million doses per year during a pandemic.
Moderna’s new facility in Canada will not only help strengthen our biomanufacturing sector and pandemic preparedness, but will also help position Canada as an mRNA centre of excellence and a global mRNA research and development hub. Moderna is committed to partnering with Canada’s leading research universities and institutions to help advance research and development here at home. For example, Moderna has already partnered with McGill University through Moderna’s mRNA Access program to accelerate vaccine innovation, as well as with the University of Toronto to do research across a range of scientific disciplines to develop new ways to treat infectious diseases.
The facility will boost the Canadian economy through the creation of hundreds of jobs during construction and operation of the facility, including direct and indirect biomanufacturing and research jobs. Moderna’s facility will also mean domestic opportunities for the brightest young minds in the field through internships, co-op positions, and other Moderna-supported training and development opportunities. In this way, the facility will enhance Canada’s talent pipeline by attracting, developing and retaining a highly skilled workforce. The facility will also offer the potential for Canadian companies to work with Moderna, and, where possible, opportunities to comprise part of Moderna’s supply chain.
The facility is expected to be operational in 2024 at the earliest, subject to planning and regulatory approvals. In addition to COVID-19 vaccines, the facility is expected to be able to produce vaccines for other respiratory diseases, such as influenza – pending their ongoing development by Moderna and approval by Health Canada.

• In Canada, immunization is a shared responsibility among the federal, provincial and territorial (FPT) governments. The provinces and territories (PTs) design, plan and deliver immunization programs. The federal government leads the regulatory approval of vaccines and supports the vaccine administration of PTs across multiple functions, including coordinating the bulk purchasing of vaccines for jurisdictions, conducting national vaccine surveillance, and facilitating FPT engagement on immunization policies and programs.