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 vaccination coverage.
As Canada and the world have returned to broader socio-economic activity following the acute phase of the COVID-19 pandemic, the risk of VPDs has increased. Monitoring uptake of routine childhood vaccinations, supporting vaccination for seasonal influenza 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.
Key Messages
• Routine vaccination programs prevent illness, save lives and are critical in supporting the health of Canadians and people in Canada.
• 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.
• 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 and seasonal vaccination for influenza, as a vital means of preventing disease, disability, and death, and reducing pressure on healthcare systems.
If pressed on influenza vaccines
• Seasonal influenza vaccines protect people against yearly influenza epidemics. In the event of an influenza pandemic (i.e., involving a novel and non-seasonal form of influenza), pandemic influenza vaccines can be developed and produced using the same technology as seasonal influenza vaccines to protect people from the novel influenza virus.
• Domestic influenza vaccine production capacity is crucial for ensuring security of supply and facilitating timely vaccine access for protecting Canadians against seasonal and pandemic influenza.
• GSK is currently the only manufacturer capable of producing seasonal and pandemic influenza vaccines in Canada. GSK supplies a large portion of Canada’s requirements for seasonal influenza vaccines for publicly funded vaccination programs (at least 4 million doses) and will be the primary supplier of made-in-Canada pandemic influenza vaccine to Canada (up to 80 million doses) should a novel influenza pandemic occur.
• Canada recently made a number of investments to bolster domestic production capacity for influenza and other vaccines, including an agreement with Moderna to secure timely access to domestically produced pandemic and non-pandemic respiratory vaccines using mRNA technology (which could include influenza vaccines) and an investment to support Sanofi in building an end-to-end influenza vaccine manufacturing facility in Canada.

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 leading to mis-trust in government, and populations exposed to mis- and disinformation (MIDI). PHAC acts as the focal point for vaccine confidence policy, research, and behavioral 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 stakeholders, 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, and Indigenous organizations, and PTs to develop evidence-based and culturally appropriate approaches designed to improve vaccination coverage rates and combat vaccine-related MIDI. 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
Research is a critical component of immunization program evidence-informed decision-making. PHAC, in partnership with the Canadian Institutes of Health Research (CIHR), funds the Canadian Immunization Research Network (CIRN), a multi-disciplinary network that addresses diverse immunization research requirements in Canada on topics related to vaccine safety, immunogenicity and effectiveness, hesitancy, and immunization program implementation and evaluation. Knowledge translation activities communicate key research findings to decision-makers, academia and relevant stakeholders.

Domestic Influenza Vaccine Production
GSK’s Canadian facility, located in Sainte-Foy, Quebec, produces seasonal influenza vaccines using proven egg-based production technology for Canada and other markets, including the United States. This facility is also able to produce pandemic influenza vaccine in sufficient quantities to vaccinate the entire Canadian population in the event of a novel pandemic, i.e. potential human transmission of A(H5N1) (up to 80 million doses, assuming a two-dose schedule). Canada’s pandemic influenza vaccine supply contract with GSK also guarantees the supply of a minimum of 4 million doses of seasonal influenza vaccine annually that FPT partners purchase for use in their publicly funded vaccination programs. For context, approximately 15 million seasonal influenza vaccine doses were procured by FPT partners for their 2022-2023 influenza programs.

A new Moderna facility is currently being built in Laval, Quebec, and will be able to produce 100 million doses of mRNA vaccines per year against respiratory viruses, which could include seasonal and pandemic influenza vaccines. This facility is expected to be operational as early as 2024.

A new Sanofi facility is currently being built in Toronto, Ontario, supported by Government of Canada investments and will be able to produce seasonal and pandemic influenza vaccines (including the high-dose influenza vaccine for older adults). This facility is expected to be operational by 2027.

• 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, providing national immunization guidance, and facilitating FPT engagement on immunization policies and programs.