Optimizing Canadian Public Immunization Programs: A Prescription for Action (Commentary) (Report‪)‬

Routine immunization programs are widely recognized as a leading contributor to improvements in population health during the past century. (1) In the past decade, provincial and territorial programs grew rapidly with support from the National Immunization Strategy, (2) adding important new vaccines for young children and adolescents (Table 1). While new vaccines have provided substantial health benefits, (3,4) expansion has been costly because of the higher costs of products such as pneumococcal conjugates and human papillomavirus (HPV) vaccines. Whereas the cost of immunizing a child through to adolescence was $35 in 1986, (5) the current cost for girls is over $800 and for boys over $450 (Table 1). Price increases are likely to continue with future vaccines. Immunization programs now represent a substantial public investment. As with other tax-funded programs, they ought to be systematically evaluated to ensure that best value and practices prevail. Ongoing evaluation of the safety and effectiveness of immunization programs is paramount for maintaining a high level of public trust and acceptance. The effectiveness of immunization programs can differ from clinical trial estimates because programs can have beneficial indirect effects, aim to achieve longer-term protection and involve more diverse populations following less precise dosing schedules. Careful monitoring of vaccine safety is warranted to detect any rare adverse events that become evident with wider use or repeated dosing as well as to refute false associations and concerns. Regular surveys of uptake of newer vaccines can identify needs for greater public education or marketing efforts. Ongoing disease surveillance provides a measure of program success and can warn of the need for a booster dose or broadened coverage of an evolving target. Seroepidemiologic studies can also detect gaps in protection and provide early warning of need for boosters or improved regional coverage.