Importantly, this NITAG does not address the additional considerations relevant to public health for population use. Currently, a second NITAG (Canadian Immunization Committee) [20] representing all provinces and territories uses a standard analytical framework [2] to examine the population health

benefits that would support public funding of a new vaccine program. However, recommendations DAPT cost from this second-level committee have sometimes been much delayed, similar to the situation in Europe [3]. While the evidence supporting routine vaccine use should be equally compelling for each province, the ability and willingness to pay often differ among them. Even when provincial public health officials favor the introduction of a new vaccine program, funding decisions ultimately rest with ministries of finance, which face many competing priorities. While health system administrators may contend that delays and limitations in funding public immunization programs reflect “due diligence”, the opportunities lost to improve health and avoid morbidity and mortality that result from this approach

deserve greater attention. The existence of recommended but unfunded vaccines was a new phenomenon for which the medical community was unprepared and resulted in the unfunded vaccines being largely ignored Cell Cycle inhibitor Thymidine kinase and inaccessible for a time. In 2002, a different perspective began to emerge about RUVs. The Canadian Medical Protective Association (CMPA, the nation’s major medical malpractice insurer) recognized the potential for physician liability if patients in their practice suffered from infections that could

have been prevented by RUVs. CMPA advised physicians to inform patients about all recommended vaccines they could benefit from if they choose to pay [21]. There were objections from some physicians about the extra time required to mention RUVs, when many were already finding it difficult to adequately discuss funded vaccines in the busy office setting. There were also practical difficulties with community access to such vaccines given limited demand. The ability to pay was limited for many families and awkward to discuss. Nevertheless, the insurer remained insistent on this best practice, which has gradually become easier for physicians to meet as other stakeholders have joined the initiative (outlined below). As demand increased for private vaccine sales, community pharmacies were more willing to stock and dispense RUVs. In a growing number of provinces, pharmacists can qualify to administer as well as dispense certain vaccines, including RUVs [22].