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Tunis M, Deeks S, Harrison R, Quach C, Ismail S, Salvadori M, Warshawsky B, Young K, Mauviel C, Henry E. Canada's National Advisory Committee on immunization: Adaptations and challenges during the COVID-19 pandemic. Vaccine 2023; 41:6538-6547. [PMID: 37658002 DOI: 10.1016/j.vaccine.2023.08.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 06/04/2023] [Accepted: 08/18/2023] [Indexed: 09/03/2023]
Abstract
The COVID-19 pandemic has challenged traditional vaccine guidance infrastructure and frameworks, and added urgency and complexity to the operation of National Immunization Technical Advisory Groups (NITAGs). Canada's National Advisory Committee on Immunization (NACI) provides immunization guidance to the Public Health Agency of Canada (PHAC) who publicly shares expert and evidence-informed guidance with Canadian provinces and territories. Throughout the pandemic, NACI and PHAC implemented many adaptations to meet urgent needs for pandemic vaccine guidance. In this paper, we describe: structural adaptations in response to the accelerated pace and amount of work required to issue recommendations that were timed around product authorizations and dynamic epidemiology; technical adaptations in response to rapidly evolving evidence of variable quality which required close monitoring, and which promoted reliance on basic vaccine principles due to incomplete direct evidence; the need to provide nimble advice (e.g., off-label recommendations, preferential recommendations); communications adaptations (e.g. identify sustainable spokespeople for the committee, receive stakeholder feedback, and ensure urgent nuanced advice was communicated to a diverse audience); and research adaptations focussing on solutions to constrained supply (e.g. prioritisation, extended intervals, and heterologous schedules). The early pandemic vaccine experience has created a roadmap of lessons and adaptations that should be leveraged in future pandemic vaccine programs, and has highlighted the essential role of NITAGs to complement regulatory structures during pandemics to ensure timely, impactful, and evidence-informed public health vaccine guidance.
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Affiliation(s)
- Matthew Tunis
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada.
| | - Shelley Deeks
- Department of Health and Wellness, Nova Scotia, Canada; Community Health and Epidemiology, Dalhousie University, Nova Scotia, Canada
| | - Robyn Harrison
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada; Alberta Health Services, Edmonton, Alberta, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases and Immunology, Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; Infection Prevention and Control, Department of Clinical Laboratory Medicine, CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Shainoor Ismail
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada; Metro City Medical Clinic, Edmonton, Alberta, Canada
| | - Marina Salvadori
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Bryna Warshawsky
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Kelsey Young
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Christine Mauviel
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Erin Henry
- Centre for Immunization Readiness, Public Health Agency of Canada, Ottawa, Ontario, Canada
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