Thank you very much, Mr. Chair. Good evening, members.
This evening I will be speaking about the role of Canada's national advisory committee on immunization in the immunization system in our country. NACI, as you know, is an expert, external body that provides independent advice to the Public Health Agency of Canada on the optimal use of authorized vaccines in Canada. NACI has been operating for over 50 years as the country's national immunization technical advisory group, and it is widely respected by provinces and territories and internationally.
The committee is made up of experts from across Canada in the fields of pediatrics, infectious diseases, immunology, pharmacy, nursing, epidemiology, pharmacoeconomics, social sciences and public health. In the context of COVID-19, Canada's federal, provincial and territorial governments utilize the advice of NACI as the authoritative body on pandemic vaccine prioritization and vaccine public health program design. Its recommendations are designed to support the pandemic public health response goals of reducing serious illness and overall death while minimizing societal disruption as a result of COVID-19.
NACI's COVID-19 advice is focused on the strategic prioritization of vaccines and specific vaccine guidance and ranking of products for clinical use. Its recommendations inform federal, provincial and territorial governments' planning for the efficient, effective and equitable allocation of COVID-19 vaccines. NACI thoroughly reviews available evidence when developing its recommendations. This includes the consideration of vaccine characteristics, such as safety, efficacy, immunogenicity and effectiveness. NACI also incorporates programmatic factors such as economics, ethics, equity, feasibility and acceptability.
NACI's guidance is advisory in nature. Immunization program planning and delivery decisions fall under provincial and territorial jurisdiction. The provinces and territories ultimately determine how to use authorized COVID-19 vaccines based on jurisdictional needs and circumstances, including local epidemiology, public health considerations, health care system capacity and vaccine management logistics.
NACI is supported by a secretariat housed within the Public Health Agency of Canada. While NACI members are not government employees and remain external to the federal government, the secretariat supports committee meetings and deliberations, the rigorous scientific review of evidence and the development of NACI statements and communication products for health care providers and the public. The secretariat support is necessary as the committee members are volunteers, holding important full-time clinical and public health roles.
NACI complements the expertise of its broad membership by conducting extensive stakeholder engagement when developing its recommendations, involving many liaison organizations. The Canadian immunization committee, which is a federal, provincial and territorial table, is actively involved at multiple points in NACI's work. When drafting guidance on COVID-19 vaccines, including the AstraZeneca vaccine, NACI sought input from the special advisory committee on COVID-19, which is made up of provincial and territorial chief medical officers of health and other senior officials.
There is an important distinction to be made between NACI's role and Health Canada's function as Canada's national regulator. It is not uncommon for NACI to provide recommendations that are broader or narrower than the conditions of use approved by Health Canada. NACI is different from Health Canada, which does not dictate practice of medicine or make recommendations on how vaccines should be used in different age groups and subpopulations for public health impact.
In keeping with its mandate to optimize the public health benefits of immunization in Canada, NACI has historically provided preferential recommendations on the use of vaccines in key populations for diseases. Some examples include influenza and shingles vaccines. In making its recommendations, NACI also takes into consideration other vaccines available in Canada and may make preferential recommendations based on the current context. This is different from Health Canada as the regulatory authority that reviews each vaccine independently to assess if there is sufficient evidence of safety, efficacy and manufacturing quality to meet regulatory requirements for authorizations.
Clinicians are very used to consulting both the product monograph and NACI advice when making their clinical vaccine decisions for patients. They do not expect these to be identical, understanding that they are driven by different perspectives.
NACI's recommendations complement regulatory indications with real-world context and with information on public health strategies based on available and evolving evidence. The committee revises its recommendations when needed based on new evidence as well as the evolving context.
On the global stage, other countries rely on their respective national immunization technical advisory groups for COVID-19 expert advice. Through the NACI secretariat within PHAC, NACI is well connected to international advisory committees of this type. In fact, Canada is currently the chair of the global NITAG network, a World Health Organization-supported forum where national technical advisory committees on immunization share information and collaborate on work plans.
The NACI secretariat is in regular contact with countries bilaterally and through the global NITAG network to stay up to date on international COVID-19 developments.
PHAC expects different approaches to be adopted around the world in response to COVID-19. Every country develops immunization programs that are informed by local epidemiology, values, preferences, social infrastructure and health care systems. Naturally, these considerations vary significantly by country.
As you are all aware, real-world evidence on COVID-19 and vaccine effectiveness is evolving in real time. NACI continues to closely monitor and review this emerging evidence and will revise its recommendations as information becomes available.
I would like to thank the committee chair and members for the opportunity to address this committee.
Thank you.