Abstract
Immunization is a public health area in which the intergovernmental challenges of formulating a national policy are evident. It is also an area in which harmonization of policy across Canada is particularly critical. The National Immunization Strategy was a F/P/T initiative designed to achieve this policy goal. The combination of national guidelines and flexible federal funding via a trust has, to date, been effective in improving equality of access to vaccines in provincial/territorial programmes with limited intergovernmental discord. The long-term success of the initiative will, however, largely depend on ongoing federal financial support and provincial/territorial views on national guidelines. This approach to immunization is a model that would lend itself well to other public health areas in which there is large variability in provincial/territorial programmes, where uniformity of programmes is particularly important and where there is a reluctance or inability of the federal government to legislatively mandate the harmonization of programmes.
Key words: National Immunization Strategy, immunization, inter-governmental relations, Canada
Résumé
L’immunisation est un secteur où la formulation d’une politique de santé publique nationale pose clairement des difficultés de coordination intergouvernementale. C’est aussi un secteur où il est particulièrement critique d’harmoniser les politiques à l’échelle du Canada. La Stratégie nationale d’immunisation, une initiative fédérale-provinciale-territoriale, visait une telle harmonisation des politiques. La combinaison de lignes directrices nationales et d’un financement fédéral souple (par l’entremise d’une fondation) a, jusqu’à maintenant, réussi à améliorer l’égalité d’accès aux vaccins dans les programmes provinciaux et territoriaux en limitant les désaccords intergouvernementaux. À long terme, l’efficacité de la stratégie dépendra cependant en grande partie d’une aide financière soutenue de la part du gouvernement fédéral et de l’opinion des provinces et des territoires à l’égard des lignes directrices nationales. La Stratégie nationale d’immunisation est un modèle qui pourrait être efficace dans d’autres secteurs de la santé publique, là où il existe une grande variabilité dans les programmes provinciaux et territoriaux, où l’uniformité des programmes est particulièrement importante et où il y a une réticence ou une incapacité, de la part du gouvernement fédéral, à harmoniser les programmes en légiférant.
Mots clés: Stratégie nationale d’immunisation, immunisation, relations intergouvernementales, Canada
Footnotes
Acknowledgements: This study was supported by a grant from the Canadian Institutes of Health Research and the Public Health Agency of Canada. Dr. Wilson is supported by the Canada Research Chair in Public Health Policy.
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