Trust, Acceptance and Sufficiency: Law as a Barrier to, and Enabler of, Routine and Responsive Immunization including COVID-19A

Primary disease prevention through immunization is a global public health priority with clear economic and health and well-being benefits. However, there is growing recognition in Canada that vaccine uptake rates are not where they need to be for adequate control of vaccine preventable diseases. Importantly, these rates can be further eroded by unanticipated disruptive events such as a pandemic for which there is yet no vaccine (e.g., COVID-19). While control of COVID-19 will be more feasible once vaccine(s) become available, this will not be a simple decision federally or for the provinces and territories as it is highly probable that different types of COVID-19 vaccines will be available in Canada which differ as to safety and efficacy parameters, age targets, etc. While practice/program decisions need to be based on sound scientific evidence, legal considerations relevant to program design and delivery will frequently arise. For example, consider cases in which there are differences between manufacturer license recommendations and effective case- and conditions-sensitive use by and within programs. This project is a first step in gaining a better understanding of immunization, both routine and responsive i.e. in a pandemic, as a 'regulated space' . Laws may both help and may also hinder. The project will generate significant new insights into the content and scope of immunization governance frameworks ( laws and regulations) that exist across Canada, offering observations about their potential as barriers to, and enablers of, public health goals, with special attention to two issues that COVID-19 has already highlighted as problematic, namely the issues of mandates and vaccine injury compensation. The ultimate aim is to assist in identifying what might be done for Canada to perform better in this setting, taking into account its actions in response to COVID-19.