VACCINE RESOURCE COMMITTEE

of the Edmonton Zone Medical Staff Association

View Full List of Vaccine Questions Here

General Vaccine Question #16:

Why are some the vaccines (RSV and shingles) not covered by the
Alberta Health Care Insurance Plan?

It is a government decision for which vaccines are covered and varies by province.

The federal government is responsible for regulating vaccines that are approved for use in Canada. Provincial/ territorial governments buy the vaccines for public programs, distribute the vaccine and govern eligibility for public funding. Each individual province/territory decides which vaccines it will pay for and which it will not, meaning one province/territory can differ from others.

The approval process begins with in-depth review of vaccine properties and performance by the national biologics regulator, the successful conclusion of which is marketing authorization (or licensure in some countries). In theory, vaccine consumption can begin at this point. However, vaccines are best provided to populations through funded public programs, consideration of which requires additional review, usually by the national immunization technical advisory group. These experts consider the broader public health implications of vaccine use including local disease epidemiology, program feasibility, cost-effectiveness, potential herd immunity, equity of access, and other issues, sometimes using a formal analytical framework to reach a recommendation for population use. The final step towards a public program is funding approval, often involving other government departments with competing funding requests impinging on the process. Whereas requests to fund vaccines are increasingly framed in economic terms, equally stringent criteria are seldom applied to other major healthcare expenditures, such as new therapeutic agents.

Alberta has an advisory committee on immunization. This committee makes recommendations to the government about which vaccines should be publicly funded and for who. The government has the final decision.

For example, Ontario funds Shingrix for ages 65 to 70, Prince Edward Island funds for age 50 and older and Alberta age 18 and older only solid organ transplant and HSCT.    

Always check with patients for their coverage for medications/vaccines. If a vaccine is recommended but not publicly funded by the Alberta Health Care Insurance Plan[KF1] , it may still be possible for it to be paid for by the federal government (for certain groups), Alberta Adult Health Benefit, Alberta Child Health Benefit or a third-party.

Sources

Government of Alberta: Immunization Policy
Elsevier: Vaccine: Approved but non-funded vaccines: Accessing individual protection
Ontario: Shingles Vaccine
Prince Edward Island: Free shingles vaccine program expanded to include Islanders 50 and over