Concerns about equity and justice were raised from the outset of the COVID-19 pandemic and the implementation of anti-COVID vaccines, initially in northern countries and later worldwide[i]. After much hesitations and discussions, the world took a significant step in terms of Social Accountability in Health[ii][iii], and more specifically in global responsibility, with the establishment of mechanisms and frameworks for access to COVID-19 vaccines. As part of ongoing vaccination efforts, the Covax initiative was a significant shared commitment[iv]. The supply and distribution, and consequently access to the vaccines, certainly did not reach optimal levels. Low-income countries had only limited access, resulting in vaccination coverage levels falling below expectations. However, a major, unprecedented development emerged from the entire process. This is the program of compensation in the absence of fault initiated to cover populations in resource-limited countries as part of the Covax initiative[v].
At the onset of COVID-19 and the related immunization, the formal mechanism for compensating victims in case of the occurrence of debilitating or harmful post-vaccination side effects had already existed for 60 years. Indeed, fresh from the horrors of Nazi medical experiments and the Nuremberg Medical Tribunal with its devastating revelations[vi] ], the German Supreme Court decided in 1953 that injuries resulting from mandatory vaccination should be subject to compensation. The country became the first nation to establish a vaccine compensation program in 1961[vii]. It often emerges that even though such a measure exists, in some cases, there is little reporting or documentation of experiences, such as the one adopted by the British government in 1979 to address the plummeting pertussis vaccination rates following parental complaints about vaccine side effects on their children[viii].
The modes of administration of these programs involve national or subnational governments with funding from national, state, or municipal treasuries, manufacturer levies, or various vaccine taxes[ix]. In light of these approaches, it is important to recognize that the compensation program initiated under the Covax framework is a significant innovation in that it is the only one with a global perspective. Similarly, its method of estimating compensations is transparent and known to all. This marks a significant step toward global equity and social accountability in health.
[i] Usher A. D. (2021). ACT-A: “The international architecture did not work for us” Lancet, 400, (10361), p1393-1394.
[ii] Boelen C. (1999). Adapting health care institutions and medical schools to societies' needs. Acad Med;74(8 Suppl):S11-20.
[iii] Eaton DM, Redmond A, Bax N. (2011). Training healthcare professionals for the future: internationalism and effective inclusion of global health training. Med Teach;33:562-9.
[iv] UNICEF (2021). COVAX: ensuring global equitable access to COVID-19 vaccines. https://www.unicef.org/supply/covax-ensuring-global-equitable-access-covid-19-vaccines.
[v] Gavi (2021). The COVAX No Fault Compensation Programme: Explained. https://www.gavi.org/vaccineswork/covax-no-fault-compensation-programme-explained.
[vi] Weindling P. J. (2008). The Nazi medical experiments in Ezekiel J. Emanuel, Christine C. Grady, Robert A. Crouch, et al. The Oxford Textbook of Clinical Research Ethics p 18-30. Oxford University Press.
[vii] Looker C. & Kelly H. (2011). No-fault compensation following adverse events attributed to vaccination: a review of international programmes. Bull World Health Organ 89:371–378. doi:10.2471/BLT.10.081901
[viii] Millward G. (2016). A Disability Act? The Vaccine Damage Payments Act 1979 and the British Government’s Response to the Pertussis Vaccine Scare. Social History of Medicine 30(2) 429–447.
[ix] Dubé E, Gagnon D, MacDonald NE, Harmon SHE, Hapuhennedige S. (2020). Programme d’indemnisation des victimes d’une vaccination : Justification et aperçu du programme du Québec. Relevé des maladies transmissibles au Canada ; 46(9):344–8. https://doi.org/10.14745/ccdr.v46i09a09f
Flu season already underway and the immunization campaign as well
The 2023-24 flu season is already underway in Canada, and the vaccination campaign is in progress as well. The measures taken encompass all routine aspects. Information regarding this campaign, including authorized vaccines, is available. Pertaining to Pluts' field of interest, the update of evidence-based data is provided to lend greater authority to vaccination decisions and guidance. The Declaration of the National Advisory Committee on Immunization (NACI) (Statement on Influenza Vaccination for the 2023-2024 Season) serves this purpose effectively. An overview of the 2022 annual flu report and the update on flu surveillance in Canada in September 2023 highlights two significant facts. The positive impact of COVID-19 on flu vaccine coverage has diminished. The goal of achieving an 80% coverage rate for seniors has not yet been reached. More information below:
The usual locations for seasonal flu vaccination by province remain the reference points for receiving the vaccine. In light of the past significance of various factors in the reasons for non-vaccination, such as not having a family doctor or not knowing where to obtain the vaccine[i], vaccination locations have gained great importance. The 2022-2023 seasonal flu vaccination coverage survey has shown the importance of some places as vaccination sites. These include pharmacies and temporary clinics, among others. Indeed, a higher number of adults preferred to receive their flu vaccine at a pharmacy (52%) or at a temporary vaccination clinic (12%) compared to the 2019-2020 season (pre-pandemic)[ii]. Vaccination locations by province can be found at the link below. Please note that for some provinces, the information must be sought on provincial websites.
[i] Roy M., Sherrard L., DubéE. et. Gilbert N. L. (2018). Déterminants de la non-vaccination contre la grippe saisonnière. Statistique Canada, no 82-003-X au catalogue • Rapports sur la santé, vol. 29, no 10, p. 13 à 23 .
[ii] Faits saillants de l'Enquête sur la couverture vaccinale contre la grippe saisonnière de 2022–2023. https://www.canada.ca/fr/sante-publique/services/immunisation-vaccins/couvertures-vaccinales/resultats-enquete-grippe-saisonniere-2022-2023.html#a1
After the management of the emergency and emergency approvals, research on COVID-19 vaccines has taken various directions, including expanding the options for more choices and improving vaccines on various fronts. The scientific review processes by expert teams and approvals make it possible to provide Canadians with vaccines for which the data and evidence provided by the manufacturers meet established requirements. The review and approval processes for different vaccines have benefited from collaboration between agencies in the United States and Canada. Internationally, to address regulatory questions, the International Coalition of Medicines Regulatory Authorities (ICMRA) and the World Health Organization (WHO) have issued a statement[i] to help address the issues faced by healthcare professionals regarding the role of regulatory agencies in monitoring anti-COVID-19 vaccines. In Canada, the list of approved vaccines for COVID-19 vaccination can be accessed at the link below. Data on the types of vaccines are also provided to meet the information and knowledge needs of citizens.
[i] OMS (2022). Déclaration à l’intention des professionnels de la santé : Comment les vaccins contre la COVID-19 sont réglementés pour des raisons d’innocuité et d’efficacité (révisé en mars 2022). https://www.who.int/fr/news/item/17-05-2022-statement-for-healthcare-professionals-how-covid-19-vaccines-are-regulated-for-safety-and-effectiveness
Don't get scammed again: Where to get vaccinated against Covid-19
The danger, especially for the elderly, of falling into the hands of fraudsters, being exposed to extortion, and having their social insurance number stolen, had raised concerns at the beginning of the pandemic. This situation was linked to the emergence of fake online vaccination appointment booking websites for COVID-19. The existence of fake vaccines and fake vaccination locations had also been mentioned. The COVID-19 vaccination is soon to experience a resurgence due to increasing disease prevalence trends. Beyond the mere desire to get vaccinated, there are preferences when it comes to choosing COVID-19 vaccination sites. The invitation to schedule a vaccination appointment is regularly issued by health authorities. However, in terms of preference, walk-in vaccination sites cater to the needs of some citizens. Given the diversity of vaccine types, some users wished to know the vaccines available at the sites before making an appointment or traveling to the vaccination location. The various COVID-19 vaccination sites have been published to facilitate appointment scheduling.
Individuals always remain weaker and more vulnerable when faced with systems and institutions. It is necessary for approaches to their protection to be anticipated within processes that could work against them and, at worst, be malevolent, regardless of good intentions. Vaccines, their administration processes, and programmatic flaws can be sources of suffering for those who receive them. The difficulty of establishing causality relationships makes the hopes of recognizing victim status uncertain. Even when requested and willingly received, nothing absolves the ultimate administrator of a vaccine from responsibility and accountability for an unfavorable and harmful outcome of vaccination. In order to address these potential damages and harms, many countries have adopted policies to support or compensate victims of vaccination. Following Quebec, which had its own program since 1985, Canada adopted a Support Program for Victims of Vaccination in December 2020. Information about the conditions and procedures for claims can be obtained from the link below.