Dr. Caroline Quach-Thanh, Quebec’s director of public health, made clear her displeasure. She is particularly alarmed by the United States’ impending transition to a new vaccination policy for infants. Figure 2 Universal hepatitis B vaccinations for newborns in the U.S. today. This very program sunsets in December 2025. Under the new policy, infants will only receive the hepatitis B vaccine if their parents test positive for the virus. Given the possibly far-reaching implications of this decision for public health recommendations, it especially merits consideration in countries with other healthcare systems.
The old U.S. policy required that all infants be vaccinated. This decision echoed the unproductive approaches of the 1980s, which were unable to prevent parent to child transmission of hepatitis B. Dr. Quach-Thanh is optimistic that Canada’s tripartite healthcare framework offers an advantage. That’s why he says going back and changing public health guidance to fit U.S. policy is nonsensical.
Differences in Healthcare Systems
Dr. Quach-Thanh pointed out that Denmark, like Canada, has a strong publicly funded healthcare system. In this approach, prenatal patients are screened for hepatitis B. Once a parent tests positive for the virus, the child is considered at risk. The answer is that, through government requirements and incentives, the child gets the hepatitis B vaccine right after birth. This points to an important distinction between Denmark’s series of reforms and the soon-to-be U.S. policy shift.
“Denmark has a publicly funded health-care system like Canada, which the U.S. doesn’t.” – Dr. Caroline Quach-Thanh
Pediatrician Dr. Cora Constantinescu seconded the need for evidence-based decision-making for vaccine policies to be established. She addressed the point that Canada’s recommendations shouldn’t be changed just because the U.S. has changed theirs.
“Just because the CDC has changed their recommendation, I do not see Canada changing their recommendations.” – Dr. Cora Constantinescu
As for Canadian populations, she further explained, no new evidence has suddenly bubbled up to the surface. There is little incentive to re-examine what’s being done.
Vaccine Recommendations in Canada
Exclusively in Canada, the National Advisory Committee on Immunization (NACI) provides recommendations on vaccines. It’s left to provincial and territorial health authorities to determine if or how they’re adopted. Canada has been at the fore advocating for inclusion of universal hepatitis B vaccination in infant immunization programs. It’s holding onto this position, even as America changes right under its feet.
Dr. Sumon Chakrabarti, an infectious diseases specialist, assured parents that fully vaccinated children would remain protected regardless of changes in U.S. recommendations. He urged travelers, especially parents, to be aware of disease outbreaks as they make decisions about their travel plans.
“As long as that disease exists somewhere else in the world, you’d have to have a very careful risk analysis on whether your population is going to be re-exposed to that disease.” – Dr. Cora Constantinescu
Dr. Constantinescu emphasized the need for equitable vaccine access and improving confidence in vaccine safety, especially considering variations between Canadian provinces. She noted that Ontario is likely to face worsening access challenges. In Alberta’s case, contrasted with strong access, they might have good access but they may still deal with vaccine confidence issues.
The Importance of Evidence-Based Approaches
The experts strongly encourage the government to go back to using an evidence-based process for Canadian vaccine recommendations. Dr. Constantinescu stressed that the development of vaccination programs should always be preceded by careful consideration, discussion, and debate within the healthcare community.
“When we make recommendations and when we make decisions, it takes reflection,” – Dr. Cora Constantinescu
She emphasized the need to do robust literature scans and cost-benefit analyses. Canada still respects this practice to this day before rolling out any vaccination schedule.
Dr. Quach-Thanh expressed hope that Canada would maintain its commitment to evidence-based approaches as it navigates the complexities of public health recommendations amid international changes.
“All this to say that when people introduce these vaccination programs, a lot of thoughts and economic analyses go into coming up with a schedule like that.” – Dr. Cora Constantinescu
