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Perry R. W. Kendall, The 2009 Provincial Decision to De-emphasize Seasonal Influenza Vaccine in Canada: Real-Time Risk-Benefit Analysis, Clinical Infectious Diseases, Volume 52, Issue 6, 15 March 2011, Pages 829–830, https://doi.org/10.1093/cid/cir037
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TO THE EDITOR—In his editorial commentary [1], Glezen did not accurately reflect the full risk-benefit analysis undertaken by provinces of Canada in their decision to deemphasize the 2009 seasonal influenza vaccine program, and in addition he misrepresents the immunization policy process followed in Canada [1].
Findings during the spring-summer 2009 that showed seasonal influenza vaccine was associated with ∼2-fold increased risk of pandemic illness were unexpected [2, 3]. However, their consistency across multiple studies (6 in total by the fall 2009) in Canada lent a credibility that could not be dismissed [2, 3]. These findings motivated urgent reanalysis of anticipated seasonal influenza vaccine benefits versus risks in Canada. They were, however, not the sole or even main determinant of provincial program decisions.
In response to these studies, provinces sought expert input through national pandemic and immunization advisory committees, but ultimately health care decisions are under provincial jurisdiction. The statement issued by the Canadian Agency for Drugs and Technologies in Health (CADTH) cited by Glezen summarized provincial decisions that were reached, but that document did not constitute the evidence base for those decisions [1]. CADTH does not play a role in Canadian decision making in this arena.
