Law as a Barrier and an Enabler

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

Primary disease prevention through immunization is a global public health priority with clear economic and health and well-being benefits, a fact emphatically demonstrated by the COVID-19 pandemic. Nonetheless, immunization is a fragmented healthcare practice in Canada, vaccination rates are not optimal, and vaccine acceptance is variable, with resistance becoming more vocal in the pandemic setting. If Canada is to develop effective strategies to increase immunization, including during disruptive outbreaks of diseases for which there are no vaccines, then we need to know much more about immunization as a ‘regulated space’, for the reality is that are significant gaps in our understanding what public factors such as regulation exist across Canada, and how they exert influence over immunization practice and public behaviour. 

The ‘Law as Enabler/Barrier Project’ is aimed at better understanding immunization as a regulated space in Canada, focusing on how law compromises or facilitates immunization objectives. It will generate insights into the content and scope of immunization governance frameworks that exist, and assist in identifying what might be done for Canada to perform better in this setting. Though meant as a scoping exercise, its objectives are to: 

  • survey 7-13 Canadian provincial and territorial jurisdictions and create a map of governance frameworks (e.g., key actors, policies, laws); 
  • assess those frameworks using the designed schema to facilitate insights into how comprehensive governance frameworks are and how they compare to each other; 
  • more closely examine approaches to the critical issues of mandatory immunization and compensation for serious adverse events following immunization; 
  • develop options for reform of the legal regulation of immunization in Canada. 

These objectives are critical to better understanding both routine and responsive or emergency immunization, and improving immunization practice and governance in Canada. They will be achieved through an environmental scan of governance/policy documents, a literature review, an online survey and interviews with actors in the immunization setting, the data from which will be triangulated to develop new insights and recommendations. 


Immunization Responses in Canada: A Nation-wide Analysis of Gaps in the "System"

On Wednesday December 8th 2021, Technoscience and Regulation Research Unit presented a symposium at the Canadian Immunization Conference entitled 'Immunization Responses in Canada: A Nation-wide Analysis of Gaps in the "System"'. 

Scholarship undertaken throughout the pandemic has identified a range of gaps in Canada’s immunization governance landscape, some of them persisting despite long-running calls for reform (e.g., absence of patient-centred health information systems, absence of unified vaccine injury compensation scheme, closed-loop
nature of decision-making, etc.). During the COVID-19 pandemic, some gaps were addressed with ad hoc measures. Presenters in this symposium will identify governance gaps, examine public health interventions against the unfolding epidemiological data, and query the extent to which evidence-based decision-making was being pursued, and the extent to which Chief Medical Officers of Health and the Public Health Agency were empowered to serve their intended purposes.

Learning Objectives

• Describe a schema for an immunization framework that reflects responsible governance, appreciating how 
different aspects of immunization fit into the overall schema. 
• Identify, compare, and summarize differences in leadership, interventions, and outcomes in different parts of Canada, drawing on the epidemiological data available across Canada. 
• Explore why different approaches were taken in different parts of Canada, again bearing in mind the demands of the concepts of responsible governance and responsible research and innovation. 
• Illustrate how clearer standards and expectations can be instantiated in a legal framework to address some of the shortcomings identified. 




Kholina, K., Harmon, S. H. E., & Graham, J. E. (2022). An equitable vaccine delivery system: Lessons from the COVID-19 vaccine rollout in Canada. PLOS ONE17(12), e0279929.

Lowe, M., Harmon, S., Kholina, K., Parker, R. & Graham, J. (2022). Public Health Communication in Canada during the COVID-19 Pandemic. Canadian Journal of Public Health.

Harmon, S. H. (2022). Vaccine Injury Compensation and Support Programs: A Values-Based Justification and Structure. Health Law in Canada Journal. 

Harmon, S. H. (2022). The immunization of children in family break-down: Questionable evidence and conceptual shortcomings in A.P. v L.K. Medical Law International.

McDonald, N., Harmon, S., Graham, J.E. (2021). An Ethics Check Up of Public Health Immunization Programs in Canada.  CCDR 47-4: COVID-19: A Year Later. Available here.

MacDonald, N.E., Dube, E, Graham, J.E. (2021). How Government Policies and Political Ideologies Impact Vaccine Acceptance: COVID-19 and Beyond. CanVax. Available here.

MacDonald, N., Comeau, J., Dubé, È., Graham, J., Greenwood, M., Harmon, S., McElhaney,  J., McMurty, C. M., Middleton, A., Steenbeek, A., Taddio, A. (2021). Enhancing COVID-19 Vaccine Acceptance in Canada. Royal Society of Canada. Available here.