Dr. Valerie Jaeger Acting President Providing Leadership in Public Health Management

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Stanley Paul
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1 2 Carlton Street, Suite 1306 Toronto, Ontario M5B 1J3 Tel: (416) Fax: (416) alpha s members are the public health units in Ontario. alpha Sections: Boards of Health Section Council of Ontario Medical Officers of Health (COMOH) Affiliate Organizations: ANDSOOHA - Public Health Nursing Management Association of Ontario Public Health Business Administrators Association of Public Health Epidemiologists in Ontario Association of Supervisors of Public Health Inspectors of Ontario Health Promotion Ontario Ontario Association of Public Health Dentistry Ontario Society of Nutrition Professionals in Public Health Hon. Eric Hoskins January 15, 2016 Minister of Health and Long-Term Care 10 th Floor, Hepburn Block 80 Grosvenor Street Toronto, Ontario M7A 2C4 Dear Minister Hoskins: Re: Immunization 2020 On behalf of member Medical Officers of Health, Boards of Health and Affiliate organizations of the Association of Local Public Health Agencies (alpha), I am writing today to congratulate you on the release of the Immunization 2020 Modernizing Ontario s Publicly Funded Immunization Program report. We are very supportive of the Government of Ontario s commitment to ensuring that public acceptance, availability and uptake of vaccinations are improved through a high performing, integrated immunization system. We agree that immunization is one of the most successful and cost-effective health interventions available, and our members remain its most vocal advocates. In examining the report, we took special interest in its proposed actions, and took special note that Action #1, Expand Immunization Delivery Models, includes the following with regards to childhood immunizations: We will look to offer additional vaccines and catch-up immunizations for school-aged children and adolescents through school-based immunization clinics. We believe that although Immunization 2020 is a longer-term plan, this is an area where immediate action can and should be taken. The attached alpha Resolutions (A HPV Immunization of All Students, A Eligibility into Perpetuity for HPV, HBV and Tdap Vaccines and A01-3, Vaccine Availability) are directly related to this action and provide the rationale for its immediate implementation. We hope that you will take these resolutions into careful consideration in the near term, and we look forward to doing our part to assist you in advancing these and other elements of the Immunization 2020 plan. Sincerely, Dr. Valerie Jaeger Acting President Providing Leadership in Public Health Management

Health Business Administrators Association of Public Health Epidemiologists in Ontario Association of Supervisors of Public Health Inspectors of Ontario Health Promotion Ontario Ontario Association

2 Copy: Hon. Kathleen Wynne, Premier of Ontario Hon. Liz Sandals, Minister of Education Hon. Charles Sousa, Minister of Finance Dr. David Williams, Chief Medical Officer of Health (A) Dr. Bob Bell, Deputy Minister, Health and Long-Term Care Roselle Martino, Assistant Deputy Minister, Population and Public Health Division, Attach. The Association of Local Public Health Agencies (alpha) is a non-profit organization that provides leadership to Ontario s boards of health and public health units. The Association works with governments and other health organizations, to advocate for a strong and effective public health system in the province, as well as public health policies, programs and services that benefit all Ontarians.

Bob Bell, Deputy Minister, Health and Long-Term Care Roselle Martino, Assistant Deputy Minister, Population and Public Health Division, Attach.

3 alpha RESOLUTION A12-10 TITLE: SPONSOR: HPV Immunization of All Students The Regional Municipality of Durham infection with HPV types 6 and 11 causes anogenital warts and with HPV types 16 and 18 is associated with cancers of the penis, anus, mouth, and oropharynx in males; and more than 70% of sexually active men and women are infected with HPV at least once in their lifetime; and HPV infection is a associated with a significant burden of anogenital warts and anogenital and head & neck cancer; and in Canada, of the ~150 men and ~200 women who are diagnosed with anal cancer every year, 80 to 90% case are HPV positive; and in February 2010, a quadrivalent HPV vaccine (Gardasil ) was authorized by Health Canada to expand its indications to include males 9 to 26 years of age for the prevention of infection caused by HPV types 6, 11, 16, and 18 and for genital warts caused by HPV types 6 and 11; and in May 2011, Gardasil was indicated in females and males 9 through 26 years of age for the prevention of anal cancer caused by HPV types 16 and 18 and anal intraepithelial neoplasia grades 1, 2, and 3 caused by HPV types 6, 11, 16, and 18; and in January 2012, the National Advisory Committee on Immunization (NACI) advised that Gardasil be recommended for use in males between 9 and 26 years of age for the prevention of anal intraepithelial neoplasia grades 1, 2, and 3, anal cancer, and anogenital warts (NACI Grade A Recommendation); and NACI also advised that Gardasil be recommended in males between 9 and 26 years of age for the prevention of penile, perianal, and perineal intraepithelial neoplasia and associated cancers (NACI Grade B Recommendation); and all grade 8 female students are eligible to receive 3 publicly funded doses of Gardasil through public health school-based immunization clinics ; NOW THEREFORE BE IT RESOLVED that alpha urges the Ontario government to expand Ontario s Publicly Funded Immunization Schedule to make Gardasil available to male students through public health schoolbased immunization clinics; AND FURTHER that the Premier of Ontario, Ministers of Children and Youth Services, Education, Finance and Health and Long-Term Care, Chief Medical Officer of Health, Chief Public Health Officer of Canada, AMO and all Ontario boards of health are so advised.

is a associated with a significant burden of anogenital warts and anogenital and head & neck cancer; and in Canada, of the ~150 men and ~200 women who are diagnosed with anal cancer every year, 80 to

4 AND FURTHER that all students who are eligible for immunization against HPV maintain their eligibility throughout high school. AND FURTHER that alpha recommends a review to be conducted of the program to enhance uptake in girls including moving the program to grade 7 and implementing a catch-up program. ACTION FROM CONFERENCE: Resolution CARRIED AS AMENDED

AND FURTHER that alpha recommends a review to be conducted of the program to enhance

5 alpha RESOLUTION A11-7 TITLE: SPONSOR: Eligibility into Perpetuity for HPV, HBV and Tdap Vaccines Board of Health of the Simcoe Muskoka District Health Unit immunization is one of the most effective public health strategies, saving more lives than any other single health intervention in Canada in the last 50 years; and the Ontario Public Health Standard requires Boards of Health to engage in activities to reduce or eliminate the burden of vaccine preventable diseases; and Human Papillomavirus and Hepatitis B virus are among the top ten, and Pertussis is among the top 35 pathogens causing death; and the respective vaccines for these pathogens (HPV; HBV; and Tetanus, Diphtheria and Acellular Pertussis [adolescent/adult type vaccine Tdap, a.k.a. Adacel]) are only funded for specific school grades or ages; and children who do not receive these vaccines in these specific times are not authorized by the province to receive these vaccines through public funding for the entire age ranges recommended by National Advisory Committee on Immunization (NACI) (i.e. these vaccines are not funded into perpetuity); and a significant proportion of children eligible to receive these vaccines do not receive them during the grade or age requirements of the province; and provincially funded provision of these vaccines for the full age range recommended by NACI would remove a cost barrier for a significant number of people, thereby increasing overall vaccination rates; and there is no such age restrictions for eligibility for other publicly funded vaccines in Ontario; NOW THEREFORE BE IT RESOLVED that the Association of Local Public Health Agencies urge the Minister of Health and Long-term Care in consultation with the Chief Medical Officer of Health to expand the eligibility of publicly funded HPV, HBV and Adacel vaccination, such that children who do not receive these vaccines at the provincially-specified grade or age continue to be eligible to receive these vaccines through public funding for the entire age ranges and eligibility criteria recommended by NACI. ACTION FROM CONFERENCE: Resolution CARRIED AS AMENDED

activities to reduce or eliminate the burden of vaccine preventable diseases; and Human Papillomavirus and Hepatitis B virus are among the top ten, and Pertussis is among the top 35 pathogens causing

6 2001 alpha RESOLUTION NO. A01-3 TITLE: SPONSOR: Vaccine Availability Haliburton, Kawartha, Pine Ridge District Health Unit Board of Health safe and effective vaccines are cost beneficial when used in appropriate populations; and vaccines licensed for use in Canada have been determined to be safe and effective by Health Canada; and the National Advisory Committee on Immunization makes recommendations as to the appropriate populations requiring immunization and for whom immunizations would be worthwhile ; and the goal of the Infectious Disease Program of the Mandatory Programs Standards is that infectious diseases will be reduced or eliminated; and use of vaccines has repeatedly demonstrated a reduction or elimination of infectious disease; and any Canadian citizen or landed immigrant who develops a vaccine preventable disease, regardless of the point of origin of the infection, is eligible for all treatment at public expense; NOW THEREFORE BE IT RESOLVED that the Association of Local Public Health Agencies (alpha) petition the Provincial Government to: 1) fund all vaccines licensed in Canada within 12 months of such licensure and 2) make all vaccines licensed in Canada available through Boards of Health for administration to the categories of individuals as recommended by the National Advisory Committee on Immunization. Status of Resolution: Endorsed by the alpha membership June 12, 2001

and vaccines licensed for use in Canada have been determined to be safe and effective by Health Canada; and the National Advisory Committee on Immunization makes recommendations as to the appropriate

Providing Leadership in Public Health Management

Providing Leadership in Public Health Management 2 Carlton Street, Suite 1306 Toronto, Ontario M5B 1J3 Tel: (416) 595-0006 Fax: (416) 595-0030 E-mail: info@alphaweb.org alpha s members are the public health units in Ontario. alpha Sections: Boards of