Pharmacies

are the main source of self-pay zoster vaccine presently across the country. Having this “third source” of vaccines and vaccinators will assist public health to rapidly deliver vaccines in the event of an epidemic. Caspases apoptosis The same infrastructure will be very helpful for expanding RUV use as pharmacists and physicians are natural partners. Physicians find it easier to mention RUVs to appropriate patients knowing the local pharmacist will then help patients make informed decisions, and will deal with vaccine administration, inventory and, payment. The role played by public health in Canada in delivering immunizations varies among the provinces, some having mainly physician-delivered and others mainly public health-delivered programs. Until recently, public health authorities overseeing both kinds of programs did not consider that they had an obligation to promote or provide RUVs. While consistent with a narrow interpretation of public health’s mandate to provide Lonafarnib mw evidence-based interventions of proven public health benefit, this may be short-sighted given that most nationally recommended vaccines have eventually

been funded for public programs. Furthermore, the public will not be aware of nuances of individual versus population benefits and governments will not be able to fund every new vaccine that offers proven health benefits to some citizens. The precautionary principle, taken to its extremes in other public health issues, might also be applied to RUVs since their contribution to risk reduction may well outweigh other costly activities of health departments, such as contact tracing after large exposure events. The below final public health concern is about equity and the opportunity cost of promoting a self-pay intervention that only some can afford, usually those at lowest risk, and thereby forgoing other activities directed at the most vulnerable. This latter argument is countered by the need to be transparent in dealing with the public, the opportunity to use RUVs to promote the benefits of vaccines more generally, and the benefits of learning more about new vaccines through their use in the field. Presently public health agencies in several

provinces recognize that an obligation exists to support the use of all NITAG-recommended vaccines, not just the ones their province has chosen to supply for free [24] and [25]. These health departments provide similar promotional materials for funded and unfunded vaccines, directed at physicians and the public. They also accept the same obligation physicians have to mention the availability and potential benefits of RUVs to appropriate individuals, as best practice. Local clinics sometimes supply RUVs if other sources are limited, akin to travel vaccines. Such a holistic attitude about new vaccines encourages greater use of these vaccines before they move from RUV limbo to the funded category and facilitates extension of vaccine use beyond narrow, funded categories.