Potentially avoidable morbidity and mortality will continue to occur. It is timely to consider alternatives to all-or-none public access to new vaccines. Should an individual’s prerogative to take advantage of an approved vaccine not be recognized and encouraged, even in the absence of publicly-funded programs? If so, how might this be accomplished? Canada has had recent experience with

a number of “recommended but unfunded vaccines” (RUVs) and is beginning to recognize an obligation to facilitate vaccine use outside of public programs. Placement of a newly licensed product in the RUV category has doomed some previous vaccines to limited uptake [10], [11] and [12], but improvements may be possible with supportive social changes. This review shares Canadian experiences with RUVs and offers suggestions that might have broad application for increasing public access to unfunded vaccines. Canada has historically been a world leader in quickly INCB28060 in vitro adding new vaccines to public programs [13], [14] and [15], but recently, delays of several years have occurred between marketing authorization and public funding of 6 new vaccines. These included pneumococcal and meningococcal conjugates, varicella, zoster, Tdap, and

rotavirus vaccines. Canada resembles Europe in microcosm: while we have a single regulatory authority and central NITAGs [16], each of the 13 provinces and Navitoclax territories that make up the country is individually responsible for immunization program funding and scope. Consequently, vaccines can be supplied to the public in some provinces but not others, for varying periods of time. For example, pneumococcal

and meningococcal C conjugate vaccines were approved for sale in 2001 but were not supplied to children in all provinces until 2005–2006. Rotavirus vaccines were first recommended by the NITAG in 2008 [17] whatever but only 5 of 10 provinces currently offer funded programs. Zoster vaccine was recommended by the NITAG in 2010 [18] but no province currently supplies it to seniors without cost. Furthermore, there appears to be no movement towards public funding of zoster vaccine, tied to the broader challenges of prioritizing and delivering immunizations for adults. The RUV category is expected to grow as more vaccines are marketed for adults, including alternative formulations of influenza vaccines for seniors. Variability also exists in the scope of funded provincial programs, which often target only a portion of potential beneficiaries, without a catch-up program for others at risk. Human papillomavirus (HPV) vaccines are currently used in limited-scope programs that differ among provinces, with only a subset providing catch-up programs for older girls/women or targeting boys, as recommended in 2012 [19]. Thus a recommendation from Canada’s NITAG to use a new vaccine is no longer synonymous with provision of the vaccine in publicly-funded programs, as it once was.