Understanding Canada’s Vaccine Injury Support Program

Transcript of the PHAC Vaccine Confidence Webinar series : Understanding Canada’s Vaccine Injury Support Program 

The following is a transcript of the PHAC Vaccine Confidence Webinar series : Understanding Canada’s Vaccine Injury Support Program live webinar on June 1, 2022.

The HTML version of the presentation can be found here
 

Slide 1

Narration by Aishwarya Shah: 

Hello and thank you for joining today's webinar on Understanding Canada's Vaccine Injury Support Program. My name is Aishwarya Shah and I'm a project officer for CANVax at the Canadian Public Health Association (CPHA).

It is our pleasure at CANVax to be hosting the Public Health  Agency of Canada's webinars on COVID-19 vaccines for healthcare providers.

To learn more about this webinar series, please visit our website at CANVax.ca in the link you see on the screen.

Before we begin, we would like to acknowledge the Canadian Public Health Association's office is situated on the ancestral and unseeded territory of the Algonquin Anishinabe people. They have been the guardians of this land for millennia and we're grateful for the example their stewardship provides. CPHA is committed to working with all First Nations, Inuit and Métis peoples and their governments in realizing meaningful truth and reconciliation.

Next slide, please.

Slide 2

Aishwarya Shah: Now on to some housekeeping items. If you have questions regarding technical difficulties throughout the webinar, please contact CANVax@cpha.ca and we will reply to you  as soon as we can. If multiple people are having the same problem, we will address it live via broadcast message in the chat.

The host will use the chat tab for extra communication to participants. Please keep an eye on that tab as well. This webinar is being recorded and will be made available on CANVax.ca and on CPHA's YouTube channel a few days after the presentation is finished. Presentation slides will also be posted on CANVax.ca.

We would love  to get your feedback as well, so please fill out our five-minute post-webinar survey and evaluation e-mail we will be sending after the webinar. Finally, if you have not  already registered with CANVax or subscribed to our newsletter, visit CANVax.ca today to do so.

Now I would like to turn the floor over to our moderator for today, Stephanie Elliott: with Public Health Agency of Canada. Over to you, Stephanie.

Slide 3

Stephanie Elliott: Thank you, Aishwarya. Good day. I would first like to thank CANVax for their support and hosting today and making this webinar possible. 

The topic of today's webinar is  understanding Canada's Vaccine Injury Support Program. We'll have a live Q&A period at the end of this presentation,so submit any questions you may have using the Q&A tab at the bottom of the Zoom control panel any time during the presentation. You can like other people's questions to vote them up in priority.

We'll answer as many questions as we can, time permitting, but we won't be able to get to all questions. As a reminder, we'll be posting a copy of this presentation and the video on the CANVax.ca website, and all registrants  will also be emailed a link. Next slide, please.

Slide 4 

Stephanie Elliott: I'd now like to introduce our speakers for today's webinar.

Stéphanie Parisian is the Acting Director of the Vaccine Injury Support Program Stéphanie's team received the mandate to implement the Vaccine Injury Support Program announced by the Prime Minister on December 10th, 2020. Since then, they've worked with partners to develop and implement the program, and this was officially launched on June 1st, 2021. Edward Maier is the Project Lead and Senior Case Manager with Raymond Chabot Grant Thornton Consulting, Inc.

Jennifer Crichton is a family physician at Rosemount Family Health Organization in Ottawa and holds an academic appointment with the Department of Family Medicine at the University of Ottawa. She's a medical consultant at RCGT Consulting, Inc. and the Vaccine Injury Support Program.

Next slide please.

Slide 5

Stephanie Elliott:  Here are the disclosures for our presenters today. 

Text on screen: 

Stéphanie Parisien has nothing to declare. Edward Maier has nothing to declare, Dr. Jennifer Crichton Receives consultant fees from Raymond Chabot Grant Thornton Consulting Inc. for the work associated with the Vaccine Injury Support Program. Stephanie Elliott has Nothing to declare

Next slide, please.
 

Slide 6

Stephanie Elliott: And here are the learner outcomes for today's presentation. At the end of the webinar, healthcare professionals should be able to explain the Vaccine Injury Support Program eligibility criteria and processes; support individuals who may have suffered a vaccine injury in submitting their claim; and to identify their role in supporting the claim process, for example, retrieval of medical records. 

Now I will pass things over to our first presenter of the day, Stéphanie Parisien. Thank you. Over to you, Stéphanie.

Stéphanie Parisian: Thanks, Stephanie. I'm happy to be here today to provide you with a bit of information and context on the creation of a Vaccine Injury Support Program from a federal government perspective.

Slide 7

Stéphanie Parisian: So what is a Vaccine Injury Support Program? These types of programs are mostly based on 3 core elements. 

First, they operate on the premise of no fault, meaning that financial support is provided to eligible individuals regardless of who is responsible or possibly at fault, e.g., a manufacturer or health  professional administering the vaccine.

Second, they are non-adversarial, meaning that they generally do not require a claimant to seek legal representation or seek expert medical review beyond what they would already be doing in the context of their injury.

And finally, these programs are intended to provide fair, timely, equitable financial compensation to individuals suffering from serious and permanent vaccine injuries. Studies have also demonstrated that Vaccine Injury Support Programs can protect and stabilize vaccine supply, reduce costs for public vaccination programs, promote investments, and enable innovation.

Next slide, please.

Slide 8

Stéphanie Parisian: So, driving factors for the pan-Canadian VISP. As you know, immunization is a core component of public health, as vaccines play an important role in reducing the incidence and severity of vaccine-preventable diseases.

For a long time, the government of Canada's provinces and territories have recognized the value of a Vaccine Injury Support Program and the COVID-19 pandemic further highlighted the importance of such a in strengthening Canada's immunization system.

Prior to the establishment of the pan-Canadian VISP, only residents of Quebec had access to financial support if they experienced a serious and permanent injury following vaccination.Quebec has had this program in place for more than 30 years. The pan-Canadian VISP now ensures equity across the country. It also brings Canada in line with a growing number of countries who have similar no-fault programs in place, including all G7 nations. 

Finally, and importantly, people who experience a serious and permanent vaccine injury while performing a public good should be supported in a fair and timely manner,regardless of responsibility or fault, should they experience a severe and permanent injury.

Next slide, please.

Slide 9

Stéphanie Parisian: So on December 10th, 2020, the Prime Minister announced the creation of a pan-Canadian Vaccine Injury Support Program. You'll recall this was around the time that COVID-19 vaccines were starting to be rolled out  in Canada.

That this provides financial support to people in Canada in the rare event they experience a serious and permanent injury as a result of receiving a  Health Canada-authorized vaccine administered in Canada on or after December 8th, 2020. The program also provides death benefits and support for funeral expensesin the rare case of death  following vaccination.

Provinces were also given the option to administer their own program with federal funding or participate in this pan-Canadian program.

All provinces and territories chose to participate in the pan-Canadian program,with the exception of Quebec, who'll continue to administer the program for residents of that province.

Next slide, please.

Slide 10

Text on screen: Shows a timeline of the Roadmap to the Pan-Canadian Vaccine Injury Support Program

December 10, 2020: new program announced by the Prime Minsiter

February 2021: Call for proposals launched

March 2021: The Public Health Agency of Canada established a Review Committee to review proposals

March 2021: Raymond Chabot Grant Thorton Inc (RCGT) Consulting unanimously selected as third party administrator.

Stéphanie Parisian: Here we have a bit of a road map on the early days of the program, following the announcement by the Prime Minister.

In February 2021, once all necessary authorities had been received, The Public Health Agency of Canada (PHAC) launched an open solicitation process to identify a third-party administrator for the program.

The solicitation was open to Canadian not-for-profit and for-profit organizations and corporations.In order to be considered, applicants were required to demonstrate experience with health claim adjudication, injury causality assessments, cost-effective delivery, and administering payments, managing personal information, and providing program delivery at the national level in both official languages.

Through the solicitation process, PHAC received a total of 4 proposals. A 6-member Review Committee comprised of expertise from inside and outside government 174 in the areas of privacy, compensation programs, procurement, and medical expertise was established to review the proposal. RCGT consulting was unanimously selected as the third-party administrator. As such, RCGT consultingis now being funded to implement  and administerthe Vaccine Injury Support Program through a contribution agreement with the PHAC.

As said before, the program launched to the public on June 1st, 2021.

Next slide, please.

Slide 11

Stéphanie Parisian: PHAC is not involved in the delivery of the Vaccine Injury Support Program, including the review and decisions on claims.

RCGT administers the program independently and oversees all aspects of the claims intake and assessment processes.

This said, PHAC did establish  clear program policy parameters for RCGT. For example, the following baseline eligibility criteria were established by PHAC: the injury be serious and permanent; from a Health Canada-authorized vaccine or immunoglobulin administered on or after December 8th, 2020  in Canada. And individuals have three years to submit a claim after the date of vaccination, date of death, or date when the injury was first apparent following the vaccination.

As part of the terms of their funding agreement, RCGT was also required to ensure alignment to the extent possible, with Quebec's long-standing vaccine injury compensation program to ensure equity across the country. 

RCGT also had to ensure that the causality assessment process was conducted by medical experts and based on accepted and recognized industry practices, such as the WHO's guidance on the causality assessment of an adverse event following immunization.

PHAC or the Public Health Agency of Canada is continuing to monitor the implementation of the program to ensure that it is as responsive as possible to the needs of those affected by vaccine injuries.

The Public Health Agency is also working closely with RCGT and the Government of Quebec in order to ensure cohesion where possible between the two programs.

Next slide, please.

Slide 12

Stéphanie Parisian: As mentioned, RCGT has independence and responsibility in the design, implementation and delivery of the Vaccine Injury Support Program. Specifically, they are responsible for the open and transparent claims intake process that is supported by a publicly accessible system for submissions of injury claims; a causality assessment process to objectively determine if there's a probable causal relationship between an injury and a vaccine; as well as the degree and duration of  disability for the purposes of determining financial support. A financial support payment framework administered in a consistent way for payments to beneficiaries; and finally, a fair and transparent appeals process.

This is my last slide.

Stephanie Elliott: Thank you, Stéphanie. As we move into our next portion of the presentation, I would like to remind you to please use the Zoom Q&A tab on your Zoom controls if you have any questions.

To present the next portion of the webinar, I will pass it over to Edward Maier from RCGT Consulting, Inc.

Slide 13

Text on slide: shows the Vacine Injury support logo along with a picture of a prescription pad and stethoscope.

Canada’s Vaccine Injury Support Program

Edward Maier, Senior Case Manager and Project Lead, RCGT 

Dr. Jennifer Crichton, MD, CCFP, MBA, MSc

Edward Maier: 

Thank you and hello.  My name is Edward Maierand I am a senior case manager and the project lead  for the Vaccine Injury Support Program,which is being administered by RCGT Consulting.

RCGT has been administering this program since its inception and I'm happy to be given  the opportunity todayto present with one of the lead physicians of our program,who will introduce herself, Dr. Jennifer Crichton.

Jennifer Crichton:  Hi everyone, as was mentioned earlier, I'm a family Doctor based in Ottawa. I also hold an academic appointment at the University of Ottawa,Dept. of Family Medicine. I want to thank you for taking the time to attend the webinar today. I think it's really important for healthcare providers and key stakeholders to be aware of and understand this program to promote both the equitable access to compensation and also to promote program efficiency as we move forward.

Edward Maier:

Thank you, Jen. So yes, let's begin the presentation. with the next slide, please.

Slide 14

Edward Maier: The VISP story begins with someone who thinks they've been injured by a vaccine and they hear about our program. They speak to their healthcare provider and ask them to complete a medical assessment form. We ask that physicians do not send in documents on behalf of applicants, as there are other documents required, including an intake form, which has all their contact information, as well as a proof of vaccination.

Once we get the application form, a preliminary review is done by a VISP lead physician and the content of the medical records that we'll need to properly assess the application is established.

Once we receive the applicant's consent, we request the medical records directly from the healthcare providers that the applicant has identified themselves.

The medical record collection is the most time-consuming step as each jurisdiction and sometimes each healthcare facility have their own processes to go through to gain access to these records.

We will be requesting records from  many facilities and physicians in Canada and ask if you do receive one to please contact us if you need any help or anything at all to help facilitate the request in a timely manner.

Once the medical records  are collected and prepared, a medical review board is assembled. The board is tasked with determining if the vaccine was the most probable cause of the injury and also to evaluate the severity of the injury itself.

More of that to come though, with Dr. Crichton.

If an applicant is approved, financial support reflexes will kick in for the applicant. Healthcare providers will continue to be contacted as we accompany the injured party through their recovery.

Now if the board decides against proceeding with the claim, the applicant still has the ability to appeal the decision. In this case, 3 new physicians are assembled to review the decisionand form a second medical opinion.

Next slide, please.
 

Slide 15

Edward Maier: So as you can see, throughout the application process, the Vaccine Injury Support Program interacts with  the medical community often. As such, we do ask the Community to be familiar with the eligibility criteria that  will be explained on the next slide. And we also ask that you recommend the program to those eligible. You can visit or recommend your patients to visit www.vaccineinjurysupport.ca where all of our application forms can also be found. The medical assessment forms could be your first interaction with our program and when approached, please provide the requested medical details on the form and return it to the applicant so they can submit it with their intake form and proof of vaccination.

Of course, we will always ask you to continue to provide the exceptional medical care and all the expertise you can, and also to document the progress and the assessment of the injuries observed, as we will be looking for those in the medical records as well. Also, when we do reach out to healthcare providers, we will be offering three ways to respond to our request. You're able to submit medical records either by mail, through a secure fax or the preferred: direct digital upload. Please let us know which you prefer when you get the request.

Next slide, please.

Slide 16

Edward Maier: So yes, here are  the eligibility criteria. 

The first one is any person receiving a Health Canada-authorized vaccine.It will also need to be submitted within 3 years of the vaccination date, the date of death, or when the onset of the injury first becomes apparent.

The injury must be reported to a healthcare provider. This is not the same as an A fee. We do simply request it's reported to a medical provider. The eligibility date for the program is any vaccination that was administered on or after December 8th, 2020.

The vaccine also must be administered in Canada, with exceptions to specific individuals, such as armed forces members and specific government officials.

The final eligibility criteria is that the injury be serious and permanent. If you have any doubt, it's important to notethat the VISP and our physicians are also able to make this decision. With more on that, here is Dr. Jen Crichton to go into more detail.

Next slide, please.

Slide 17

Jennifer Crichton: Let's take a minute and we'll read through the WHO's definition of a serious and permanent injury. That is what the Quebec program uses and what the federal program is also using.

So a serious and permanent injury is defined as a severe life-threatening or life-altering injury that may require in-person hospitalization or prolongation of existing hospitalization, and, importantly, results in persistent or significant disability or incapacity or where the outcome is a congenital malformation or death.

So there is some degree  of subjectivity within the definition. It's intended to be permissive and open-ended.

As I mentioned, it's consistent with Quebec's program and really there's nuance to each individual case. That is what makes this subjectivity necessary within the definition.

Any individual's past medical history, social history, disease course, illness experience these are all things that can really have an impact on whether a case meets the serious and permanent threshold in the board's eyes. So that's why making a truly individualized case assessment is necessary.

This serious and permanent definition gets back to one of today's webinar objectives. Healthcare providers are the frontline in making sure that the right claims get through to the program, as the program's goal  is to provide compensation to those who have suffered both serious and permanent injuries.

So healthcare providers can helpin the case where an injury is evolving or improving. You might recommend that  an applicant wait to delay their application until their condition is stabilized, as we do clearly see some applications where there's still some expected recovery, and the degree of injury is fairly uncertain.

Conversely, we don't want to discourage applications for someone that you feel is deserving, so just know that you do have a role to play in this, but that the board within the program will also be making these determinations for each case  on an individualized basis.

Next slide, please.

Slide 18

Jennifer Crichton:

So, after the claims are received by Ed's team at RCGT, the board of three physicians can make their causality assessment, again using the World Health Organization model. According to the WHO, this assessment can't prove or disprove an association between an event and an immunization. It's meant to just assist in determining the level of certainty of whether such an association might exist.

It's very hard to definitively say there's a causal association or an absence of an association on a case-by-case basis.So the Medical Review Board, composed of three individual physicians, we'll do this assessment. We have the ability to pull in more subject-matter whenever deemed necessary.

And, in general, these boards will consist of generalists, such as family medicine, emergency medicine, internal medicine, with the relevant subspecialties as necessary.

We move forward with a 2/3 majority decision, which is the same as Quebec's program. The injured party is anonymous throughout the process. All the medical records have any personal identifying information redacted.

Our program does not require that there's a patient representative and this differs from Quebec's program. One reason being we wanted to ensure equitable access. We didn't want to put the onus on the claimant to find a healthcare provider that's willing to champion their application within the program.

And then, it's important to note we use the Brighton Collaboration case definitions for diagnosis wherever possible. The Brighton Collaboration doesn't have an exhaustive list of adverse events following immunization, though. And then we walk through the causality algorithm that the World Health Organization has published. And this is just looking at whether there's strong evidence for other causes.Is there known causal association with the vaccine in the published peer-reviewed medical literature? Is there a temporal link between the vaccination event and the injury? Is there any strong evidence against a causal association? Are there any qualifying factors that are unique to this individual or vaccine that should be considered?

So our physicians within the program are constantly reviewing the most up-to-date medical literature on vaccinations and obviously, for the COVID-19 vaccines, this is a continuous evolvement we have to stay up to date with.

24:31 We've really... ..(illegible) . so far the combination of generalists with subspecialists brings expertise and perspective to the assessment process.

Next slide, please.

Slide 19

So once the...(illegible) that there's causal association between the vaccine and injury, then a comprehensive injury assessment is completed. This is another step where healthcare providers can assist here by forwarding updated clinical status when requested by RCGT. The medical records are obviously used to determine this assessment, and it's based on the Quebec Automobile Insurance Act or SAAQ framework, again consistent with Quebec's vaccine injury compensation program. And from this we can determine a percentage of injury or ..(illegible) . category.

We also have the ability to recommend periods of assessment where you are receiving current expense systems, physiotherapy, income replacement, that sort of stuff, to reassess if a condition is improving or worsening. That obviously doesn't apply to lump-sum payments.

And before I speak about the examples at the bottom of the slide, it's important to mention that these are just diagnoses submitted to the program. They don't represent necessarily claims that have been processed or compensated. But since June 1st, 2021,  there have been submissions for VITT, Guillain-Barré Syndrome.

Next slide, please.

Slide 20 

Jennifer Crichton:

So some of the challenges with the case assessments: I've already alluded to the fact that the COVID-19 vaccines are obviously quite novel, and the postmarket literature is always evolving.And we really have to make decisions based on the best available evidence at the time.

Again, getting back to the idea that individual case factors are really important as they  make assessments nuanced. We really do have to look at things on a case-by-case basis while considering the medical literature. Because an individual's age, past medical history, those sorts of things can impact their background risk of an event occurring independent of vaccination.

Some of the discussions so far involved the VITT type of thrombosis versus a non-thrombocytopenic  thrombosis event as the literature is not really solid on this yet, as well as some diagnoses that might not have any  functional impact on the individual at present, but in theory might change an individual's risk factor for an adverse event in the future, and how those things are assessed. So again, some evolving things mostly due to the novel nature of the COVID-19 vaccines.

We do our best to be consistent with Quebec's program in terms of our assessments and the physicians within this program do meet regularly with some from the Quebec program in order to achieve this.

And we can go to the next slide

Slide 21

Jennifer Crichton: I'll hand back to you, Ed, to continue.

Edward Maier: Yes, thank you, Jen.And yes, once the majority of the Medical Review Boardhas confirmed that on balance of probabilities ,the vaccine was the likely cause of the injury and that it should qualify as severe and permanent, our financial support mechanisms of the program will kick in. As you can see here, there are different forms of support given, including one-time payments, either for compensation of an injury, death benefits to beneficiaries and funeral benefits as well.

There are also recurring payments for injured persons, if they lost income, to reimburse any sort of medical expenses, and we do have a wide variety of expenses that are covered from home adaptation, personal support workers, transportation, reimbursements of therapies, all of which is to go to the goal of the program, and that's to ensure as little out-of-pocket expenses are incurred by the injured person or their family.

Next slide, please.

Slide 22

Edward Maier: In the past year, we have received approximately 750 applications to our program. The relevance of VISP in the current COVID environment is obvious, but it is also important to mention that the VISP is to cover any Health Canada-approved vaccines.

And we have received applications for other vaccines as well. Just as we cover all of these sorts of vaccines, we are also receiving claims for a wide variety of injuries, and each application  will be assessed individually.

The timeline, that we will always strive to improve, varies case by case, with the current expectation of no more than 12 to 18 months. The most common delay is based on the collection of medical records

On our website: www.vaccineinjurysupport.ca, you can find specific statistics of our program and our and these will also be updated shortly.

Next slide, please.
 

Slide 23

Edward Maier: So here we will ask for your help. As members of the immunization community help us by giving feedback so that we can continuously improve our program. You are now aware of our program, please mention it to your colleagues. This will only help increase the awareness and the availability of the program to more and more Canadians. We rely on the medical community to continue to provide evidence of emerging vaccine-associated injuries and encourage collaborations whenever possible.

When requested, please let us know how we can best collect  the medical records to help speed up our applications case, as we do truly wish  to support all those eligible in a timely fashion. We are also in need of specialists who are interested in participating in our program. This includes neurologists, physiatrists, cardiologists and thrombosis specialists.

If you wish to provide us with any feedback, if you're interested  in joining our program or need any information at all, please do not hesitate to send an e-mail to info@vaccineinjurysupport.ca or visit our website www.vaccineinjurysupport.ca where we'd be happy to help as best we can.

On behalf of Dr. Jennifer Crichton: and the whole of this team here,I'd like to thank you for your time and attention. I will now pass it back to our moderator for any questions.

Next slide, please.
 

Slide 24

Stephanie Elliott: Thank you very much to our presenters. Great presentation. As we move into the Q&A period, remember you can use the Q&A tab on the Zoom Control Panel and feel free to like other questions to bump them up in priority. Only questions that follow within the purview of this webinar topic will be addressed. We won't be answering more general questions re vaccines or vaccine safety.

We did receive some questions in advance through our registration forms, so I will get started with some of those questions.

We will try to answer as many as possible, but we won't get to all of them. I am going to direct to Dr. Crichton : What kind of process is done  to determine if someone has experienced a vaccine injury?

That's a great question, Stephanie. And so once the RCGT has received all of the relevant medical documentation from the claimant's healthcare provider or the institutions where they've  received medical care for the injury, and then there is a lead physician within the program who'll review the medical documentation, ensure it is complete and then we'll make suggestions in terms of...

Stephanie Elliott: I think we may have lost.  Dr. Crichton there.

Jennifer Crichton: I'm sorry about that. Did you get any of my answer?

Stephanie Elliott: We got the first step, but you might want to start from the beginning again.

Jennifer Crichton: I'm so sorry about that. So from the moment the RCGT receives the claim and collects the relevant medical documentation, there is a lead physician who will review that documentation, ensure it is complete, and select 2 other physician board members who would be appropriate to assess the injury in question, and these might include  generalists or specialists, again on a case-by-case basis. 

Each of these three physicians will conduct an independent review of the medical documentation, again ensuring that it is complete, and then from there they'll make their individualized assessment while consulting the Brighton Collaboration case definitions, what's available in the published peer-reviewed on such injuries, and any vaccine associations with it to conduct  an individualized causality assessment using the WHO algorithm I described in the presentation. 

From there. the physicians will meet to discuss the case in further detail and then decide if there is more than likely on the balance of probabilities, a causal association between the injury and the vaccine. I'm not sure if I need to go anywhere beyond that.

Stephanie Elliott: That's great. Thank you so much, Dr. Crichton. This next question is going to Stéphanie. There were a couple of questions to this end in the chat today. So what about our non-Canadians who are visitors or non-residents? Are they eligible to apply to this if they received a vaccine in Canada?

Stéphanie Parisian: Yes, good question. And because we do specify that every time we speak about it we say Health Canada-authorized vaccine administered in Canada. Yes, they would be eligible to apply to the Vaccine Injury Support Program, and we followed that. Quebec has the same type of criteria, and we also examined what other countries were doing, such as the US, and that you would apply to the program in the country in which you were vaccinated.

So the answer is 'Yes'.

Stephanie Elliott: Great, thank you so much for that. So this next question is for Edward. How many people have been issued an offer of compensation thus far into the program?

Edward Maier: It's a good question, and I would defer to our statistics that will be uploaded shortly, and ask you to visit our website for that information in the near future. Thank you.

Stephanie Elliott: Thanks so much. Another question for you, Ed. What is the maximum injury benefit provided under the program?

Edward Maier: It's a great question and depending on how you'd like me to answer that, there is no set maximum that one individual can claim from the program as there can be lifetime stewardship or following along with benefits recurring year-to-year, month-to-month, expense by expense.

In referring to the injury indemnity itself, the one-time lump-sum payment, the initial maximum for the program is $275,000.And that is a maximum. As Dr. Jen pointed to earlier,the Medical Review Board will determine a percentage of injury,which will go against that maximum.This maximum of $275,000 will be indexed every year as well to keep up. Thank you.

Stephanie Elliott: All right, so it sounds like there's a maximum for the lump sum, but for ongoing expenses and compensation, there's not necessarily a set limit. Am I understanding that correctly?

Edward Maier: Correct, correct. We could be providing benefits to applicants and injured people for a very long time, and we will continue to support them any way we can. Great, thank you so much for that.

Stephanie Elliott: This next question is going to be for Dr. Crichton. How long does someone have to be experiencing a vaccine injury before being able to access this? Can they access it any time after vaccination? Is there a time limit or does it  have to be a certain amount of time since they received their vaccine?

Jennifer Crichton: That's a really great question, and again, there's no set threshold for this. You know there might be injuries in which it's quite dynamic, there is some recovery expected and the permanence of the injury is really not clear yet. In that case, I would encourage a healthcare provider if they deem it appropriate, to delay the application to the program, and until they have a more clear picture of the injury's permanence. If there's a question to what degree they will have some recovery, but there's some certainty regarding the permanence of some degree of disability or injury, then I think, maybe that's fair to submit. But, you know, the converse to that would be the rare event of a death. Obviously, that's a permanent injury with no recovery, and so there's no set temporal threshold for an injury in order to be eligible for the program. It will also vary person to person and diagnosis to diagnosis, after how long you might expect their maximal recovery to be achieved.

So just to summarize, there's no set threshold, and it's really going to be up to the healthcare providers to discuss, with some shared decision-making  between themselves and the claimant before making the decision to go forward with an application. Thanks.

Stephanie Elliott: Thanks. I'm going to follow up on that with my own clarifying question. So if someone does apply, perhaps a little early, and it's not clear if they are going to have some recovery from their injury. And the medical advisors who are looking at their case say it's maybe a little early to tell what the extent of the injury is. Do they simply put that application on hold? Can they reapply again later on, if they have a sustained injury? Is a process in place for determining that?

Jennifer Crichton: That's a really good point, and I'll start and then maybe I'll hand it to Ed in case he wants to add anything. But if we pick an example where there is clearly a causal  association between someone's injury and the vaccine, they had  no risk factors to develop this injury, and there is published evidence in the literature that vaccine A can cause injury B, but they're just in a state where there might be some expected recovery, then it might be entirely fair to submit that claim and our Medical Review Board will consider that, and we do have the ability to communicate with the claimant and healthcare provider to recommend that things be reassessed in a certain prescribed amount of time.

Jennifer Crichton: Ed, do you have anything you wanted to add on that point?

Edward Maier: Sure, yes, and well answered, Jen. I think the only thing that I would add is that you know we would encourage the application to our program and we will evaluate it on a case-by-case situation if there is a likelihood of full recovery. We will postpone any financial support until the injuries have stabilized to a point where we're able to make that determination whether it is, in fact, both serious and permanent. Good question though. Thank you. 

Stephanie Elliott: Great, thank you so much. So the next question is going to be for Stéphanie. Is the Vaccine Injury Support Program for all vaccines that are recommended by the National Advisory Committee on Immunization in public health programs, as is the case in Quebec?

Stéphanie Parisian: Thank you for the question. It is for all Health Canada-authorized vaccines, so that's the definition and it doesn't matter if your doctor said, I think you should get this vaccine or not, or if NACI has recommended it. There were some questions about  off-label use and things like that when we were thinking about the program.

And regardless of how it is used, again, going back to the idea of it, it is a no-fault program, so as long as the vaccine has been  authorized for use in Canada by Health Canada, it would be covered under the Vaccine Injury Support Program.

Stephanie Elliott: Great, thank you for that. And Edward, I have another question for you. What is the proportion  of applications submitted versus those accepted by VISP?

Edward Maier: Another great question, and for specifics, I would again wait for the statistics to be shared in the near future. As an approximation, currently about a third, maybe about 30% approximately of the claims that we have received early in the program. It is still just celebrating its first birthday today. So about a third of the applications have been approved.

Stephanie Elliott: Great, thank you for that, and happy birthday, VISP. Thank you so much.

It looks like we have run through all of the fantastic questions that everyone has, so we are going to wrap up our webinar today. I'd like to say thank you to our speakers for their presentations and thank you all for joining us today. We hope the information provided will help you in your practice.

Can we go to the next slide, please?

Slide 25

Stephanie Elliott: So for more information, resources, and videos, take a look at these links and again this deck with live hyperlinks will be posted on the CANVax.ca website, so you'll be able to click through there to get a little more information.

Next slide, please.

Slide 26

Stephanie Elliott:

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So thank you very much for attending and have an excellent day.