Influenza and pneumococcal vaccination in Canada and the United States, 1980-1993: what can the two countries learn from each other?

This study compares influenza and pneumococcal vaccination in Canada and the United States during the period 1980-1993. In Canada, the annual distribution of influenza vaccine during this period increased from 33 to 146 doses per 1,000 population. Provincial health departments purchased 80%-90% of all doses distributed. In the United States, annual distribution of influenza vaccine ranged from 70 to 102 doses per 1,000 population from 1981 to 1990 but increased to 159 doses per 1,000 population over the next 3 years. Throughout the study period, the distribution of pneumococcal vaccine in the United States greatly exceeded that in Canada. Despite similar recommendations regarding the use of these vaccines in the two countries, vaccination practices have differed. In Canada, success with influenza vaccination but not pneumococcal vaccination appears to reflect active public-sector involvement in programs for vaccine purchase and delivery. In the United States, the recent increase in the use of both influenza and pneumococcal vaccines has occurred in the absence of substantial public-sector involvement and may reflect the entrepreneurial nature of American medical practice.