Academic journal article Canadian Journal of Public Health

Coming Events * Activités À Venir

Academic journal article Canadian Journal of Public Health

Coming Events * Activités À Venir

Article excerpt


Objective: Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose.

Methods: Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices.

Results: The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs.

Discussion: The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion.

Key words: Immunization programs/economics; delivery of health care/economics; influenza vaccine/economics; direct service costs

La traduction du résumé se trouve à la fin de l'article. Can J Public Health 2009;100(5):340-43.

Each fall in Ontario, public health delivers, promotes and provides the annual influenza vaccination program to the residents of Ontario. Although public health is the distribution point for all seasonal influenza vaccine within each geographic health unit, the vast majority of vaccine is given through hospitals, long-term care facilities, physicians and employers.

In Wellington-Dufferin-Guelph Public Health (WDGPH), 61,675 doses of influenza vaccine were delivered in 2006, of which 11,592 doses were provided by public health staff. Public health receives $5.00 per dose for each influenza vaccine delivered.

This funding envelope has generated discussion among public health units regarding the actual cost of influenza vaccine delivery. Although many "actual costs" have been proposed informally, there is an absence of critical economic evaluation in the literature applicable to Ontario flu clinics run by public health. This analysis seeks to answer the question: Can public health agencies provide influenza immunization within the funding envelope of $5 per dose? The data from 2006 flu clinics were used to create a cost template to analyze future flu vaccine delivery models.


Actual flu clinic data were used to reflect real scenarios. All data analyzed came from the records of both the finance department and the vaccine preventable disease program of WDGPH and reflect 2008 cost data. Unit costs of supplies were calculated by dividing the cost per box by the number of units per box. Unit costs for disposal were obtained by dividing container disposal cost by the average number of syringe units that each contained. Facility costs were the total financial payment made to a facility during a flu clinic as paid by the finance department. Labour costs were based on the salary of either public health nurses (PHNs) or clerical staff, being at step 5 of the recorded WDGPH pay scale. Benefit costs were added to labour costs at a rate of 24%, reflecting current actual cost. …

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