Why vaccine coverage must become core plan design
Immunization is one of the most powerful health investments available. The World Health Organization estimates vaccines prevent 3.5 to 5 million deaths each year, making them a foundation of population health and economic stability.
Despite this, Canada’s private drug plans continue to send a contradictory message: prevention is optional. Mapol’s Private Drug Plan Leadership: Vaccine Coverage Report Card 2025 shows that only 71 percent of plan members have coverage for recommended adult vaccines − leaving nearly one in three without access. More than 1.5 million vaccine claims were declined in 2023 simply because vaccines were not covered. When prevention is treated as discretionary or capped at inadequate levels, it reinforces the misconception that vaccines are “nice to have” rather than essential care.
This approach is out of step with today’s workforce. Employers are supporting aging employees, individuals with chronic conditions, and those more vulnerable to infection − yet vaccines, among the most effective preventive tools in medicine, remain inconsistently covered. As Normandin Beaudry highlights, it is difficult to justify reimbursing preventive drugs like statins while excluding vaccines that prevent severe, costly illness.
Some plans also impose unnecessary administrative barriers, such as requiring prescriptions for vaccines already classified as Schedule II (pharmacist‑controlled, non‑prescription). These barriers delay access, create inequities across provinces, and do not reflect modern pharmacy practice.
The cost of waiting for illness
Shingles can lead to weeks of acute pain and months of post‑herpetic neuralgia (PHN). The recombinant zoster vaccine demonstrates over 70 percent effectiveness against shingles and over 80 percent against PHN. Long‑term follow‑up shows protection can last beyond a decade. For employers, shingles is a predictable and preventable cause of prolonged absence.
Pneumococcal disease is a leading cause of severe respiratory infection, especially in older adults and those with health risks. Newer pneumococcal conjugate vaccines significantly reduce community‑acquired pneumonia and invasive pneumococcal disease, preventing hospitalizations and long recoveries. In practical terms, pneumonia often results in weeks of lost productivity − much of it avoidable.
Human papillomavirus (HPV) is an important cause of cervical and oropharyngeal cancers. Canadian guidance clearly positions HPV vaccination as cancer prevention. Large Swedish registry studies show a dramatic reduction in invasive cervical cancer among vaccinated individuals, particularly when vaccination occurs earlier. Some countries have set national elimination goals − including Australia, which aims to eliminate cervical cancer by 2040, and England, which targets 2035. Early vaccination provides the strongest protection, but adult catch‑up remains critical.
Lyme disease: the turning point we can anticipate − or wait to regret
After many years with no preventive option, a viable Lyme disease vaccine is finally approaching approval. Without modernization of benefit design, many Canadians risk being excluded from this innovation the moment it becomes available.
Lyme disease, caused by Borrelia burgdorferi and transmitted by blacklegged ticks, often goes unnoticed at exposure. Early symptoms may include a spreading rash or a flu‑like illness, while later stages can involve facial palsy, severe joint inflammation, cardiac involvement, and neurologic complications. Early treatment improves outcomes, but uncertainty following a possible tick bite can cause significant worry for families and outdoor workers.
The leading vaccine candidate, VLA15, is in Phase 3 trials in North America and Europe, with regulatory submissions expected in 2026. Scientific assessments frame VLA15 as a critical tool against a rising vector‑borne threat that personal protective measures cannot contain. For outdoor and mobile workers − including forestry, landscaping, construction, recreation, agriculture, and delivery − a vaccine could prevent chronic fatigue, recurrent joint disease, and prolonged follow‑up care.
We have seen this scenario before: preventive tools exist, but benefit structures leave people without access. It is essential not to repeat that pattern.
A modern approach to prevention
Rather than treating vaccines as optional extras, benefit plans can strengthen prevention by integrating routine adult immunization into core coverage. This means aligning benefits with clinical recommendations, ensuring annual maximums are sufficient for full vaccine series, and removing administrative steps that slow access. Plans can also support prevention by communicating coverage clearly, including dependents in vaccine strategy, and embedding immunization reviews into workplace health initiatives.
The economic argument is clear
Vaccination consistently prevents the most costly consequences of illness: hospitalizations, extended absences, chronic complications, and avoidable disability claims. Prevention is not a perk − it is sound, evidence‑based plan management. When vaccines are treated as essential care, the message is unmistakable: employees’ health deserves protection before it breaks.
Frédéric Leblanc has served as strategic leader, drug programs at iA Financial Group since 2019. Frédéric has over 20 years’ experience in the pharmaceutical sector. He has worked in drug development, product management and reimbursement, business development, and government relations. With his expertise, he plays a key role in drug management strategies for group insurance clients. He is also a member of the Ordre des pharmaciens du Québec (Quebec Order of Pharmacists).
