Some children across the country have fallen behind on their routine immunizations during the COVID-19 pandemic, with vaccination rates dropping by several percentage points in some provinces.
Pediatricians and other health officials say the decline in routine immunizations is troubling as cases of polio — a vaccine-preventable disease — emerge in other parts of the world.
“As we move forward through the pandemic, we really need to focus on children maintaining and receiving these routine immunizations that we otherwise previously took for granted,” said Dr. Sloane Freeman, a pediatrician at St. Michael’s Hospital and an assistant professor in the department in Pediatrics from the University of Toronto.
Some experts say there could be several reasons someone might not get vaccinated, but don’t think hesitancy is the main culprit. Those who spoke to CBC News suspect that school closures during the pandemic, reallocation of public health resources and staff and a greater focus on COVID-19 vaccines may be behind the decline.
“It’s a good wake-up call that we need to be extremely diligent and possibly provide additional resources to catch this group of children because we know they’ve been missed,” said Julie Bettinger, a professor of pediatrics at the University of British Columbia and vaccine safety scientist at the BC Vaccine Evaluation Centre
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Vaccination rates are falling
Pediatricians in Canada said they were seeing more unvaccinated children than usual at this time of year.
Just this week, Dr. Fatima Kakkar, an infectious disease pediatrician and professor of pediatrics at the University of Montreal, saw children who had never been vaccinated against tetanus. She says it’s “surprising to see how many” are without protection.
“For the most part, younger children missed their regular appointments during the peak of the pandemic and just never caught up.”
South Hill Family Health Center doctors administer flu shots to their patients in their underground parking lot in Vancouver on October 16, 2020. (Ben Nelms/CBC)
Latest data provided by government officials in Alberta and Saskatchewan show drop in vaccination rates for many of the routine immunizations.
In Alberta, most vaccination coverage rates decreased compared to 2020. Among them was the second dose of measles, mumps and rubella vaccine among seven-year-olds, with the province’s coverage increasing from 79.2% to 75.8% in 2021 Mr.
In Saskatchewan, data from June 2021 compared to data up to this June shows that immunization coverage has dropped among two-year-olds. While 76.4 percent of two-year-olds were immunized against whooping cough with four doses in June 2021, only 73.4 percent had been vaccinated against the disease by the end of this June.
Provincial pertussis immunization rates among seven-year-olds also declined over the same time period in that province.
The reduction in vaccination coverage may not sound like much, but one pediatrician says the changes are striking.
“You’re actually looking at hundreds of children who are now stunted or not immunized. And that can make a huge difference in terms of seeing some of the diseases that we have vaccinations for that we shouldn’t be seeing,” said Dr. Aisha Kurji, a Saskatoon pediatrician and assistant professor at the University of Saskatchewan.
Freeman said Ontario is seeing “really, really low coverage” for school immunization programs.
The number of 12-year-olds in Ontario who were vaccinated against meningococcal conjugate (MCV4), human papillomavirus (HPV) and hepatitis B at school decreased significantly when comparing data from the 2019-2020 school year to 2020-2021.
In the 2019-2020 school year, about 70 percent of 12-year-olds started but did not complete the HPV vaccine series. That coverage rate dropped to about 20 percent the following school year.
“We really need to make sure that they are caught and that these immunization programs continue and are well resourced going forward,” Freeman said Wednesday during an online media event hosted by the Ontario Medical Association.
Why the drop out?
Last month, UNICEF said about 25 million children worldwide have skipped routine immunizations against common childhood illnesses, calling it a “red alert” for the child’s health.
Bettinger says that in Canada, school-age children have been the most affected because they usually get their routine immunizations at school. But with the pandemic affecting school enrollment, vaccinations didn’t always happen.
“We probably have at least two years of children who have potentially missed these vaccines,” she said.
She added that the COVID-19 immunization programs rolled out across the country are also demanding on the system.
“The resources that were required are kind of mind-boggling, to be honest. And certainly that’s been the public health priority for the last few years, so a lot of the other routine public health activities just weren’t as well covered,” she said.
A Quebec spokesman says fewer routine vaccines were given out in schools as nurses were redeployed to vaccinate against COVID-19, schools were closed for parts of the pandemic and students were absent due to outbreaks.
But it added that regional health authorities have tried to catch up with students who missed school vaccinations in 2020 and 2021.
Ontario and Manitoba government spokespeople say redeployment of public health staff during the pandemic has also affected data collection.
Freeman says families also haven’t had access to the health care system like they would have before the pandemic.
Some parents also delayed routine vaccinations because they worried about interactions with the COVID-19 vaccine, Kurji said. That’s why she says guardians should address their concerns to a health care provider.
“If you have questions, be sure to ask … whoever is doing the vaccines, what to do and how to help them answer your questions and any fears you have,” she said.
Health care providers from the Toronto Southeast Family Health Team held a COVID-19 vaccine clinic for children under five in East Lynn Park, Toronto, on August 12. (Evan Mitsui/CBC)
Bettinger added that getting enough children vaccinated against diseases like measles and polio is something Canadian public health officials have struggled with for years.
According to Federal data for 2017last available, all provinces and territories fell short of the national vaccination target of 95 per cent for many of the routine childhood vaccines.
But Bettinger cautions against assuming that lower vaccination rates among some children are due to vaccine hesitancy. That may exist, she said, but it’s a smaller fraction of people compared to those who may not have their children vaccinated because of access.
“The pandemic has really disrupted services,” she said.
“We know there’s mountains of evidence showing that the easier you make it for a parent to vaccinate their child, the more likely the child will be vaccinated.”
Covid-19 vaccines
As families prepare to return to school in the next few weeks, Freeman wants caregivers to also consider getting their child vaccinated against COVID-19.
A nurse applies a post-vaccination band-aid against COVID-19 to a child on August 4. (Ben Nelms/CBC)
Federal data shows that 42.44 percent of children ages 5 to 11 have completed their elementary grades. In the 12-17 age group, almost 19 percent completed their primary series and received a booster.
“If [COVID-19 cases] walk up, we really want our kids to be protected,” Freeman said.
How to vaccinate more children?
Freeman said public health units need to think about creative solutions for implementing routine vaccines, especially to reach underserved or marginalized populations.
Facilitation is key, with school-based immunization recommended because children are already in school and much more accessible, according to Freeman and Bettinger.
“The easier we make it, the more likely people are to do it,” Bettinger said.
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