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Understanding Vaccines

School-Based Vaccination Is on Hold — and It’s a Big Concern

children holding hands
children holding hands

Dr. Vivien Brown

Family Physician, Assistant Professor, University of Toronto, & Chair of the Task Force on the Crisis in HPV Vaccination in School System, Federation of Medical Women of Canada

Experts are stressing the importance of getting school-based vaccine programs back on track after COVID-related delays.

Many Ontario youth receive a series of important vaccinations at school. School-based vaccine programs help protect children against infectious diseases and some cancers and are an effective and equitable way to reach youth.

“We want everybody to have access and we know that school-led vaccine programs are the most equitable way to have the population immunized,” says Dr. Vivien Brown, a family physician, assistant professor at the University of Toronto, and Chair of the Task Force on the Crisis in HPV Vaccination in School System for the Federation of Medical Women of Canada.

A sharp decline in coverage

In Ontario, grade seven students are offered a quadrivalent meningitis vaccine, hepatitis B vaccines, and HPV vaccines. In the school year prior to COVID, 58 percent of Ontario students received both doses of their HPV vaccine, but during COVID that number plummeted to 5.8 percent and 0.8 percent for the 2019 to 2020 and 2020 to 2021 school years, respectively, according to Public Health Ontario’s annual Immunization Coverage Report for School Pupils in Ontario.

“As a result of the pandemic, public health resources were diverted, and the school-based programs were put on hold,” says Dr. Brown. “Then school was put on hold, and Public Health wasn’t going into the school system to administer the vaccines. The children who got vaccinated in the fall of 2019 didn’t get their second shots in the spring of 2020, so we have some children who are partly immunized and then the children in 2020 and 2021 weren’t immunized at all.”

Schools in Ontario were closed longer than any other jurisdiction in Canada, but even now, with children back in class, the school-based vaccine programs have not been fully reinstated.

We want everybody to have access and we know that school-led vaccine programs are the most equitable way to have the population immunized.

Playing catch-up

Instead, Ontario’s 34 Public Health units are playing catch-up in a “patchwork” method, says Dr. Brown. While some units are planning Saturday clinics and some are going into schools, there’s no unified strategy — nor has there been an education campaign to help alert parents that their child may have missed vaccines or that they should attend a clinic.

The University of Toronto’s Dalla Lana School of Public Health and McMaster University’s Michael G. DeGroote School of Medicine co-published a report regarding how to maintain school-based immunization programs during the pandemic. It recommends that Ontario implement a comprehensive catch-up strategy to close the gaps in immunization coverage and prevent outbreaks of vaccine-preventable diseases. The report recommends a multi-pronged and transparent approach that engages six key stakeholder groups — government, public health, primary care physicians and pharmacists, schools, community leaders, and caregivers —to ensure equitable and efficient access to catch-up immunizations for Ontario children.

“What we’re encouraging and what the Federation of Medical Women is encouraging is that we bring vaccines back into schools, have public health clinics, give the vaccines to pharmacies, hold clinics the way we held COVID clinics, and take mobile units into certain communities,” says Dr. Brown. “We’re saying do everything, not just one thing. There are a lot of barriers in the system, and we need to make this accessible and convenient. In addition, catch-up metrics need to be established and plans modified if metrics aren’t met.”

Protecting children’s health

We owe it to Ontario children to make vaccination accessible and convenient, especially when these particular vaccines are so important for their health.

“Meningitis has a 10 to 20 percent mortality rate,” says Dr. Brown. “It’s not a common disease but it’s a very severe disease when it happens. Hepatitis B affects your liver and you can die from it or become a chronic carrier, putting yourself or your partner at risk. As for HPV, it’s a common virus and about 75 percent of adults will have it at some point in their life, and most of us clear the virus the way you clear a common cold. But about 20 percent will have persistent HPV, which increases your risk of six different kinds of cancer, including cervical cancer, head and neck/throat cancer, anal cancer, and other genital cancers.”

The HPV vaccine is so effective that the Canadian Partnership Against Cancer released a plan showing that Canada could completely eliminate cervical cancer, and getting vaccination rates to 90 percent is part of that plan.

“These are deadly diseases that we don’t see often because we’ve been immunizing, which is why the fall-off of the school-based vaccine program is so worrisome,” notes Dr. Brown.

As Dr. Brown, the University of Toronto, and McMaster University outline, a collaborative approach is needed to get us back on track.

This article was made possible with support from a research based pharmaceutical company.

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