As Canada readies to vaccinate kids aged 5-11, a look at immunization across the country
Do kids get vaccinated in school? What is 'mature minor' consent?
With Health Canada expected to approve Pfizer-BioNTech's COVID-19 vaccine for children aged five to 11 — and as it continues to review Moderna's pediatric version — parents of younger school-aged children must now decide whether they'll be queuing up to get their kids these shots.
Here's a quick refresher about vaccinations for children and school-related immunization.
Who's responsible for childhood immunizations?
Parents and guardians are ultimately responsible for getting their children immunized. Who actually gives kids their regular shots, however, depends on region. In some areas, it might be a nurse, or specifically a public health nurse, while elsewhere it may be a pediatrician or family physician/general practitioner. In some cases, like for a flu shot, it could be a pharmacist.
Provinces and territories distribute and manage delivery of vaccines, which are approved and procured by the federal government.
Health officials across the country have already been planning how to roll out COVID-19 vaccines for the 5-11 age group, ranging from setting up specific pediatric vaccination clinics (some with therapy dogs), incorporating pediatricians and family physicians and enlisting pharmacies as well.
In every province and territory, schools are also a common public space to host vaccination programs for students. Multiple regions have mentioned planning COVID-19 vaccine clinics in school spaces, as they've already done for older children, teens and families.
Looking to the COVID-19 vaccination rollout for younger kids, "there needs to be adjustments in the mass clinics to accommodate children and use of pain- and anxiety-management techniques, because we know that many children are afraid of needles and that could be a stressful event to be vaccinated in a crowd," said Ève Dubé, a medical anthropologist and researcher at the Quebec National Institute of Public Health.
Is immunization mandatory to attend school in Canada?
Childhood immunization is highly recommended by public health and school officials across Canada as a long-lasting, effective protection against vaccine-preventable diseases.
In order to attend school in Ontario, the Immunization of School Pupils Act requires proof of vaccination (or being granted an exemption) for a series of diseases, including diphtheria, measles, mumps, polio, rubella, tetanus and more. A section of New Brunswick's Public Health Act mandates that parents or guardians of students starting school — which is typically at kindergarten — show proof of vaccination (or have an accepted exemption).
British Columbia's Vaccination Status Reporting Regulation compels families to disclose a student's immunization record or seek an exemption. In the event of an outbreak — of measles, for instance — unvaccinated students are required to remain at home for a set period of time.
Other provinces and territories don't make vaccination mandatory, but schools in those regions may still review the immunization records of students registering for school for the first time. Alternately, public health officials or school nurses may review children's immunization records at the age they typically start school or at subsequent intervals.
In Alberta, for instance, public health reviews come in Grades 1, 6 and 9. If vaccinations are missing or incomplete, information sheets about them are typically sent home, along with parental consent forms, ahead of routine in-school clinics.
Compelling immunization can increase uptake, according to research from the U.S., where every state has some vaccine requirements. But in Canada, it's less clear, said Dubé.
Ontario has required proof of vaccination for school attendance since 1982, she said, whereas Quebec doesn't. "But when we compare Quebec vaccine uptake versus Ontario vaccine uptake, it's quite similar."
Will COVID-19 vaccines be added to the current list of shots for children?
In early October, California became the first U.S. state to require COVID-19 vaccination for its K-12 students. Over the past few months, different voices in Canada have called for provincial health officials to add vaccination against COVID-19 to the existing list of childhood vaccinations, including the chair of the Toronto District School Board (Canada's largest school board), the head of public education advocacy group People of Education and Toronto's medical officer of health, Dr. Eileen de Villa.
At this point, however, it doesn't seem like Canadian provinces and territories are moving in that direction.
In late October, Ontario's Chief Medical Officer of Health Dr. Kieran Moore said he won't be adding it to the province's list, but will consider the "ongoing threat" of COVID-19 as he reviews that decision going forward. Saskatchewan Premier Scott Moe said in early November he also will not mandate that schoolchildren receive a COVID-19 vaccine.
WATCH | Mandating vaccination for students can 'backfire,' says epidemiologist:
Do all regions have school-based vaccination?
The approach to immunizing kids varies across Canada, with differences that include who gives the shots, at what age or grade a particular vaccine is given, when immunization is officially recorded, what kind of followup from health workers exists and how vaccination data is collected and published.
However, all provinces and territories do regularly participate in vaccination programs in conjunction with local public health officials, with many held in primary and secondary school settings.
Standard vaccine programs were delayed last year due to the pandemic, but many catch-up initiatives for routine immunizations are planned or already underway.
The federal government lists the recommended immunization schedules that exist in each province and territory and provides a tool for families to figure out a schedule for children under six, as well as for students from Grade 1 through 12 (or Secondary V in Quebec).
How is Canada doing with childhood vaccinations?
Every two years, Statistics Canada conducts the Childhood National Immunization Coverage Survey (cNICS) to measure the proportion of kids who have received all routine vaccinations at the ages of two, seven, 14 and 17, as well as what parents and guardians know and think about vaccines.
Initial analysis of the most recent survey, which took place in 2019, found that while the majority of two-year-old Canadians received all the recommended suite of vaccines, there was still room to improve uptake. According to Canada's National Immunization Strategy, the goal for childhood vaccination coverage is 95 per cent by ages two and seven, and 90 per cent for adolescents.
No province or territory has met the childhood goals for all vaccines.
Newfoundland and Labrador comes the closest, meeting the goal for multiple vaccines and typically registering the highest coverage across Canada's regions.
Does a child always need parental consent for vaccinations?
The age that kids can themselves consent to receiving a vaccine (versus getting parental consent) varies across Canada and is based on whether they are assessed to be a mature minor by a health-care professional. That can start at age 12 in Manitoba and B.C., for instance, going up to 18 in Alberta.
A child or adolescent assessed as a mature minor must learn the risks and benefits of the vaccination from a health-care provider and understand this information ahead of granting consent. Their medical record would be kept confidential, so parents or guardians of a student deemed to be a mature minor may not be aware of the vaccination.
