It could take years to catch up on child vaccinations in Ontario post-pandemic

Ontario is still playing catch up on routine vaccinations that many children missed during the pandemic and public health officials are warning that it could take years to solve the problem.

“What we see around the world is when the vaccination rates drop, you have a resurgence of vaccine preventable disease,” Dr. Anna Banerji, a Toronto-based pediatric infectious disease specialist, told CTV News Toronto.

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“If someone had measles and they were with a group of unvaccinated kids, then for every person that has measles, they typically would infect about nine or 10 other kids. And so it's extremely, extremely infectious.”

About 60 per cent of seven-year-olds are fully vaccinated against the measles—as well as other illnesses such as mumps and varicella—according to a report published by Public Health Ontario in the end of March.

This is a significant drop from coverage in 2019-2020, when those numbers were between 82 per cent and 86 per cent.

Ontario has seen a mild resurgence of the measles this year, with 13 cases identified in 2024 so far.

Of the seven children infected, five children were unvaccinated while the immunization status of two others were unknown.

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Three of the adults had two doses of the vaccine while one was unvaccinated and the status of two others are unknown. All but one case has been tied to travel.

In 2023 there were seven lab-confirmed cases of measles reported in Ontario.

 

For the 2022-2023 school year, just under 60 per cent of seven-year-olds were vaccinated against diphtheria, tetanus, polio and pertussis. Immunization coverage rates were similar for 17-year-olds with the exception of the polio vaccine, which has a strong 90 per cent coverage rate.

Hepatitis B coverage among 12-year-old students stands at about 58.4 per cent for that school year, while HPV immunization coverage is at 47.8 per cent.

A spokesperson for Public Health Ontario said factors such as lack of in-person health care and delayed non-essential appointments during the COVID-19 pandemic negatively affected childhood vaccinations.

School immunization programs were also put on hold due to closures. The report noted that while in-person classes resumed for most students in 2021-2022, most public health units didn’t resume immunization programs until the following year.

“This was very disruptive to the delivery of immunizations during routine well-child visits and for adolescents needing their tetanus-diphtheria-pertussis booster at 14-16 years of age,” officials said in a statement.

“This has probably led to under-reporting of immunizations to public health, but the degree to which this under-reporting has impacted our coverage estimates is unclear.”

Some communities may also have a general difficulty accessing health care, Banerji said, adding that factors such as miscommunication with new immigrants or misinformation can also play a part.

“The reason why we're living so long and the reason why kids aren't dying at a young age is three things really: It's access to clean water, sanitation and vaccination,” she added.

“I think that people forget that.”

Could take 7 years for Peel to catch up

At a meeting last week, Peel’s Medical Officer of Health Dr. Katherine Bingham said that about 50 per cent of students in the region were missing at least one mandated vaccine dose.

A report presented to Reel Region's council noted that “multi-year strategies” are needed to address the backlog and disruptions to routine childhood immunizations.

“Without significant dedicated resources, we estimate it will take seven years to complete screen and catch-up and achieve pre-pandemic coverage rates,” Bingham said in the meeting.

In Toronto, it is unclear when immunization coverage rates will return to pre-pandemic levels.

“This is a really important question,” Dr. Vinita Dubey, Associate Medical Officer of Health, told CTV News Toronto.

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According to city data, there is 57.1 per cent immunization coverage for Toronto students between grades 10 and 12 for Hepatitis B.

Coverage for the HPV vaccine is 50 per cent and the meningococcal quadrivalent vaccine is 77.5 per cent.

“Why are we 10 per cent lower when we are doing the same program that we did pre-pandemic and that's, I think, something that we really need to pay close attention to. Is it vaccine fatigue, is it vaccine hesitancy, or is it just complacency?”

Dubey says the vaccination rates in Toronto speak to the importance of school immunization programs, especially for vaccines that require multiple doses over time.

“These vaccines can prevent cancers and it's the kind of thing that you ideally get before you're ever exposed to these infections. And then it will give you that protection into your life.”

‘We need to be resourced’

The COVID-19 pandemic showed that if resources are funnelled into immunization programs, they can be successful, Dubey said.

“We need to pay attention to that. We may actually need to put in more efforts to get back to where we were. It's not just restarting what we had,” she added. “We need to be resourced accordingly.”

In November, Toronto’s Board of Health asked for $3.8 million from the Ministry of Health to support catch-up immunizations through vaccinations clinics as well as the promotion of routine vaccination.

A nurse administers a vaccination to a child in this Friday, May 17, 2019 photo, at a facility in Mount Vernon, Ohio. (THE CANADIAN PRESS/AP/Paul Vernon)

A spokesperson for the Minister of Health said in a statement they have increased investments to public health units by an average of 16 per cent since 2018.

They also said they restored a 75-25 funding model to public health units in 2023. However the same government also slashed funding 2019 to a formula that had the province funding 70 per cent of funding and 30 per cent being contributed by municipalities.

“We are also working with PHU’s to clarify their roles and responsibilities. All changes are in direct response to the asks of Public Health Units and Municipalities across the province,” the statement says.

“Our government knows it is never too late to get caught up, and back on track with immunization schedules. That is why we are working with our partners, including public health units to catch children up on their routine vaccines. This includes memos from the Chief Medical Officer of Health communicating this focus to PHUs over the last few years. We have seen efforts remain strong across providers, including increases in school-based programs in the last two school years and we will continue to build on this progress.”

There is also a concern that some children may have received their vaccinations but that parents may not have reported it.

The data is reliant on parents and guardians submitting their children’s immunization record to public health units. Both Peel Region and Toronto officials have said it would be beneficial if physicians and clinics could input the data directly into a provincial system.

As it stands, if a child is missing a dose of a mandatory vaccine, public health units have to send parents notifications, threaten students with suspensions, and then actually suspend students if their vaccinations aren’t up to date. Dubey said the process is successful, and both Toronto data as well as numbers provided by Public Health Ontario show that immunizations are starting to slowly go up.

In Peel Region, officials have said that they are currently “mailing orders of suspension to students in Junior Kindergarten to Grade 1 who have not provided updated immunization records”

The ministry did not say if they would consider a provincial immunization registry when asked by CTV News Toronto.

With files from CTV News' Jesse Tahirali