Achi news desk-
Ontario is still playing catch-up on routine vaccinations that many children missed during the pandemic and public health officials warn it could take years to solve the problem.
“What we see around the world is when the vaccination rates go down, you have a resurgence of a vaccine-preventable disease,” Dr. Anna Banerji, a pediatric infectious disease specialist from Toronto, told CTV News Toronto.
“If someone got measles and they were with a group of unvaccinated children, then for every person who has measles, they would usually infect about nine or 10 other children. And so it’s highly contagious.”
About 60 percent of seven-year-old children are fully vaccinated against measles — as well as other illnesses such as mumps and varicella — according to a report published by Public Health Ontario at the end of March.
This is a significant reduction from the provision in 2019-2020, when those numbers were between 82 per cent and 86 per cent.
Ontario has seen a mild resurgence of measles this year, with 13 cases reported in 2024 so far.
Of the seven children who became infected, five children were unvaccinated while the immunization status of two others was unknown.
Three of the adults received two doses of the vaccine while one was unvaccinated and the status of two others is unknown. All but one case is tied to travel.
In 2023, seven laboratory-confirmed measles cases were reported in Ontario.
For the 2022-2023 school year, just under 60 per cent of seven-year-old children were vaccinated against diphtheria, tetanus, polio and pertussis. Immunization rates were similar for 17-year-olds except for the polio vaccine, which has a strong coverage rate of 90 percent.
Hepatitis B coverage among 12-year-old students is about 58.4 percent for that school year, while HPV immunization coverage is at 47.8 percent.
An Ontario Public Health spokesperson said factors such as a lack of personal health care and delays in non-essential appointments during the COVID-19 pandemic have negatively impacted childhood vaccinations.
School immunization programs were also delayed due to school closures. The report noted that although in-person classes resumed for the majority of students in 2021-2022, the majority of public health units did not resume immunization programs until the following year.
“This greatly disrupted the provision of immunizations during normal visits to healthy children and to adolescents who need 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 it is not clear to what extent this under-reporting has affected our estimates of coverage.”
Some communities may also have general difficulty accessing health care, Banerji said, adding that factors such as miscommunication with new immigrants or misinformation may also play a role.
“The reason why we live so long and the reason why children don’t die young is really three things: access to clean water, sanitation and vaccination,” he added.
“I think people forget that.”
It could take 7 years for Peel to catch up
At a meeting last week, Peel Medical Officer of Health Dr Katherine Bingham said about 50 per cent of students in the region miss at least one mandatory vaccine dose.
A report presented to the Reel District council identified the need for “multi-year strategies” to tackle the backlog and disruption to routine childhood immunisations.
“Without significant dedicated resources, we estimate it will take seven years to complete screening and catch-up and achieve pre-pandemic coverage rates,” Bingham said at the meeting.
In Toronto, it is unclear when immunization rates will return to pre-pandemic levels.
“This is a very important question,” Dr. Vinita Dubey, Liaison Medical Officer of Health, told CTV News Toronto.
According to city data, 57.1 percent of immunization coverage for Toronto students between grades 10 and 12 is for Hepatitis B.
Coverage of the HPV vaccine is 50 per cent and the quadrivalent meningococcal vaccine is 77.5 per cent.
“Why are we 10 percent lower when we do the same program as we did pre-pandemic and that, I think, is something 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 this is the kind of thing you ideally get before you’re exposed to these infections. And then he will give you that protection in your life. “
‘We need to have resources’
The COVID-19 pandemic showed that if resources are channeled into immunization programs, they can be successful, Dubey said.
“We need to pay attention to that. We may need to put in more effort to get back to where we were. It’s not just a restart of what we had,” he added. “We need to be resourced accordingly.”
In November, the Toronto Board of Health requested $3.8 million from the Ministry of Health to support catch-up immunizations through vaccination clinics as well as promoting routine vaccinations.
A spokesperson for the Minister of Health said in a statement that they have increased investments in public health units by an average of 16 per cent since 2018.
They also said they had restored the 75-25 funding model to public health units in 2023. However, the same government also cut 2019 funding to a formula that had the province funding 70 percent of funding and 30 percent is contributed by municipalities.
“We are also working with PHU’s to clarify their roles and responsibilities. All changes are in direct response to the requirements of Public Health Units and Municipalities throughout the province,” the statement said.
“Our government knows it’s never too late to get caught, and back on track with immunization schedules. That’s why we work 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 informing PHUs of this focus over the past few years. We have seen efforts continue to be strong across providers, including an increase in programs in schools in the last two school years and we will continue to build on this progress.”
There is also concern that some children may have had their vaccinations but parents may not have reported it.
The data relies on parents and guardians submitting their children’s immunization record to public health units. Peel Region and Toronto officials have said it would be beneficial if doctors and clinics could enter the data directly into a provincial system.
As it is, if a child misses a dose of a mandatory vaccine, public health units must send notices to parents, threaten students with suspensions, and then suspend students if their vaccinations are not up to date. Dubey said the process was successful, and the Toronto data as well as numbers provided by Public Health Ontario show that immunizations are slowly starting to increase.
In Peel Region, officials have said they are currently “posting suspension orders to students in Kindergarten Junior to Grade 1 who have not provided updated immunization records”
The ministry did not say whether they would consider a provincial immunization registry when asked by CTV News Toronto.
With files from Jesse Tahirali of CTV News
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