What we know about why some kids are missing routine vaccinations

Some children across the country have fallen behind on their routine immunizations during the COVID-19 pandemic, with vaccination rates dropping off by several percentage points in some provinces.

Pediatricians and other health officials say the decrease in routine immunizations is concerning as cases of polio — a vaccine-preventable disease — emerge in other parts of the world. 

“As we move forward through the pandemic, we really have to focus on children maintaining and getting these routine immunizations that otherwise before we sort of took for granted,” said Dr. Sloane Freeman, a pediatrician at St. Michael’s Hospital and an assistant professor in the University of Toronto’s pediatrics department.

Some experts say there could be several reasons why someone isn’t vaccinated, but don’t think hesitancy is the main culprit. Those who spoke to CBC News suspect school closures during the pandemic, public health resources and staff reallocated and a greater focus on COVID-19 vaccines may be behind the dip.

“It’s a good wake-up call that we need to be extra diligent and probably provide extra resources to catch this group of kids up because we know they were missed,” said Julie Bettinger, a University of British Columbia pediatrics professor and vaccine safety scientist at the Vaccine Evaluation Center in B.C. 

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Vaccination rates falling

Pediatricians across Canada said they’ve seen more unvaccinated kids than usual this time of year.

Just this week, Dr. Fatima Kakkar, an infectious diseases pediatrician and pediatrics professor at the University of Montreal, saw children who have never had a tetanus shot. She says it’s “surprising to see how many” are without the protection.

“For the most part, it’s younger children who missed their regular appointments during peak pandemic time and have just never caught up.”

Recent data provided by government officials in Alberta and Saskatchewan show a drop in vaccination rates for many of the routine immunizations.

In Alberta, most vaccination coverage rates dropped when compared to 2020. Among them is the second dose of measles, mumps and rubella vaccine among seven-year-olds, with the provincial coverage going from 79.2 per cent to 75.8 per cent in 2021.

In Saskatchewan, data from June 2021 compared to data until this June shows that immunization coverage dropped among two-year-olds. While 76.4 per cent of two-year-olds were immunized against pertussis with four doses in June 2021, only 73.4 per cent were vaccinated against the disease by the end of this June.

Provincial immunization rates for pertussis among seven-year-olds also declined during the same timeframe in that province.

The decrease in vaccination coverage may not sound like a lot, but one pediatrician says the changes are striking.

“You’re actually looking at hundreds of kids who are now behind or unimmunized. And that can make a huge difference in terms of seeing some of the diseases that we have vaccinations for and shouldn’t be seeing,” said Dr. Ayisha Kurji, a Saskatoon pediatrician and assistant professor at the University of Saskatchewan.

Freeman said Ontario is seeing “really, really low coverage” for the school-based immunization programs. 

The number of 12-year-olds in Ontario who were vaccinated against meningococcal conjugate (MCV4), human papillomavirus (HPV) and hepatitis B in school dropped significantly when comparing data from the 2019-2020 school year to 2020-2021.

During the 2019-2020 school year, about 70 per cent of 12-year-olds had started but not completed the vaccine series for HPV. That coverage percentage dipped to around 20 per cent the following school year.

“We really need to make sure that they get caught up and that these immunization programs continue and are well resourced moving forward,” Freeman said Wednesday during an online media event organized by the Ontario Medical Association. 

Why the drop-off?

Last month, UNICEF said about 25 million children worldwide have missed out on routine immunizations against common childhood diseases, calling it a “red alert” for child health.

Bettinger says in Canada, school-aged children were most impacted, as they would typically receive their routine immunizations in school. But because of the pandemic affecting rollout in schools, vaccination didn’t always happen.

“We have probably at least two years of kids who have potentially missed those vaccines,” she said. 

She added the COVID-19 immunization programs rolled out across the country also demanded a lot from the system.

“The resources that were required is kind of mind-boggling, to be honest. And certainly that was the priority for public health over the last couple of years, so many of the other routine public health activities were just not as well-resourced,” she said.

A Quebec spokesperson says fewer routine vaccines were given out in schools because nurses were redeployed for COVID-19 vaccination, schools were closed for portions of the pandemic and students were absent due to outbreaks.

But they added that regional health authorities tried to catch up on the students that did miss out on school vaccines in 2020 and 2021. 

Government spokespeople from Ontario and Manitoba both say that the redeployment of public health staff during the pandemic has also affected data collection. 

Freeman says families also didn’t access the health-care system like they would have before the pandemic. 

Some parents also postponed routine vaccinations because they were worried about the interactions with the COVID-19 vaccine, Kurji said. That’s why she says guardians should address their concerns with a health-care provider.

“If you have questions, make sure you ask … whoever is doing the vaccines, what to do and how to help them answer your questions and all your fears,” she said.

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 2017 federal data, the latest available, all of the provinces and territories failed to meet the national vaccination goal of 95 per cent for many of the routine vaccines for kids. 

But Bettinger cautions against assuming lower vaccination rates among some kids is due to vaccine hesitancy. That may exist, she said, but it’s a smaller proportion of people compared to those who may not have gotten their kids vaccinated because of access.

“The pandemic really interrupted services,” she said.

“We know there is mountains of evidence sort of showing the easier you make it for a parent to vaccinate their child, the more likely that child will be vaccinated.”

COVID-19 vaccines

As families prepare for the return of school in the next few weeks, Freeman wants guardians to also think about getting their child vaccinated against COVID-19. 

Federal figures show that 42.44 per cent of kids five to 11 years old have completed their primary series. In the 12-17 age group, almost 19 per cent have completed their primary series and received a booster. 

“If the [COVID-19 cases] go up, we really want our children protected,” said Freeman. 

How can more kids get vaccinated?

Freeman said public health units need to think of creative solutions to administer routine vaccines, especially to reach under-served or marginalized populations.

Making it easier is key, with school-based immunization recommended since kids are already in school and are much easier to access, according to Freeman and Bettinger. 

“The easier we make it, the more likely people will do it,” said Bettinger.