UNDER S TANDING Vaccines
Senior
Anna Sibiga
Jessica Golyatov
Kylie Armishaw
School-Based Vaccination Is on Hold — and It's a Big Concern
Experts are stressing the importance of getting school-based vaccine programs back on track after COVID-19-related delays.
Tania Amardeil
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-19, 58 percent of Ontario students received both doses of their HPV vaccine, but during COVID-19 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
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
We want everybody to have access and we know that school-led vaccine programs are the mostwayequitable to have the population immunized.
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 schoolbased vaccine programs have not been fully reinstated.
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-19 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.
To find out how to catch up your kids on immunization please contact your local public health unit. Visit phdapps.health.gov.on.ca/phulocator to find yours.
Canadians Should Be Aware of HPV Prevention Steps for All Ages
Canadians should be aware of the risk of HPV and the preventative measures that can be taken to avoid this potentially-deadly virus.
Amélie McFadyen, CEO of HPV Global Action
What is human papillomavirus (HPV) and why should all Canadians be aware of the virus?
Over 75 percent of Canadians will have one form or another of HPV in their lifetime. People come into contact with this virus through any skin-to-skin sexual contact below the waistline with fingers, mouth, or other body parts, even without penetration. Condoms give good protection against sexually transmitted infections (STIs), unwanted pregnancies, and HPV in general, but they don’t fully protect people from this virus because there’s still direct skinto-skin contact.
What risks are associated with HPV? Unfortunately, there are typically no signs or symptoms of this virus for either partner, regardless of sex or gender. HPV could appear as genital warts or could lead to cancers of the tonsils, vocal cords, tongue, throat, anus, cervix, vulva, vagina, and penis. Genital warts are small, raised lumps that can grow in clumps or alone. They’re usually painless but
may cause itching, burning, or slight bleeding. They can be found anywhere from the waist down to the knees, on the front and back of a person’s body, and in the mouth. HPV can also stay asleep in a person’s body for up to 40 years and later surface as a cancer. This means that what you’re doing now, or have done in the past, could affect you years or decades later.
What can families do to best protect themselves from HPV?
The good news is that there are preventative methods. HPV vaccination is the best protection from this virus. It has benefits for people of all ages. The vaccine protects people from being affected by different types of the virus with which they haven’t already come into contact. If a person has cleared an HPV-related infection (genital warts or an HPV-related pre-cancer), then the vaccine will help protect against reinfection. Furthermore, if you have a cervix, getting routine cervical screening, whether vaccinated or not, can help detect cervical cancer earlier.
How has the COVID-19 pandemic impacted school-based vaccination programs for diseases such as HPV?
Considering Canada’s current annual mortality rates for HPV-related cancers, interruption of school-based HPV vaccination programs resulting from the COVID-19 pandemic may have devastating consequences to these children’s health in the coming decades. In many provinces, at least two cohorts of children eligible for the HPV vaccine haven’t received full protection against HPV strains that may cause cancer due to these interruptions. Experts are now trying to assess the impact of this, recognizing that the COVID-19 pandemic has irrevocably altered public perception of the threat posed by infectious diseases, such as HPV.
For more information and resources on HPV, HPV prevention, and its related cancers, visit hpvglobalaction.org