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.
“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.
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.
“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.
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 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.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
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