Question Period Note: Impact of Covid-19 on Children's Vaccination

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The COVID-19 pandemic and associated public health measures that aim to limit transmission of the virus have adversely impacted the availability and accessibility of prevention and health services at all levels, including routine childhood vaccinations.

Routine vaccination programs remain one of the most effective measures to protect Canadians against vaccine-preventable diseases (VPDs), such as measles, mumps and tetanus. Many common infectious diseases that were once a major cause of morbidity and mortality in Canada are now preventable with vaccines. Nevertheless, VPDs remain a public health concern in Canada thereby reinforcing the importance of achieving the highest possible levels of vaccination.

Key Messages
• Routine immunization programs prevent illness, save lives and are critical in maintaining the health of Canadians and healthcare system capacity.
• When enough people are vaccinated against vaccine-preventable diseases, we protect ourselves and those around us. Children, immunocompromised individuals, the elderly, and those who do not have up-to-date vaccinations are at greater risk of contracting vaccine-preventable diseases.
• We are working with provinces and territories to monitor and strengthen routine childhood immunization coverage, including disparities in coverage across key groups, and mechanisms to ensure access to life-saving vaccines.
• We are also working to ensure that public health and primary care services support parents and families in catch-up of delayed/missed childhood immunizations in order to prevent potential outbreaks of vaccine-preventable diseases and to support population protection in Canada against many vaccine-preventable diseases that continue to circulate internationally.

Background
Global estimates of vaccination coverage in 2020 suggested that 23 million children did not receive basic vaccines through routine immunization services, which is 3.7 million more than in 2019. Disruptions to routine childhood immunization services during the COVID-19 pandemic leading to decreased vaccine coverage are concerning for possible resurgence of vaccine-preventable diseases (VPDs), including measles.

International and Canadian public health authorities continue to recommend that routine immunizations are essential health services that should not be deferred.

Vaccine Surveillance
High levels of vaccination coverage for VPDs are required to help ensure the ongoing health and safety of Canadians, particularly children, people who are immunocompromised (who have weakened immune systems), and the elderly. The Public Health Agency of Canada (PHAC) monitors and leads surveillance of national vaccination coverage and effectiveness for the general population, as well as populations at greater risk of disease and/or severe outcomes. Updated vaccination coverage goals and VPD reduction targets were agreed to by PTs in 2017, in line with current evidence. Coverage goals range from 80-95% depending on the age group and the VPD. The Childhood National Immunization Coverage Survey (2019) showed that while vaccination coverage in Canada is good, Canada is not reaching national coverage goals except for the tetanus-diphtheria-pertussis (Tdap) vaccine booster dose among 17-year-olds (95% against a goal of 90%) while meningococcal vaccine coverage (89% in 2019) is approaching the target goals (90%) among 17-year-olds. It should be noted that these may underestimate vaccination coverage because the information is taken from vaccination records which may not include some vaccines, or where information is missing/incomplete or illegible.
Further, due to the ongoing pandemic, a decrease in vaccination coverage is being reported by PTs due to the closure of some primary care offices as well as healthcare workers being mobilized to respond to COVID-19.

There is currently limited data to quantify the impact of the pandemic on pediatric immunization coverage in Canada, and any differential impacts on specific groups of children.
• An Ontario study showed that childhood immunization coverage rates for children under 2 years in Ontario decreased significantly during the early period of the COVID-19 pandemic, especially in children aged 15 to 18 months old. The coverage rates recovered in the second half of 2020 but remained lower overall compared to pre-pandemic rates.
• Analysis of Quebec’s vaccination registry data showed that vaccination coverage decreased for children under two years of age in 2020, relative to 2019, but with a near complete catch-up subsequently.
• Analysis of Alberta’s vaccination registry data showed that vaccination coverage decreased in infants in 2021, relative to 2019. On January 26, 2023, Alberta Health Services declared a pertussis (whooping cough) outbreak in its South Zone. The communities where the pertussis outbreak has been declared have lower vaccination coverage than that in other communities thereby demonstrating the importance of vaccination in the prevention of vaccine-preventable diseases.
• PHAC is planning to publish the results of the Childhood National Immunization Coverage Survey in the summer of 2023.

Vaccine Confidence
Vaccine hesitancy has been a longstanding challenge to reducing the burden of childhood illness around the world and was identified as a top threat to global health by the WHO in 2019. The rapid spread of mis- and dis-information on COVID-19 vaccines is challenging confidence in all vaccines, including routine childhood vaccinations. PHAC is working with provinces, territories, Indigenous organizations and a range of trusted partners and stakeholders in public health to address vaccine hesitancy by enhancing capacity building, information resources, culturally appropriate vaccination approaches, and supporting community-led approaches to build vaccine confidence and reduce access barriers. The Agency is also working to support health care providers with reliable information on vaccines, and evidence-based strategies and resources to effectively discuss vaccines with their patients and clients, including to support discussions and decisions about childhood vaccination.
 

• Vaccines can protect children against 16 serious diseases, including polio, mumps, diphtheria, chicken pox, measles, whooping cough (pertussis), and tetanus, among others. Many vaccines for VPDs are offered early in life (i.e., to infants, children and youth), based on evidence of the optimal timing and protection of the vaccinations, as reflected in provinces’ and territories’ (PTs) recommended immunization schedules. Most of the vaccines recommended in early life provide over 90% protection against the disease, with protection being lifelong for some vaccinations.
• The best way to protect children's health is to prevent these diseases in the first place by keeping their vaccinations up to date.
• During the first two years of the ongoing pandemic, a decrease in routine childhood vaccination coverage was reported by PTs due to the reduction of in-person primary care visits, disruptions in school-based vaccination programs, as well as healthcare workers being mobilized to respond to COVID-19. Decreased confidence in vaccines stemming from widespread and growing mis- and dis-information may also be widening gaps in vaccine acceptance as parents hesitate to get their children fully vaccinated.
• Disruptions to routine childhood immunization services leading to decreased vaccine coverage are concerning for the possible resurgence of VPDs, including measles.
• Several provinces have reported on the impact of the COVID-19 pandemic on routine childhood vaccine coverage, and catch-up efforts are underway to address gaps in immunization coverage across Canada.
• There is currently limited data to quantify the impact of the pandemic on pediatric immunization coverage in Canada at the national level, and any differential impacts on specific groups of children. However, several jurisdictions indicated an initial impact during the first year of the pandemic, with subsequent return to pre-pandemic levels of vaccine coverage as catch-up programs and strengthening access to routine immunizations are prioritized across the country.
• Multiple countries worldwide have reported significant declines, delays and disruptions in the administration of routine childhood vaccines and VPD immunization coverage starting in the months following the pandemic declaration.
• The highly infectious nature of many VPDs, the fact that the majority of the vaccine coverage estimates are below the set goals in Canada, and the low vaccine coverage estimates in some other countries elevate the risk of outbreaks of potentially serious VPDs domestically and globally.