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Students line up before attending class on the first day of school in Montreal on Aug. 31.Graham Hughes/The Canadian Press

With the first COVID-19 vaccine for children under 12 expected to be authorized in Canada soon, there is growing debate among health officials and experts over whether kids should be subject to mandatory vaccination policies, and whether they should be able to claim non-medical exemptions.

There is clear consensus in the medical community that any COVID-19 vaccine approved for children under 12 in Canada would be safe and effective, but some officials have advocated for delaying making inoculation a condition of going to school.

On Thursday, Kieran Moore, Ontario’s Chief Medical Officer of Health, said the province won’t mandate COVID-19 vaccination for children right now.

“We have to look at the trends and the ongoing threat of this virus,” Dr. Moore said, adding that if COVID-19 continues to pose a public-health threat in the months and years ahead, it may be added to the list of immunizations required for school in the province.

Ontario and New Brunswick are the only two provinces with existing laws requiring students to be vaccinated against childhood illnesses, such as measles, in order to attend school. But both provinces allow children to opt out of vaccine policies for medical and non-medical reasons. British Columbia implemented a reporting system in 2019 that requires parents to inform schools of their childrens’ vaccinations.

The upheaval caused by the pandemic has led some experts to advocate for increased use of vaccine mandates in schools to control the spread of COVID-19.

One of the most high-profile votes of confidence in childhood vaccine mandates came in September, when Toronto’s Medical Officer of Health, Eileen de Villa, said COVID-19 vaccines should be added to Ontario’s list of required immunizations for school. Although she does not have jurisdiction over provincial health matters, her words reverberated throughout the province.

Dr. de Villa declined an interview, but Joe Cressy, chair of the city’s board of health, said the idea of mandating vaccines for students is based on sound science and can reduce the effects of COVID-19 on children.

“This isn’t new, nor should it be controversial,” Mr. Cressy said, adding that any mandates should be adopted alongside grassroots efforts to provide education about vaccine efficacy and safety. “This should be an extension of that which we already do and have done for decades, which is require vaccines to protect kids in school.”

Kumanan Wilson, an internal medicine specialist at the Ottawa Hospital, said he feels provinces will eventually turn to the use of mandatory vaccine policies for school-aged kids, particularly if vaccination rates among children remain low and new waves of COVID-19 arrive.

Some medical professionals caution that moving too quickly could undermine parents’ faith in the vaccination program. Joanne Langley, a pediatric infectious disease specialist at Dalhousie University, believes a wait-and-see approach to vaccine mandates for kids is the right move for now. She said it’s important to monitor the vaccine rollout, see how parents respond, and then make adjustments as needed based on vaccination rates and disease spread.

“I think the first thing is to offer the program and provide really good information so parents can go into their injection visit with confidence that they’re doing the right thing,” she said.

But she and others say it may be time to rethink the use of non-medical exemptions. Currently, many mandatory vaccination policies in Canada allow individuals to opt out for reasons such as religion, personal belief or conscience. Anti-vaccination advocates often cite the Charter of Rights and Freedoms in their defence.

But health experts say it’s unclear those exemptions are reasonable, particularly during a prolonged public-health emergency when refusal to get vaccinated can endanger other people’s health.

“Most of the major religions have said ‘yes, please get vaccinated,’ ” Dr. Langley said. “They’re walking hand in hand with science.”

Adam Kassam, president of the Ontario Medical Association, said the organization’s view is that the only valid exemptions to COVID-19 vaccines should be medical ones. People who have experienced severe allergic reactions after receiving COVID-19 vaccines may qualify for medical exemptions, although Dr. Kassam said anyone in that situation could consult with an allergist to determine if they are able to receive a vaccine.

The other situation where a medical exemption could be granted would be a case where someone experiences heart inflammation after a shot, which is a rare side effect of mRNA-based COVID-19 vaccines, particularly the Moderna version. Dr. Kassam said in those cases people are often advised to wait before receiving their second doses.

“Those are the areas where those exemptions would be valid. And to be very honest, it is unlikely that there would be significant flexibility with those definitions,” Dr. Kassam said.

In Toronto, Mr. Cressy said the board of health had been advocating for the elimination of non-medical exemptions even before the pandemic, because the number of people requesting them was on the rise. According to Mr. Cressy, requests for non-medical exemptions among Toronto students rose from 0.8 per cent in 2006 to 1.72 per cent in 2019.

An online presentation from the Toronto District School Board this week said there are a “significant number” of staff requesting exemptions to the board’s mandatory vaccination policy for teachers and other workers. According to figures posted online, 1 per cent of staff are seeking creed-based exemptions, while another 0.6 per cent are seeking medical exemptions.

Many religions, including the Mennonite Church Canada, have come out in support of vaccines. The church’s executive ministers issued a statement that said religious exemptions should not be granted.

“We have heard concerns from some members of our constituency regarding the vaccines. However, we do not believe these concerns justify an exemption from COVID-19 vaccinations on religious grounds from within a Mennonite faith tradition,” the statement said.

Richard Moon, a law professor at the University of Windsor, said a person requesting a religious exemption may sincerely believe it’s a valid reason not to get vaccinated. But given the current circumstances, he said, a court would likely rule that vaccine requirements are justified under the limitations provision of the Charter of Rights and Freedoms.

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