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A nurse prepares a dose of the Pfizer-BioNTech COVID-19 vaccine for children, in Montreal, on Nov. 24, 2021.ANDREJ IVANOV/AFP/Getty Images

It isn’t really a surprise that COVID-19 vaccination rates for children lag considerably behind those for adults, even two months after Health Canada first approved pediatric doses of Pfizer’s vaccine. At present, only around half of Canadian kids aged 5 to 11 have received at least one dose, even though supply is plentiful.

Parents who were willing to tolerate some perceived risk about unknown immediate and long-term side effects of vaccination were always going to be less tolerant of that risk when making the decision for their children, particularly since we know that children are less likely to suffer severe outcomes from COVID-19. Access was also always going to be an issue, since vaccinating a child usually requires some degree of pre-planning and extra time (as do most things with children), which can be difficult for single parents and parents who work odd hours. Adults have long been able to get themselves jabbed at all sorts of places along their daily routes, but kids, especially pandemic-era kids, don’t have routines that extend much beyond school and home. Without the opportunity for vaccination right in front of them, many children – especially those from low-income communities where parents work irregular hours – will remain unvaccinated.

That’s why some regions have moved to vaccinate kids in schools, during classroom hours. Newfoundland and Labrador began a program of in-school vaccinations nearly right after the pediatric dose of Pfizer’s COVID-19 vaccine was approved, and the province now boasts the highest proportion of kids aged 5 to 11 who have received at least one dose, at 76 per cent. Some schools in Quebec began vaccination programs in schools as early as November. The City of Toronto has organized vaccination clinics at a handful of schools in priority neighbourhoods, and it plans to expand to additional schools in the coming weeks. Ontario is now encouraging other health units to adopt similar initiatives.

There’s plenty of evidence that shows that school immunization programs increase vaccine uptake and challenge socio-economic barriers, while still allowing parents to withhold consent if they so choose. It should be the premier initiative to try to improve vaccination rates among children, along with culturally sensitive outreach programs and communications that address the root causes of COVID-19 vaccine hesitancy.

Some teachers’ unions, school boards and parents have called for a blunter instrument – vaccine mandates – to improve school safety and try to drive up vaccination rates among kids attending in-class learning. But while the announcement of mandatory COVID-19 vaccination might reflexively result in an uptick in appointments (as has been observed when similar announcements have been made throughout this pandemic), the effect is usually fleeting, while unintended consequences fester for weeks after.

In the case of a mandate for health care workers in B.C., those unintended consequences were staff shortages in hospitals and cancelled diagnostics and procedures. We’re currently seeing the unintended consequences from a vaccine mandate for truckers in supply chain disruptions and growing social unrest. And with schools, the unintended consequence will almost certainly be greater absenteeism among kids from racialized and low-income communities, which currently have some of the lowest rates of vaccination for children compared to more affluent communities. Indeed, a vaccine mandate might increase vaccination rates among children over all, but it will come at the expense of vulnerable kids who have already experienced disproportionate learning loss throughout this pandemic.

It is true that some provinces “require” proof of vaccination for students to attend schools (in practice, parents can easily opt out by signing a form and watching an educational video). But to perceive this vaccine – and the hesitancy that surrounds it – as in any way akin to vaccines that have long been mandatory for school attendance is to fundamentally misunderstand parents’ concerns about long-term effects and the speed with which this vaccine was developed. Simply declaring it compulsory is thus a surefire way to make parents feel alienated and unheard (especially parents from communities with historically fraught relationships with government and public-health authorities), while providing excellent grist for the anti-vaxxer mill, which will surely delight in another opportunity to promote further conspiracy and hysteria.

Obviously there are very good reasons to want to see as many children as possible vaccinated against COVID-19, but there is scant evidence that the threat in schools is so pernicious that it is worth adopting a policy that will further sow social and political divisions, alienate parents and inevitably kick some of the most vulnerable kids out of schools. Especially not when there are other options – such as school clinics during instructional hours – that markedly improve access, particularly when combined with outreach initiatives. The bluntest instrument in this case is far from the best one. Parents should be aided and encouraged – but not forced – to get their kids vaccinated.

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