Colleen Flood, Bryan Thomas and Kumanan Wilson are all members of the University of Ottawa Centre for Health Law Policy and Ethics.
The vaccination of children gives us another important tool to fight COVID-19, but it comes with a dilemma: Now that children age five and older can be vaccinated, should it be a requirement for attending school? California has announced plans to require schoolchildren to be vaccinated, but to date no Canadian province has followed suit. This despite entreaties from prominent public-health experts such as Eileen de Villa, Toronto’s Medical Officer of Health.
On the surface, there are many compelling reasons for mandating pediatric vaccinations. While children are far less likely to develop serious forms of COVID-19, the risk is nonetheless greater than with other vaccine-preventable diseases for which there are school mandates in some provinces. There is also an increased risk that unvaccinated children will contract and transmit the virus to other children, causing school closures, and they are at higher risk of transmitting it to their families and the broader population.
The primary concern with the Pfizer-BioNTech vaccine is the risk of myocarditis, an inflammation of the heart muscle that leads to shortness of breath and chest pain. Older boys and young men who have received that mRNA vaccine have experienced myocarditis at a rate of 1 in 10,000, and most recover quickly. The long-term effects of COVID-19 vaccination are not yet known, but vaccines rarely have enduring side effects. By comparison, the risks from COVID-19 for children and for broader society are much greater.
Mandating COVID-19 vaccination for schoolchildren is controversial, and there is bound to be misinformation disseminated by opponents – for example, claiming that a mandate would be contrary to the Charter of Rights and Freedoms.
In Ontario and New Brunswick, school vaccination mandates for illnesses such as measles, mumps and rubella are mitigated by allowing parents to request exemptions on either medical or non-medical (i.e., religious or philosophical) grounds. This is an imperfect solution: With vaccine-hesitant parents requesting non-medical exemptions in growing numbers, Ontario has seen outbreaks of once well-controlled diseases such as measles. Some public-health experts have urged the elimination of non-medical exemptions.
There is some debate as to whether these exemptions are required by the Charter, which protects freedom of conscience and religion. It is unlikely that prevailing forms of vaccine hesitancy, rooted in mistrust of the pharmaceutical industry and government regulators, qualify for Charter protection.
In an early Charter ruling, the Supreme Court explained that protections for conscience apply only to “comprehensive value systems” and “profoundly personal beliefs that govern one’s perception of oneself, humankind, nature.” Over the years, courts have cited this doctrine when rejecting conscience claims from people skeptical of the value of seatbelts, and provincial human-rights tribunals have echoed the point in explaining why vaccine hesitancy is not a trait protected against discrimination.
Nevertheless, political reluctance to mandate a newly approved vaccine as a condition of attending school is understandable. The consequences would be grave for children, who would lose access to education or be forced to switch to remote learning due to the beliefs of their parents. A hard mandate may be needed if the threat of COVID-19 suddenly surges, but for now, the focus should likely be on softer strategies that promote childhood vaccination.
First, all efforts should be made to make vaccination convenient for those who want it by ensuring easy access within schools themselves, following up to ensure second doses are received or requiring employers to give parents time off work to take their kids for shots.
From there, provincial governments could empower schools to require that students register their vaccination status, but allow the unvaccinated to attend – except in the event of an outbreak. This approach has the benefit of minimizing or even eliminating school closures for those who have been vaccinated. Meanwhile, the prospect of being sent home for days or weeks at a time may provide another incentive for children to get vaccinated.
If our primary aim is to incentivize vaccination, the provinces have another option at their disposal: Like adults, younger people could be required to show proof of vaccination when entering non-essential settings such as restaurants and movie theatres – an approach recently announced by New York City.
Too often our pandemic response has involved postponing difficult policy decisions to the 11th hour, then scrambling to implement solutions as case counts grow out of control. Regardless of which policy path is chosen, now is the time to roll out a comprehensive strategy to boost child vaccination.
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