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Guest column: Should governments mandate children’s vaccinations for school attendance?

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Health Canada recently authorized Pfizer’s COVID-19 vaccine for children aged five-11, concluding the benefits — 90.7 per cent efficacy in preventing the disease — outweigh any risks.

The state of California has already announced plans to require vaccination for school children. To date, no Canadian province has followed suit, despite entreaties from prominent public health experts like Eileen de Villa, Toronto’s Medical Officer of Health.

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On the surface, there are many compelling reasons for mandating pediatric vaccinations.

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While children are far less likely to develop serious illness from COVID-19, the risk is nonetheless greater than for 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 risks of transmitting the infection both to their families and the broader population.

The primary concern with the Pfizer children’s vaccine is the risk of myocarditis, an inflammation of the heart muscle leading to shortness of breath and chest pain. Older boys and young men receiving the vaccine have experienced myocarditis at a rate of 1 in 10,000, but most recover quickly.

The long-term effects of COVID-19 vaccination are not yet known, but vaccines rarely have long-term side effects. By comparison, the risks from COVID-19 both for children themselves and for broader society are much greater.

Mandating COVID-19 vaccination for school children is controversial and there is bound to be legal misinformation disseminated by opponents. For example, claiming that a mandate would be contrary to the Charter of Rights and Freedoms.

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In Ontario and New Brunswick, school vaccination mandates (e.g. for measles, mumps, 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 given how with vaccine-hesitant parents requesting non-medical exemptions in growing numbers, Ontario has seen outbreaks of once well-controlled diseases like 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 will 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 science around seat belts; provincial human rights tribunals have recently echoed the point in explaining why vaccine hesitancy is not a trait protected against discrimination.

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Nevertheless, political reluctance to mandate a newly approved vaccine as a condition of attending school is understandable. 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 and requiring employers to give time off work to parents taking 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 school for days or weeks at a time may provide the incentives needed for many to get vaccinated.

If our primary aim is to incentivize vaccination, the provinces have another option at their disposal. As with adults, younger people could be required to show proof of vaccination when entering settings such as restaurants and movie theatres.

Whatever policy path is chosen, we should be developing policy options now regarding childhood vaccination and dispelling legal misinformation.

Too often our pandemic response has involved postponing difficult policy decisions to the 11th hour and then scrambling to implement solutions as case counts grow out of control.

Colleen M. Flood, Bryan Thomas and Kumanan Wilson are members of the University of Ottawa Centre for Health Law Policy & Ethics.

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