Now isn’t the time for vaccine mandates, even with low rate of COVID-19 shots for kids: experts

Fewer than half of Canadian children ages five to 11 have received their first COVID-19 vaccine dose, but Canadian experts say now may not be the time to start mandating them for students attending school in person.

In December, Windsor’s city council endorsed a recommendation from its health unit that all elementary school students be vaccinated before returning to school. 

Meanwhile, in the United States, New York City now requires students to be vaccinated before taking part in extracurricular activities. California, which already has strict vaccine requirements for students, is mulling the addition of the COVID-19 vaccine to that list.

“For provinces that don’t have vaccine mandate policies, to start a conversation about vaccine mandates at a time where emotions are very heightened around vaccination is a risky endeavour,” said public health researcher Devon Greyson.

Greyson, an assistant professor of health communication at the University of British Columbia, has studied the efficacy of childhood vaccine mandates. They found that while uptake does increase, the boost can’t be solely attributed to mandates. Better communication, access and reporting systems also played a role.

In fact, in some jurisdictions, mandates did more harm than good by pushing some people away from vaccination, Greyson says. But Greyson notes that for regions with existing vaccine mandates, adding COVID-19 vaccination “absolutely makes sense.”

“I recommend first really trying to build confidence in the population and make it as easy as possible for people to get vaccinated before considering a policy that has potentially negative consequences on children or parents,” they said.

A children’s COVID-19 vaccine clinic is set up at the Scotiabank Arena in Toronto, on Dec. 21, 2021. About five per cent of five- to 11-year-old children in Canada have been fully vaccinated against COVID-19. (Chris Young/The Canadian Press)

No provincial or territorial government has announced plans for a COVID-19 vaccine mandate in schools, but jurisdictions such as Ontario and New Brunswick already require vaccinations for certain preventable diseases in students entering the public school system. 

Legislation to strengthen mandatory-vaccination rules for N.B. schoolchildren was proposed in 2020, but was defeated. “There are varied opinions, and very strong opinions,” Premier Blaine Higgs, who voted in favour of the change, said earlier this month on CBC’s Power & Politics.

Dr. Cora Constantinescu, a pediatric infectious diseases expert who counsels vaccine-hesitant parents, says that with lower vaccine uptake among five- to 11-year-olds — and children returning to classrooms — there’s an urgency get them vaccinated as soon as possible. But she stopped short of calling for a mandate.

While Constantinescu believes that a vaccine mandate could be effective she pointed out some children risk being kept out of the classroom as a result of such a policy.

Only about five per cent of children ages five to 11 have been fully vaccinated, according to the Public Health Agency of Canada. Prime Minister Justin Trudeau expressed concern over the low vaccination rate on Wednesday, saying that it puts society’s most vulnerable people at greater risk.

WATCH | Experts weigh in on hesitation around vaccinations for kids:

Experts explain slower vaccine uptake among children

2 days ago

Duration 1:44

Ève Dubé, a INSPQ medical anthropologist, and Dr Fatima Kakkar, a pediatric infectious diseases specialist, weigh in on why some parents are still hesitant to get their children vaccinated against COVID-19. 1:44

Access remains a key issue

In October, California Gov. Gavin Newsom announced the COVID-19 vaccine would be added to the list of vaccinations required for students to attend school in-person. The policy will be enforced after the federal government approves the vaccines, and the state will grant exemptions for medical reasons, plus religious and personal beliefs. 

Some school districts have already enacted mandates in the state.

Young children are particularly good at spreading respiratory illnesses — and that’s likely the case for COVID-19 as well, according to Annette Reagan, adjunct assistant professor at the UCLA Fielding School of Public Health in California. 

People wait to get their children vaccinated at a COVID-19 vaccination clinic in Montreal. Dr. Cora Constantinescu says that providing greater access to vaccines could help improve the vaccination rate among five- to 11-year-olds. (Ryan Remiorz/The Canadian Press)

She says that justifies the addition of COVID-19 vaccines to existing mandates.

“Increasing vaccination rates and stopping transmission in younger children is a good thing for our community, but it comes with the mandates,” said Reagan, noting that such policies limit parental autonomy.

The reasons behind low uptake among the pediatric group in Canada are varied, according to Greyson, but might be explained by timing and limited access to clinics.

Pfizer-BioNTech’s Comirnaty vaccine was approved by Health Canada for the five to 11 cohort in late November — just weeks before the holidays when non-emergency medical appointments tend to slow down. 

Pediatric vaccine doses may also be less widely accessible compared to adult doses, said Constantinescu, making it more difficult for parents to get their kids immunized.

“The low-hanging fruit of vaccine uptake is always access,” said Constantinescu. “We have not made this as easily accessible as we could have.”

Constantinescu believes, however, that the narrative children experience more “mild” illness when they contract COVID-19 is a key factor behind the low vaccination rate — a message that parents should reconsider.

“We pray and hope that it’s just going to be a mild illness in most kids. That would be fantastic and I sure hope that, but we don’t know,” she said. 

“What we do know is that the vaccine is safe and we have enough supply.”

‘It’s in the best interest of your child’

Perhaps the most significant risk that comes with vaccine mandates, however, is the potential for children with vaccine-hesitant parents to miss out on in-person learning. 

Constantinescu argues that some children may not get the protection provided by vaccination or the benefits of learning in person.

With new evidence that negative side effects, such as myocarditis, are rare in the five to 11 bracket, she says now is the time to “shout from the rooftops” that vaccinating against COVID-19 is safe.

“This is the top vaccine-preventable threat to our children and we have a safe vaccine,” she said.

“We need to tell parents this is about protecting your child, first and foremost. It’s not about saving the pandemic, it’s not about saving the world.”

“This is because it’s in the best interest of your child.”


Written by Jason Vermes with files from Ashley Fraser, CBC News and The Associated Press.

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