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Is mandatory COVID-19 vaccination for school attendance the answer to increasing vaccine uptake in children?

Op-ed in the Toronto Star by Dr. Sloane Freeman, Dr. Ripudaman Minhas and Dr. Kevin Schwartz

The COVID-19 vaccine is safe, effective, and recommended for children aged 5 years and older, yet, nationwide, COVID-19 vaccine uptake has been low in children 5-11 years of age. To date, only 28 per cent have received two doses.

Increasing vaccination rates in this age group must be our priority. Some provinces have mandatory immunization programs for school-aged children, and questions have been raised about the suitability of this approach for the COVID-19 vaccine.

As pediatricians and child health advocates, our considerations surrounding COVID-19 vaccine mandates in children include: Will they prevent serious disease in the individual? Will they protect the community by decreasing transmission? Will they address the root cause of low uptake in children? There is much debate as to whether mandating the COVID-19 vaccine for school attendance is an ethical and equitable way to increase uptake in this age group.

A key benefit of a mandatory COVID-19 child vaccination policy would be its effectiveness in increasing vaccination rates and preventing serious illness in children. With more children exposed to Omicron each day, increasing vaccination in this age group is essential, especially for children with medical and developmental complexity.

Furthermore, COVID-19 has disproportionately impacted marginalized and racialized communities in Canada, with higher rates of hospitalization in children. Requiring the COVID-19 vaccine for school attendance could increase protection of children in hard-hit communities and accelerate the pace of vaccination in all school-aged children.

A mandate would also improve parents’ perception of the importance of the COVID-19 vaccine. Historically, vaccines that were mandated have been viewed as essential by the public.

Many advocates have suggested that mandating COVID-19 vaccination to increase uptake would reduce transmission. A recent preprint study from Ontario demonstrated that two or three vaccine doses were very effective at preventing hospitalizations and death from Omicron in adults. However, two doses provided only 40 per cent protection from mild infection within two months and no protection after six months.

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