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Routine immunizations are among the many things disrupted by the pandemic, and Dr. Noni MacDonald says we must have solid plans to catch up before a COVID-19 vaccine becomes available.
The pediatrician and well-known vaccine expert teaches at Dalhousie University and co-authored a paper published in the Canadian Journal of Public Health earlier this month. Titled ‘COVID-19 and missed routine immunizations: designing for effective catch-up in Canada,’ the article examines the need to do this “quickly and effectively.”
The authors note that the pandemic has disrupted routine immunization programs worldwide. They say no one is safe from vaccine-preventable diseases “until we are all safe,” adding that if routine vaccine and catch-up programs are done well during the pandemic, it will strengthen the country’s “immunization foundation” for a future COVID-19 vaccine roll out.
“Not getting kids immunized has long term downstream problems in that you end up with kids scattered across the country who will not be immunized, and then when measles comes in it’ll just pick them off,” MacDonald said in an interview.
“That causes us a lot of distress in terms of the amount of money it costs to shut down an outbreak when it happens. And it can kill kids. It’s not trivial to not be immunized.”
MacDonald said many Canadians believe the diseases for which we receive routine immunizations — measles, mumps, rubella, whooping cough, polio, etc. — aren’t a problem. She said that’s simply “not true,” and points out that in jurisdictions where routine immunization has been lax, there have been large outbreaks.
“The US almost lost its measles elimination criteria in 2019 because they had so many measles cases across the country,” she said. “And not in one group only, but splattered all over the country picking up people who hadn’t been immunized.”
A mumps outbreak among university-aged people in the Halifax area in 2007 was a result of Canada not doing a second dose of mumps vaccine in a catch-up program.
“So they only put in the second dose when they put it in universally, but they didn’t catch up to kids who’d gone before, and whoops. Look what happened,” MacDonald said.
Disrupted Grade 7 routine vaccines
In Nova Scotia, students in Grade 7 during the 2019-2020 school year had their second round of in-school routine vaccines through Public Health postponed due to this spring’s province-wide shut down of schools. On July 3 the province announced that those students would be able to catch up on their missed immunizations during the months of July and August at “round two”summer clinics hosted by Public Health.
With less than a week left before those immunization clinics close up shop, Nova Scotia Health (NSH) said it’s been “very well-attended overall.”
“As clinics are still in progress, we won’t have final numbers until they are completed and that information has been compiled,” NSH spokesperson Brendan Elliott wrote in an email. “For any students in this cohort who weren’t able to attend a summer clinic, Public Health will be working to ideally catch them up on their immunizations in the fall. Planning for fall clinics and those details are still being worked out.”
MacDonald applauded Nova Scotia’s strategy for the missed second dose of the Grade 7 in-school program. But she said there will be parents who can’t easily access such clinics, and some children will inevitably fall through the cracks.
“Access has to be made really simple here. Maybe we need to do it not just at public health clinics for school aged kids,” she said. “Maybe some of those vaccines need to be given in pharmacies. We need to see how well we do with the program, but we need to catch up as much as we can.”
Children born in the past 12 months might also be behind on their vaccines, and MacDonald urges parents of children between the ages of 18 months and two years old to confirm their children have received their 18-month doses.
The Department of Health and Wellness has an online list of routine immunization schedules for children, youth, and adults. MacDonald said everyone should know their immunization status.
“We cannot just leave it by chance to somebody picking up that you’re not fully immunized,” she advised. “This is a health issue we need to pay attention to because you have the potential of dying if you don’t.”
Playing catch-up with COVID-19
MacDonald cautions that it’s not only children who are impacted by pandemic-related interruptions in routine immunization schedules. She said recommended routine immunization for seniors, including pneumococcal and influenza vaccines, could be affected. So could pertussis (whooping cough) and influenza vaccines recommended for pregnant women.
Determining a catch-up plan before the arrival of a COVID-19 vaccine is key, MacDonald said. Although it’ll be “a while” before it’s available, we need to have established strategies for not only prioritizing the vaccine, but for its safe, effective and efficient distribution.
“And when we’re doing that, can we catch people up? If I have somebody who’s 65 who comes in to get their COVID vaccine at some clinic I’m going to be doing it at, should I also not be offering them their pneumococcal vaccines and other vaccines that they may have missed,” she asked.
“Or that 25 year old who’s going to get his COVID vaccine but never got that second dose of mumps vaccine? Should I be doing that? Those are questions we need to be taking into account and thinking about.”
Potential for double whammy this winter
Although people are encouraged to get a flu shot every year, it’s especially important this upcoming winter with the possibility of a second wave of COVID-19 crashing into influenza season.
“We do know that people die from influenza every year…We don’t do the tally of people dying of flu every year, and we probably should. To make it real,” she said.
“We had a couple of kids last year in flu season who were literally at death’s doorstep from flu. They recovered, but they could have died. This happens every year and it happens in the adult hospitals all the time. Influenza does not have the same mortality rate as COVID does, but people still die from this and we could do better.”
MacDonald points to Australia, where the peak winter flu season runs from June to August. Last month, experts in that country stated that hundreds of flu deaths were avoided because of public health measures implemented to prevent the spread of COVID-19.
“What I’d love to see in Nova Scotia is a high uptake rate of flu vaccine, keep on doing what we’re doing to protect us from COVID, and maybe we can really stamp down flu this year,” she said.
“What we want is to decrease the influenza season and make it less impactful. So we’re going to take up less beds in the hospital for that, decrease the mortality from it, and then we have more resources available to treat COVID. There is a potential for a double whammy.”
Nova Scotians, she said, need to understand that there’s no quick fix for COVID-19. MacDonald believes it’ll be two years before everyone is immunized and we have community protection from the virus. This means social distancing, frequent hand washing and mask wearing need to become essential and accepted daily habits.
“This is not about conspiracy. This is not about people getting you. This is about saving. This is about keeping you protected, me protected, our families protected, our communities protected,” she said.
“Vaccinate and do the things that we need to do to protect us from COVID in the interim.”
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