Let's not rush to mandatory vaccines for children

Fear fuels parental hesitancy. Don't worsen it, says Raywat Deonandan.

Is there any more touchy pandemic subject than whether parents should vaccinate their children? The idea of injecting my own infant with a relatively new pharmaceutical product when he is otherwise fit and healthy does not fill me with joy. On the other hand, in case you hadn't heard, there is an epidemic of a virulent respiratory disease afoot, one that is known to torment, disable and even kill children, however rarely. Surely I would want to protect my child from the insidious SARS-Cov2 virus?

The risk-versus-reward computation when it comes to vaccinating children is not an easy one. As best we know, the risks posed by the COVID vaccine are vanishingly small, but not zero. A tiny proportion of vaccinated children experience serious, though treatable, adverse events, such as myocarditis (heart muscle inflammation).

Meanwhile, trials show an astonishing vaccine efficacy of 100 per cent among children. But the reward of offering protection against COVID is admittedly small, as children are thought to be less likely to suffer from symptomatic COVID — though some do become hospitalized and die.

About 11 per cent of COVID cases in Ontario are experienced by children, though they comprise 19 per cent of the population. And so far in this province, only one child death is thought to have been caused by COVID. But one is too many. And the Delta variant is painting a new picture, in which increases in serious pediatric cases are being seen in the United States.

So if the personal risk and personal reward are both small, how does one decide? For many, the tiebreaker is the reward to society: getting a significant step closer to herd immunity. With the Delta variant ascendant with its hyper-transmissible nature and slight challenge to vaccine effectiveness, the threshold for achieving herd immunity has been pushed quite high indeed, to the point where if only Canadian adults were to be immunized, we likely would not have enough resistant bodies to get the job done. Vaccinating children becomes an important strategic move to get us closer to something resembling herd immunity.

Absent high levels of population immunity, we will experience recurring outbreaks mostly among unvaccinated groups. Since schools are finally becoming understood as both essential services and contributors to community transmission, we certainly do not want preventable outbreaks occurring in schools. So it makes sense to want to maximize vaccine uptake among eligible schoolchildren.

This brings up a very divisive policy question: Should COVID vaccines be made compulsory for schoolchildren? Ontario already requires that children attending schools in person must be immunized against nine infections, including tetanus and diphtheria. COVID vaccination, being one of the most efficient strategies for limiting an acute public health crisis, could rationally be added to that list.

But the 1990 Immunization of School Pupils Act allows for exemptions due to “conscience or religious belief,” which could presumably encompass a wide array of mindsets. Given the high prevalence of vaccine hesitancy among parents, the number choosing the exemption option could be substantial, putting in doubt whether mandatory vaccination would indeed render a substantial increase in population immunity.

My fear is that making this particular vaccine mandatory for children would not only be rejected by a skittish population, but would inadvertently strengthen the narrative of those wishing to characterize public health as insidious authoritarian government overreach. It would set back our efforts to win over hearts and minds to unite Canadians behind our battle against COVID.

Absent compelled vaccination, we must endeavour to educate parents and walk them through individualized risk-reward analyses. And accommodation can be explored for those who will not, or cannot, be vaccinated.

Parental hesitancy is fuelled by fear, misinformation and apathy. Making vaccination compulsory addresses the apathy, but accentuates the fear and strengthens the credibility of misinformation. The danger in legislating compliance is in inadvertently increasing the behaviour we seek to suppress.

Compelling shots for children has its own risk-reward ratio. While it might inch us closer to herd immunity and safer schools, it might also push wavering parents toward hardcore anti-vax camps, impairing our ability to enact deeper public health improvements in the long term.

Let us educate, and incentivize rather than bludgeon parents with the brute force of the law. In the end, reason and caring must win out.