This disease is spiking in an Ontario city. But there's a vaccine - if you can afford it

Can you put a price on pro‐ tecting your children from a potentially deadly menin‐ gitis-causing bacterial in‐ fection?

Right now, it's about $320 per child, unless you happen to have private insurance, for a two-dose vaccine recom‐ mended by public health offi‐ cials in Kingston, Ont. - one of a handful of regions in Canada seeing a spike in lo‐ cal cases of invasive meningococcal disease (IMD).

IMD is a rare but lifethreatening bacterial infec‐ tion that can infect the brain and spinal cord, causing meningitis, and the blood‐ stream, causing septicemia.

Up to 10 per cent of peo‐ ple infected with IMD die, ac‐ cording to Health Canada, and complications include deafness, limb amputations and permanent brain dam‐ age. There are almost 200 cases in Canada per year on average.

Most IMD cases are caused by five types of bac‐ teria: A, B, C, Y and W-135, though in Canada, group B causes most illness, ac‐ cording to the health depart‐ ment.

Kingston, Frontenac and Lennox & Addington Public Health (KFL&A) is recom‐ mending the meningococcal B vaccine for people under age 25. It's not a routine vac‐ cine like meningococcal C, typically given to babies at age one, or meningococcal ACYW-135, administered in Grade 7 in Ontario, said the health unit.

Currently, no provinces or territories cover the cost of the meningococcal B vaccine for all children, according to the Canadian Paediatric Soci‐ ety.

Crystal Harris, 45, plans to vaccinate her two teenagers after getting letters from their schools in Kingston last week recommending the shots. She says she was sur‐ prised when she realized how much it would cost, and was grateful she has private insurance that covers it. She also knows she's one of the lucky ones.

"I cannot imagine having to pay that money to keep your children safe and healthy," Harris told CBC News. "It's simply wrong."

People with certain highrisk medical conditions are eligible for a free vaccine, as is anyone who comes in con‐ tact with a case. But at this point, the Kingston commu‐ nity at large isn't eligible for publicly funded vaccination, said Dr. Piotr Oglaza, medical officer of health at KFL&A Public Health.

The cost for the general population - about $160 per dose, with two doses re‐ quired - is "absolutely" a bar‐ rier, especially for someone who doesn't have private in‐ surance, Oglaza said.

"I fully understand and appreciate that dilemma and that struggle that individuals may face.

"But really, the best pro‐ tection against this is the vac‐ cine."

Rare but risky

Last Thursday, KFL&A Public Health warned of an increase in invasive meningo‐ coccal disease type B activity in the region - three cases in recent months, including one pediatric case, according to Oglaza. Its last case was in 2013, he said.

Kingston isn't the only re‐ gion seeing an increase. Last month, health officials in the Eastern Townships of Quebec called for vigilance after con‐ firming two cases of invasive meningococcal infection in the region, one of which re‐ sulted in a death. The specific type of case isn't yet known.

Manitoba public health of‐ ficials also recently warned that the province had seen 11 cases and one death be‐ tween Dec. 21 and Feb. 29. The serogroup of one of those cases was identified as type B.

Manitoba typically has six cases of IMD reported in a year.

While IMD cases in Cana‐ da are rare, outbreaks do oc‐ cur across the country, says a 2023 report from the Nation‐ al Advisory Committee on Im‐ munization.

Most cases came from children under age five and adolescents aged 15 to 19, the report said.

"Outbreaks of meningo‐ coccal B disease are usually small and localized, and are primarily seen among ado‐ lescents and young adults, especially those living in dor‐ mitory or other group set‐ tings," said Devon Greyson, an assistant professor at the School of Population and Public Health at the Univer‐ sity of British Columbia.

University campuses in At‐ lantic Canada have had out‐ breaks in the last few years, including student deaths.

In May 2023, Nova Scotia began offering the meningo‐ coccal B vaccine for free to people aged 25 and under living in group settings, such as university residences. Then in January, Prince Ed‐ ward Island expanded its free vaccine eligibility to all postsecondary students.

'Multiple tiers of privi‐ lege'

There are "multiple tiers of privilege going on" in ter‐ ms of vaccine accessibility, between the out-of-pocket cost, the potential for cover‐ age by private insurance, and the fact that if you don't have a family doctor, you may not even be having these conver‐ sations, said Ian Culbert, the executive director of the Canadian Public Health Asso‐ ciation.

"For low-income people, it simply isn't an option."

Funded vaccine programs have much higher uptake rates than unfunded ones, he noted. But even the hesi‐ tancy for funded vaccines such as the measles shot - is increasing post-pandemic, he added.

A new poll released last week by the Angus Reid Insti‐ tute found that a growing number of Canadian parents say they are opposed to vac‐ cinating their children.

Among the 1,626 survey re‐ spondents, 17 per cent of parents of minors said they were "really against" vacci‐ nating their kids, compared with about four per cent in 2019.

Given that, there's even less incentive for provincial and territorial governments to fund some of the vaccines for diseases that are less common, Culbert said, even though the outcome of catching IMD can be much more serious than mumps or measles.

"It's this risk-benefit that as individuals we have to think about, but that the gov‐ ernments need to think about, as well."

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