As Canada readies to vaccinate kids aged 5-11, a look at immunization across the country

With Health Canada expected to approve Pfizer-BioNTech's COVID-19 vaccine for children aged five to 11 — and as it continues to review Moderna's pediatric version — parents of younger school-aged children must now decide whether they'll be queuing up to get their kids these shots.

Here's a quick refresher about vaccinations for children and school-related immunization. 

Parents and guardians are ultimately responsible for getting their children immunized. Who actually gives kids their regular shots, however, depends on region. In some areas, it might be a nurse, or specifically a public health nurse, while elsewhere it may be a pediatrician or family physician/general practitioner. In some cases, like for a flu shot, it could be a pharmacist.

Provinces and territories distribute and manage delivery of vaccines, which are approved and procured by the federal government. 

Health officials across the country have already been planning how to roll out COVID-19 vaccines for the 5-11 age group, ranging from setting up specific pediatric vaccination clinics (some with therapy dogs), incorporating pediatricians and family physicians and enlisting pharmacies as well.    

In every province and territory, schools are also a common public space to host vaccination programs for students. Multiple regions have mentioned planning COVID-19 vaccine clinics in school spaces, as they've already done for older children, teens and families.

Looking to the COVID-19 vaccination rollout for younger kids, "there needs to be adjustments in the mass clinics to accommodate children and use of pain- and anxiety-management techniques, because we know that many children are afraid of needles and that could be a stressful event to be vaccinated in a crowd," said Ève Dubé, a medical anthropologist and researcher at the Quebec National Institute of Public Health.

Childhood immunization is highly recommended by public health and school officials across Canada as a long-lasting, effective protection against vaccine-preventable diseases. 

In order to attend school in Ontario, the Immunization of School Pupils Act requires proof of vaccination (or being granted an exemption) for a series of diseases, including diphtheria, measles, mumps, polio, rubella, tetanus and more. A section of New Brunswick's Public Health Act mandates that parents or guardians of students starting school — which is typically at kindergarten — show proof of vaccination (or have an accepted exemption).

British Columbia's Vaccination Status Reporting Regulation compels families to disclose a student's immunization record or seek an exemption. In the event of an outbreak — of measles, for instance — unvaccinated students are required to remain at home for a set period of time.

Other provinces and territories don't make vaccination mandatory, but schools in those regions may still review the immunization records of students registering for school for the first time. Alternately, public health officials or school nurses may review children's immunization records at the age they typically start school or at subsequent intervals. 

In Alberta, for instance, public health reviews come in Grades 1, 6 and 9. If vaccinations are missing or incomplete, information sheets about them are typically sent home, along with parental consent forms, ahead of routine in-school clinics.

Compelling immunization can increase uptake, according to research from the U.S., where every state has some vaccine requirements. But in Canada, it's less clear, said Dubé.

Ontario has required proof of vaccination for school attendance since 1982, she said, whereas Quebec doesn't. "But when we compare Quebec vaccine uptake versus Ontario vaccine uptake, it's quite similar."