School-based immunizations took a hit during COVID-19 pandemic

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School-based immunizations for children and adolescents in Alberta dropped dramatically in the first two years of the COVID-19 pandemic, according to newly-published research.

And while a significant amount of catch-up has occurred since then, it’s likely that some Alberta students still haven’t been immunized with vaccines they should have received in Grade 6 or Grade 9, says Hannah Sell, whose study was published in the journal Vaccine.

Sell was a master’s student in the School of Public Health when she carried out her research in 2021. Her graduate studentship study was part of a larger project called Vaccination in a Pandemic, overseen by Shannon MacDonald, an associate professor in the Faculty of Nursing and adjunct professor in the School of Public Health.

“It’s an important issue because school-based immunization programs historically have been a way to present an equal opportunity for children to be up-to-date on their immunizations,” says Sell. Many parents who work multiple jobs or have transportation and language issues have challenges getting their kids vaccinated elsewhere.

Sell examined the pandemic’s impact on two immunizations: HPV vaccines, normally given in Grade 6 to prevent cervical and some other cancers later in life; and meningococcal vaccine, given in Grade 9 to protect adolescents from meningitis and other potentially fatal illnesses. The shots are given by public health nurses who come to the schools.

Sell analysed data from several Alberta Ministry of Health databases, including the provincial immunization repository, to look at the number of children vaccinated in school programs in 2019-20 and 2020-21, compared to 2017-18.

The rates for HPV coverage in Alberta were already lower pre-pandemic than public health officials would like, but they fell even further once the pandemic hit. In 2017-18, 66.4 per cent of eligible students received their HPV shots, but that fell to 5.6 per cent in 2019-20, followed by 6.6 per cent in 2020-21. For the meningococcal vaccine, there was no dramatic drop in 2019-20 because most students received their shots before the pandemic hit, but in 2020-21, only 54.6 per cent received their shots, compared to 86.8 per cent pre-pandemic. Rates were even lower in private schools.

Public health officials developed catch-up strategies but priority was given to infant immunizations because those children were at higher risk. Catch-up programs for school-aged vaccinations began later in 2020 and in 2021 but varied by zone, sometimes taking place in schools — when they were open — and sometimes in community clinics. Sell followed the 2019-20 cohort for a year and found that coverage rates did recover but were still lagging behind pre-pandemic numbers.

“We need additional strategies to get these kids caught up,” says MacDonald, who was Sell’s research supervisor. “We do not want to have our cervical cancer rates spiking 20 years from now because these kids didn’t get their HPV vaccinations.”

Findings from Sell’s study and MacDonald’s larger project have been shared with policy-makers and other public health officials, in hopes of influencing program and resource planning in the event of another pandemic.

Sell, who now works as an epidemiologist at the BC Centre for Disease Control, says she’s grateful to WCHRI for the studentship that supported her project. “This study was a perfect opportunity to build my analysis skills and also make connections and get practice communicating with different stakeholders. It was a kicking-off point for my current career.”

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Hannah Sell was supervised by Shannon MacDonald. Her graduate studentship was funded by the Stollery Children’s Hospital Foundation through the Women and Children’s Health Research Institute.