Opinion

We must limit barriers to vaccine access for children and youth

The Ontario government’s announcement that children 12+ can register for a COVID-19 vaccine was welcome news for children, youth, families and those on the front line who have been witness to the impact of this pandemic on young people.

As many have articulated, children have borne the brunt of the pandemic, with racialized children and youth most affected. Remote learning, the absence of sport and recreation activities, and the lack of face-to-face support from professionals have compounded isolation, limited peer contact and left many children with little respite from their homes.

The “non-medical symptoms of COVID-19” are emerging around the world: stalled psychosocial development and poor mental health compounding inequities related to learning and child poverty; increased risk of violence; exploitation and abuse; and neglected physical conditions offer compelling reasons to immunize Ontario’s children quickly to contribute to a return to our pre-pandemic life as soon as possible. 

For the government to meet its goal of children 12+ receiving both shots by the end of August, we must heed the lessons learned from the adult vaccination rollout and swiftly maximize access to clinics and minimize vaccine hesitancy.

Ontario has asserted that anyone living in the province who wants a vaccine should receive one and this should remain true for children. We must universally eliminate barriers to access including the requirement to present an OHIP card or other government-issued ID. Letters from schools or health/social service agencies confirming age and address should suffice for children that don’t have access to typical ID. 

Trusted adults and easy access to multilingual, high-quality information about vaccines will be key to engage children early and often about COVID-19 and the vaccine. However, we must remember that not all of Ontario’s children have a supportive relationship with their families of origin nor do they have the option of being accompanied to a clinic by a trusted adult. If able to provide informed consent, children in foster care, those living with informal caregivers, those living independently, involved with the shelter system or those that have informed opinions that differ from their anti-vaccine guardians should all have the right to make the decision to be vaccinated independently from a parent or guardian. Their right to do so if competent is enshrined in the Health Care Consent Act and we should not entertain any efforts to put these rights aside.  

Immunizers are excellent at obtaining informed consent and should be left to do their job, free from additional forms with unnecessary co-signatories for young people who understand what they are consenting to. This approach also supports best practice at the time of immunization: Youth able to provide informed consent may not feel comfortable answering questions related to pregnancy and should not feel they have to disclose their personal health information in front of their guardians. Feeling forced to do so may lead to inaccurate responses to critical questions of the consenting process. Additionally, if a child who is deemed to be competent refuses the vaccine in situ, an immunizer should not proceed to the act of immunizing the child, despite the parent wanting to consent on their behalf. And, importantly, if a capable child wishes to be immunized despite the guardian’s anti-vaccine position, that child should be permitted to be vaccinated and be supported by easy access to a clinic.

Logistics should be carefully considered to ensure barriers are mitigated wherever possible, including strategies to limit wait time for young people, many of whom in June are focused on exams during the final month of school. Clinics should have dedicated inter-professional staff to support young people who may have needle phobias. Using the infrastructure that local public health units have already established will be key to moving quickly. Adults already know how to access these clinics that have become familiar sites in neighborhoods across the province. These mass vaccination clinics will have a place alongside pop-ups in hot-spot communities that work in conjunction with faith and cultural leaders. The recent success of a pop-up clinic in Toronto in which a high school principal was key in getting 1,400 people in his school community vaccinated illustrates the central role schools can play in the effort and the opportunity for logistical and leaderful engagement from our colleagues in education.

For the adult campaign, community social media groups on Facebook and Twitter have become a necessary hub for the dissemination of local vaccine information (the innovation and success of @VaccineHunters being one of the best examples) and while they are ready to again feature heavily in this campaign, there is opportunity for us to do better. As soon as clinics are confirmed, they must be broadly communicated using multiple channels, including those young people access, such as TikTok. Family practice clinics, youth-serving social service agencies, faith and cultural organizations and schools know their families and should broadly communicate information from trusted sources about the vaccine and how to get vaccinated in their local area.    

Supporting independent access for competent youth has surrogate benefits. Those working in clinics have observed youth 16+ (and adults) craving some sense of community and connection, going in small groups to get vaccines, which will be the reality, too, for some of the older youth in the 12+ cohort. Public messaging should encourage and support this to leverage “positive peer pressure” and peer support.

Children and youth aren’t so different from adults in that some will be hesitant and influenced by misinformation on social media and, in some cases, in their family or peer group. Some recent press has stated that those under 25 might in fact be more hesitant than other cohorts. It will be important to directly address the reasons for hesitancy using age- and culturally-attuned resources alongside encouragement to speak to elders and faith and community leaders.

Increasing vaccination eligibility to younger Ontarians is a hopeful step in ending the pandemic. Working together to eliminate barriers for children and youth and ensuring as smooth a process as possible will speed this outcome.

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Authors

Marisa Cicero

Contributor

Marisa Cicero is a social worker whose work since last March has focused on supporting the child welfare sector’s response to COVID-19. Marisa is a mother of two girls in the 12+ cohort and would like them to be afforded a private conversation with their immunizer.

Julie Maggi

Contributor

Julie Maggi is an assistant professor in the Department of Psychiatry at the University of Toronto, a staff psychiatrist at Unity Health in Toronto, and she has been working as an immunizer at hospital and pop-up clinics. Julie is a mother of a 10-year-old son who she would like to see empowered to consent for his vaccine.

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