A challenging time for children
Dr. Rey D. Pagtakhan
Prime Minister Justin Trudeau visits a vaccination site in Montréal, Quebec, on July 15, 2021. Photo by Adam Scotti (PMO)
US President Joe Biden recently applauded local leaders and knocked governors with anti-mask directives, saying, “To the mayors, school superintendents, educators, local leaders who are standing up to the governors politicizing mask protection for our kids: Thank God that we have heroes like you… This isn’t about politics—this is about keeping our children safe.”
Lamentably, Canada has its share of political leaders – fortunately only a few – who are not fully supportive of all public health guidance. Worse, there is a small minority of people who not only refuse to get vaccinated but also deliberately spread disinformation messages about the virus, vaccines and vaccination. In addition, they co-mingle unmasked with others and pose a health threat to them, including to children who cannot protect themselves.
A dangerous environment for American children
Indeed, unvaccinated, unmasked American adults are the major source of the current surge of COVID cases, including in children, in many states with low vaccination rates such as in Florida, Missouri, Louisiana and Texas. Alarming news reports coming from these states tell of suffering children, exhausted nurses and pediatricians, and of a baby girl with COVID-19 who was airlifted 150 miles because of the Houston hospital bed shortage.
Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas said, “We have not seen kids pile into pediatric ICUs across the South like we’re seeing right now.” Said Dr. Paul Offit, a pediatric vaccine specialist from the Children’s Hospital of Philadelphia and a vaccine adviser to the US Food and Drug Administration, “(unvaccinated, unmasked) adults have really let our children down.”
The circumstances identified below help define why the current situation in America is a dangerous environment for their children:
- The contagious Delta variants continue to surge and mutate in the southern US;
- There is no vaccine approved for those under the age of 12;
- Those who go to school and day care will be gathering closely together during their classroom and play activities;
- The schools and daycare centres may not have upgraded their ventilation systems;
- Full vaccination among the vaccine-eligible, 12-year-and-over population has not reached yet the desired goal;
- Children may come from homes in regions and communities with low vaccination rates;
- Response to wearing masks and getting vaccinated has become deeply politically polarized; and
- More so now than last year, children develop serious disease requiring hospitalization and ICU admission for life-support. – Madeline Holcombe. CNN News. August 11, 2021.
What is the situation with Canadian children?
The American situation gives us a picture of what could be coming for Canadians. In fact, Canada’s Public Health Agency has only recently announced that the Delta-driven fourth pandemic wave is underway. Since extreme contagiousness is a defining hallmark of the Delta variant, does this mean the country is facing an imminent COVID wildfire?
Senior health reporter Andre Picard made the observation in his opinion piece, “Brace yourself for more COVID-19 nastiness” (Globe and Mail, August 9, 2021) that “the much-dreaded fourth wave of COVID-19 … could be the toughest one yet … we’re going to experience a new kind of nasty, with a lot more children and young adults getting sick and hospitalized than in earlier waves.”
At the same time, Canada has not experienced the same magnitude of pediatric alarm being experienced in the US due in large part to the high vaccination rate we have in Canada with the two mRNA vaccines that are highly protective even against the Delta variants. Another possible explanation is the lesser partisan divide we have compared to the US.
While I share the optimism that the overall Canadian situation would not be devastating, I am cautious and concerned about the situation with our children under the age of 12. They are unvaccinated because there is still no approved vaccine for them. And they are returning to schools next month – a necessity for their overall development. This age-group of children depends, therefore, on older children and adults eligible for vaccination to have theirs as soon as possible. This situation also underscores the point that all safety precautions must be in place for the unvaccinated, non-vaccine eligible children.
I consider the situation with Canadian children under 12years of age challenging and, therefore, merits our critical attention. This means we should all acknowledge that masking, physical distancing, smaller class sizes, adequate ventilation systems and, when indicated, isolation, contact tracing and testing, all serve their useful purposes as we navigate the fourth wave. Most important, get fully vaccinated so that we can protect our nation’s children.
Current vaccination status implications
Canada’s percentage of fully vaccinated is 62.6 per cent of the total population or 71.2 per cent of the eligible 12-year-of-age-and-over population for whom vaccines are approved for use. (Source: CTV News, August 12, 2021) The corresponding figures for the partially vaccinated are higher, but I have excluded them in this discussion since partial vaccination offers protection below the acceptable regulatory threshold. We shall consider them for what they are – the necessary step to full vaccination.
While the statistics for the fully vaccinated in Canada compare better than in the USA and in most other countries, certain rural and remote areas in Alberta, Saskatchewan and Manitoba are reporting full vaccination rates as low as only 16 per cent. Since our country’s full vaccination target has been placed higher at 90 per cent of the total population to effectively confront the extreme contagiousness of the dominant Delta variants and the emerging Delta variant plus, these rural and remote regions in the prairies are particularly at much greater risk of a full-blown resurgence as the Delta-driven fourth wave spreads. Hence, the greater threats to the area residents and to the control of the pandemic.
The unvaccinated versus the fully vaccinated
Difficulty accessing the vaccines, religious beliefs and disinformation are some of the common reasons that keep residents from getting vaccinated. The first is more amenable to finding a solution, such as establishing a neighbourhood vaccine hub, which can 1) establish a community presence, 2) be available to answer questions, 3) provide vaccine information, and 4) administer vaccinations as Ottawa Public Health has done with success in increasing vaccination numbers (Josh Pringle, CTV News, August 11, 2021).
The latter two reasons would require more intensive counter measures, including repeated public reporting on the proportion of all new cases, hospitalizations, and deaths coming from the unvaccinated, partially vaccinated and fully vaccinated. For example, Saskatchewan reported last month that “more than 90 per cent of all new cases and hospitalizations were unvaccinated or partially vaccinated people; 95 per cent of ICU admissions were unvaccinated or partially vaccinated; and 100 per cent of deaths were unvaccinated.” These figures are consistent with the US Centers for Disease Control and Prevention (CDC) data, which shows that full vaccination has provided the following:
- an eight-fold reduction in people getting the disease;
- a 25-fold reduction in both COVID-19 related hospitalizations for serious disease; and
- a 25-fold reduction in COVID-19 related deaths.
Meeting the full vaccination target
Currently, 27.4 per cent of the total population (that is, 10,413,435 of 38,005,238 Canadians) or 18.8 per cent of the eligible population (that is, 7,144,984 Canadians) have yet to receive their full vaccination to reach our national target of 90 per cent. The current figures reflect approximately 6.5 million more Canadians were vaccinated during the last half month. This is a positive development. At this current pace of vaccination, it appears Canada can reach its target of 90 per cent full vaccination coverage by the time fall begins.
Flattening the fourth wave
Admittedly, even full vaccination cannot completely prevent transmission. Be that as it may, Canada’s Chief Public Health Officer, Dr. Theresa Tam, felt the fourth wave could be flattened, depending on how successful the country is in hastening full vaccination coverage, and the tempo and extent of reopening.
My preceding commentary discussed the challenges posed by re-opening of international borders without regards to vaccination status of incoming passengers, reopening of schools without requiring full vaccination, public health measures failing to reckon with the intermingling of non-vaccinated and vaccinated populations, absence clear protocols for safety in healthcare and related settings, and unavailability of approved vaccines for children under 12 years old.
In the intervening half month, it appears that several provinces – although not all – have moved in the right direction to address the challenges, and vaccine developers have announced that vaccines for those under 12 years of age may soon be ready for emergency use approval.
Vaccine certificates and passports are a necessity
For greater clarity, proof of vaccination for the purpose of international travel is best called a “vaccine passport,” while one for the purpose of verifying the status of a full vaccination is best called “vaccination certificate.” These may be required in doing certain jobs and entering certain places that would make unvaccinated people co-mingle with vulnerable people, such as in healthcare and day-care settings; long-term and elder care institutions; schools, also in public safety work (police, firefighters, and military); non-essential businesses (bars, restaurants, gyms); entertainment (theatres, concerts) and sports facilities.
In the opinion piece, “The time for debating COVID-19 vaccine passports is over,” published in the July 26, 2021, issue of the Globe and Mail, Andre Picard persuasively made the case for a mandatory vaccination certificate and passport. The same paper’s subsequent editorial, “Yes to vaccine mandates. Yes to vaccine passports,” of August 12, 2021, echoed the same conclusion, citing historical precedence, similar regulatory examples in other areas, and equivalent rationale for the protection of Canadians, individually and collectively. They underscored the need for “verifiable, secure, standardized, accessible and portable” documentation that is focused on clarity, simplicity and fairness and urgently adopted as time is of the essence.
Getting fully vaccinated and having a vaccine certificate and vaccine passport can be the difference between wellness and illness, between a mild disease manageable at home and a more severe type requiring hospitalization and ICU admission for life-support, or between life and death for self, loved ones, neighbours, co-workers or unknown contacts in the community. Acting now on both necessities would certainly mitigate if not eliminate the challenging pandemic environment children are in. We owe it to those who cannot protect themselves.
Dr. Rey D. Pagtakhan, P.C., O.M., LL.D., Sc.D., M.D. M.Sc. is a retired lung specialist, professor of child health, author of articles and chapters in medical journals and textbooks, and a former health critic, Parliamentary Secretary to the Prime Minister, and cabinet minister, including Secretary of State for Science, Research and Development.
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