Toronto Public Health tracks school vaccination numbers through two means: exemption rates and coverage rates. In order to receive an officially recognized religious or philosophical exemption (medical exemptions are not included in the figure), parents must fill out the requisite paperwork and attend an education session, making it a more comprehensive measure of who definitely isn’t vaccinated. Coverage rates, in contrast, are self-reported, calculated by gathering students’ vaccination status from parents.

During the COVID-19 pandemic, TPH paused its efforts tracking vaccination rates for public school students, setting off a years-long backlog in data collection they’re now working to fix a year at a time. Many students missed out on key vaccines during lockdown periods, and even more now have out-of-date records because their parents haven’t submitted their vaccination status.

The average TDSB school coverage rate for the MMR vaccine post-pandemic (beginning in the 2023-24 school year) is 65 percent, and the TCDSB’s rate 83 percent, both lower than pre-pandemic numbers. It’s likely both figures could be undercounting, missing students who are vaccinated but whose information is missing from the TPH database. It’s certain that both figures are lower than the federally recommended 95 percent coverage. Vaccination stats have similarly dropped for the diphtheria, pertussis, tetanus, and polio (DPT) vaccine and for voluntary middle-year vaccines like hepatitis B, human papillomavirus, and meningococcal.

“We know that there is under-reporting,” says Vinita Dubey, associate medical officer of health for TPH. “It is a very manual process, and a lot of parents don’t realize that when they get the vaccine at their doctor’s office, the doctor doesn’t automatically give us that information.”

Dubey’s team has restarted the vaccination coverage recording program paused during the pandemic, sending out thousands of letters to parents asking for updates to their children’s vaccination status. They’re going a single grade cohort at a time, focusing first on kids born in 2008, who may have missed key middle-grade vaccines due to the pandemic, and kids born in 2016, who are due for kindergarten vaccine boosters.

Before the pandemic, data was available for an entire school’s student body. Now, among elementary students, we only have data for second-graders in the 2023-24 school year, making school-to-school comparisons difficult. For example, most of the alternative schools where The Local found high rates of pre-pandemic vaccine exemption are now missing from TPH data because their grade 2 cohorts are too small, fewer than 10 students in total, to reveal vaccination data. It’s hard to tell how long it will take to get back to pre-pandemic levels of vaccine coverage and data collection.

“It took us three years to get in this place,” Dubey says. “It’s going to take us time to get out of it.”

This year, Toronto Public Health began suspending hundreds of high school students who didn’t report being up-to-date on their mandatory MMR and DPT vaccines and who did not have a formal exemption. Their hope is that the suspensions will prompt parents and students to either catch up on the mandatory vaccines, which may have been missed due to the pandemic, or to go through the formal exemption process, thereby improving the city’s records on vaccine coverage. (In 2019, following a rise in non-medical exemptions, TPH actually asked that the province end the practice of allowing exemptions; the province denied the request.)

Bramadat notes that school boards, family doctors, and in the case of Catholic schools, religious heads could be doing more to encourage uptake and dispel vaccine misinformation among parents exempting their kids from mandatory vaccines. “It’s not like we have to just leave it to the internet or just hope that things get better,” he says. “The good news is that there is a solution. The bad news is it’s expensive and takes time.”

It starts with health care professionals being given more time, resources, and training to have necessary conversations with vaccine hesitant parents, addressing their concerns and the potential risks in depth, rather than through pamphlet after impersonal pamphlet.

But with Ontario’s medical system overtasked and underfunded as it is, that burden can also be shared by schools talking to parents and children directly. Just as students are taught about civics, Bramadat says, public health should be integrated into the classroom.

When there’s another pandemic, “we want the kid and the parents to be well equipped for the conversation, to know the difference between between a virus and a bacteria, to know the difference between aborted fetal material and stem cell lines. We want them to have some literacy when these issues are all of a sudden bombarding them on social media.”

And in the Catholic school system especially, it’s up to church leaders to leverage the shared ethics and values of the community, he adds. “This common sense of well-being and taking care of one another and being healthy can be used, I think, to generate pro-vaccine attitudes, or to make sure rational vaccine science is protected and promoted.”