EXPLORING SCHOOL-BASED IMMUNIZATION PROGRAMS AND THE IMPACTS OF THE COVID-19 PANDEMIC IN THE CANADIAN MARITIMES

Abstract

Introduction: School vaccine programs help support equitable access to routine vaccines for students. The COVID-19 pandemic and associated public health measures affected three school years and shifting learning environments during this time affected school vaccine program service delivery. The Canadian Maritimes, comprised of Nova Scotia, Prince Edward Island and New Brunswick, experienced low COVID-19 cases and applied unique public health measures throughout much of the pandemic compared to other parts of Canada. The aim of this research was to explore school-based immunization programs and the impacts of the COVID-19 pandemic in the Maritime provinces.

Methods: Informed by the Behaviour Change Wheel, a three-phase, sequential mixed methods approach was used to address the research aim. Phase 1 included an environmental scan of school vaccine programs between the 2018/2019-2022/2023 school years to describe and compare changes in provincial school vaccine programming and vaccine coverage. Findings informed questions included in Phase 2 interview guides, where stakeholders were interviewed about experiences with school vaccine programs before, and throughout, the pandemic. Findings from both phases were integrated to develop evidence-based, theory-informed recommendations to address identified barriers. Stakeholders co-developed recommendations using the acceptability, practicality, effectiveness, affordability, safety and equity (APEASE) criteria.

Results: The environmental scan identified a range of in-school and community approaches to catch-up students on vaccinations. Vaccine coverage decreased in each province during the pandemic and has yet to return to pre-pandemic levels. Stakeholders (n=39) identified existing barriers and enablers to school vaccine programming, and new factors created by the pandemic, including school staff-public health relationships, low buy-in from school staff, staff shortages and student anxiety. Half of the 26 developed recommendations scored at least 80% across the APEASE criteria, with remaining recommendations receiving moderate scores across one or more criteria.

Conclusions: School vaccine programming experienced a range of barriers to service delivery and optimal vaccine uptake prior to, and throughout, the pandemic. Utilizing the Behaviour Change Wheel and complementary tools, we developed a range of evidence- based, theory-informed, and stakeholder-approved recommendations which can be tailored to address provincial barriers to school vaccine program delivery and improve associated vaccine uptake.