For hundreds of thousands of families around the province, back to school means buying books and pencils, new backpacks and shoes. But for a growing number of students, it also means a trip to the doctor for a booster shot.

Ontario’s quasi-mandatory vaccination system requires all students to provide proof of vaccination upon enrolment or have a parent sign a form opting out. If neither is completed, students can be suspended.

The system has been in place for more than 30 years, and most Toronto schools have immunization rates above 80 and 90 per cent. But of the 858 public, private and Catholic schools included in a Toronto Public Health database, a few laggards stand out from the crowd.

According to a Star analysis of the records, 12 Toronto elementary schools and eight high schools have vaccination rates for diphtheria, polio and tetanus (DPT) or measles, mumps and rubella (MMR) under 70 per cent.

ALPHA Alternative Junior School near Queen St. W. and Spadina Ave. has the distinction of being the only school with less than half its students immunized in both categories. Only 50 per cent of the students at its partner high school, ALPHA II, have both vaccinations.

The TDSB declined to comment on vaccination issues and referred inquiries to Toronto Public Health. Dr. Christine Navarro, associate medical officer of health said that low immunization rates tend to be concentrated in certain schools that might cater to a particular religious or philosophical community.

“Exemption rates are very low in Toronto, typically less than 2 per cent,” she said. ALPHA Jr.’s exemption rate is 39 per cent.

But Greenwood Secondary, near Danforth and Greenwood Aves., has a low exemption rate of less than 1 per cent, but still has a frighteningly low vaccination rate: 50 per cent for DPT and 39 per cent for MMR.

“That gap is a lack of information,” Navarro said. “Some newcomers require translation . . . some parents just aren’t aware.”

Indeed, Greenwood is a specialized school that serves newly arrived Canadians and transitions them into their neighbourhood schools. This transient population makes it a ripe candidate for public health education outreach, Navarro said.

The information published by Toronto Public Health, however, dates back to 2011-2012 for the elementary schools and 2012-2013 for the high schools. In many cases, the students who were there when the statistics were collected have already moved on.

While more recent vaccination information is being constantly collected by Public Health, it isn’t compiled and analyzed more often due to the extra work that would require, Navarro said. Officials hope to release updated statistics this fall.

A recent C.D. Howe Institute study criticized Ontario’s mandatory-vaccination model for being both heavy-handed and ineffective. While alienating some people with religious or cultural aversion to vaccination, the policy hasn’t achieved the national immunization target of 95 to 99 per cent.

Ontario’s paper immunization books are easily misplaced and place the onus on parents to keep track of vaccinations. Public officials, by contrast, only know who is vaccinated once they reach school, much later than the mandatory enrolment in public vaccination programs at birth that occurs in Alberta, for example.

“It is a very labour-intensive process to assess all of the students for their immunizations. If there was a single portal for information, where when a child gets a vaccine, it would automatically get entered and we would get that information in real time, then we would all — parents, health care providers and public health all have access to records,” said Navarro.

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“Unfortunately right now, we’re not there. The yellow card is definitely not ideal.”

Click here for a full list of schools vaccination rates.