With daycares and schools closed across Canada during the COVID-19 pandemic, immunization requirements aren't being enforced by public health officials, and that has doctors worried about a possible surge in measles, whooping cough and other serious, vaccine-preventable illnesses.

The Canadian Paediatric Society is urging family physicians and other clinicians to ensure young patients don't miss their vaccines.

Dr. Joan Robinson, a spokesperson for the society, said keeping children at home won't completely protect them from vaccine-preventable diseases.

"Meningitis can be acquired from a completely healthy child or adult who carries the bacteria in the nose or throat," said Robinson, who is a pediatric infectious disease physician at the University of Alberta in Edmonton.

A family might have older children in their home who carry the bacteria and could spread it to the younger child, she said.

She notes that some diseases also require three doses of vaccine in order for protection to be complete — and the pandemic shouldn't interrupt the schedule of jabs.

But not all medical clinics and doctor's offices have the infrastructure or enough personal protective equipment (PPE) like gloves and masks to offer routine vaccinations safely. Many clinics are closed altogether for the time being, amid quarantine measures imposed by the provinces and territories.

Drive-up vaccination

One doctor has come up with a creative way to inoculate his young patients.

Dr. Daniel Flanders, a pediatrician in Toronto, is administering drive-up vaccinations in the alley behind his office.

"This is a way to vaccinate the children in our community, while at the same time limiting our PPE [use]."

In this makeshift doctor's office, there are no doorknobs to touch, no shared waiting space, no close-up conversations with office staff.

Marion Mallette brought her one-year-old daughter Violet to the drive-up clinic. "We just wanted to make sure we were keeping on top of her schedule, and we were concerned because of what's going on right now."

It took about a minute for Violet to receive her vaccines while sitting on her mom's lap on a plastic chair outside the clinic. The vaccines were stored in a fridge set up outside and running with an extension cord.

'Pandemic is bad enough'

Physicians and public health experts warn that a delay in immunizing even a small number of children heightens the risk of non-COVID outbreaks.

Pediatricians say they understand if inoculations can't take place for a month or two. But once restrictions start to reach three months or more, they worry that the herd immunity rates that protect vulnerable individuals in the community could crumble.

"This pandemic is bad enough," Flanders said. "If we layer on top of that vaccine-preventable infection outbreaks, that is really unthinkable."

In April 2019, New York City Mayor Bill de Blasio declared a public health emergency in parts of Brooklyn due to a measles outbreak. There was a spike in cases in the U.S. since 2018, following a three-year period of relatively low numbers. (Shannon Stapleton/Reuters)

The World Health Organization is equally concerned.

Globally, the immunization of more and more children has led to historic progress against diseases like polio.

The United Nations health body said Thursday that when immunization services are disrupted, even for brief periods during emergencies, then the risk increases for outbreaks of measles and polio.

Last year's deadly measles outbreak in Congo, which took more than 6,000 lives in a country already facing its largest Ebola outbreak, highlights the importance of maintaining essential health services, including immunizations, WHO said.

Dr. Katherine O'Brien, a Canadian pediatric infectious disease physician and epidemiologist with WHO in Geneva, says gaps in herd immunity affect the whole world, not just the local population.

"Measles anywhere is measles everywhere, even in Canada, which does have a strong immunization program," O'Brien said.

O'Brien said WHO is collecting information from different member countries trying innovations such as:

Administering vaccines in areas physically separated from sick patients coming in to be seen.

Limiting visits to one parent with one child.

Scheduling more days for vaccines, meaning fewer patients per day, so they can physically distance.

WHO recently listed vaccine hesitancy as a global public health threat, along with pandemics.