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A group of pediatricians is warning of a “potentially devastating collision course” ahead of the approaching flu season without a mass immunization strategy.

In a new petition launched online Saturday, the pediatrics section of the Ontario Medical Association identified three key factors that could produce challenges this fall: unprecedented interest in flu shots, the decreased capacity of physicians to deliver vaccinations, and the “co-circulating” coronavirus.

Every year, more than 1,000 Canadian children are hospitalized with influenza and hundreds die across North America, the petition says.

“COVID-19 stands to compound that risk and complicate the logistics of getting our communities adequately immunized against flu,” the physicians wrote.

While children appear to be at decreased risk of severe COVID-19 symptoms, much is still unknown, including how the virus interacts with flu.

“Unlike COVID-19, we already have effective flu vaccines, available now.”


The new petition calls for a “better centralized, universal infrastructure” in Ontario for vaccinating the most vulnerable children, those six months to four years of age who typically visit their family doctors and pediatric clinics for the flu shot. Those clinics are not equipped to handle an influx of patients if interest in the flu shot is indeed spiking, says pediatric emergency physician Dr. Dina Kulik.

Kulik told that patients have been reaching out to her and her colleagues “in droves” asking for the flu shot, which is typically administered in October and November each year. The flu shot is not yet available in Ontario, where Kulik practices.

Recent surveys support the observation that interest is spiking among parents. In August, a global survey published in The Journal of Pediatrics identified a nearly 16 per cent increase in the number of caregivers that said they plan to get their child vaccinated against the flu. Researchers suggested that “[c]hanges in risk perception due to COVID-19” may be playing a role.

But family doctors and pediatrician clinics aren’t equipped to safely immunize hundreds of patients—as they typically would—during a pandemic, said Kulik. Some of those clinics have also yet to open, she added.

Instead, Kulik suggests there’s a need for “mass immunization programs” that allow for more efficient physical distancing and other health protocols necessary during the COVID-19 crisis. This could be “outdoor tents set up where kids can go through one at a time,” she said, citing research that shows there is less transmission of the virus outdoors. 

Alternatively, immunization programs could be implemented in schools as they have been for Hepatitis B and Human papillomavirus (HPV) among older elementary school children.

“That poses other challenges since some kids are not in school, and other might be sick at the time,” she noted. Other options could be modelling a mass immunization strategy off drive-thru testing sites for COVID-19 where people wouldn’t even have to leave their vehicle.

Asked what support the province will provide concerned pediatricians, Ontario’s Minister of Health Christine Elliott didn’t specify any new initiatives to expand the existing influenza vaccine system outside individual clinics.

“Pharmacies are able to administer flu vaccines, although not to very young children—they will still need to be administered in their physicians’ offices,” said Elliott, adding that physical distancing, masking and hand-washing will help prevent the flu as well. “We are anticipating that if everyone continues to follow the same public health measures as they are to prevent the transmission of COVID, this should help the transmission of flu as well.”

A spokesperson for Ontario's Ministry of Health told Monday that the province plans to unveil a "comprehensive plan" to prepare for this year’s flu season in the coming weeks. According to the spokesperson, that plan will include steps to prevent the risk to vulnerable populations and minimize the spread of the flu, while ensuring the health care system can provide responsive services.

"To be clear our province had a highly successful flu campaign this past year. We were able to administer over 4.4 million vaccines last year, additionally we also saw pharmacists administer 15 per cent more vaccines last year then the year prior. Our province also saw the level of hospitalizations from the flu drop from 5,406 to 4,943," said the spokesperson.

"As we look ahead to this year’s flu season it will undoubtedly contain an extra element with COVID-19 being ever-present."


As health experts sound alarm bells for the approaching flu season, one country’s experience has presented a possible upside to COVID-19 “co-circulating” at the same time as influenza: Australia. Every year, Canadian physicians model their flu vaccine predictions off of the Oceanic country, which this year saw record low influenza infection rates. Experts credited lockdowns and other pandemic protocols for stamping out the flu there. 

While this initially may have seemed encouraging for the Canadian flu forecast, says Kulik, the country’s COVID-19 caseloads entering flu season are not similar. Australia, which has recorded nearly 27,000 COVID-19 cases, logged fewer than 100 new cases a day in June and less than 500 a day for much of July and August, the peak of its flu season. Over the last week alone, Canadian health officials have recorded more than 7,000 new cases