Review Reports - Lessons from Ontario’s COVID-19 Vaccination Strategies: Implications for Preventing Measles Resurgence in Canada

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

This opinion manuscript reviews vaccination strategies implemented in Ontario during the COVID-19 pandemic and considers how lessons from these approaches may inform measles prevention in Canada. The manuscript is concise and accessible, and its focus on practical immunisation strategies is appropriate for an opinion article. I have only a few comments that the authors could consider, as follows:

The corresponding author should ideally use an institutional e-mail address.
Figure 1 currently reads more like a summary table than a figure. The authors could redesign it as a conceptual framework in which COVID-19 vaccination strategies are grouped into broader operational domains, such as access expansion, targeted outreach, surveillance of coverage gaps, and communication, with arrows showing how each domain could be adapted to measles catch-up vaccination, routine immunisation strengthening, and outbreak prevention.
The manuscript would benefit from a clearer discussion of the biological and epidemiological differences between COVID-19 and measles, particularly the much higher transmissibility of measles and the need for well-established two-dose measles-containing vaccine coverage to prevent outbreaks.

Author Response

For research article: Lessons from Ontario’s COVID-19 Vaccination Strategies: Implications for Preventing Measles Resurgence in Canada

Response to Reviewer 1 Comments
1. Summary
Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions highlighted in red in the re-submitted files.
2. Questions for General Evaluation	Reviewer’s Evaluation	Response and Revisions
Does the introduction provide sufficient background and include all relevant references?	Yes/Can be improved/Must be improved/Not applicable
Are all the cited references relevant to the research?	Yes/Can be improved/Must be improved/Not applicable
Is the research design appropriate?	Yes/Can be improved/Must be improved/Not applicable
Are the methods adequately described?	Yes/Can be improved/Must be improved/Not applicable
Are the results clearly presented?	Yes/Can be improved/Must be improved/Not applicable
Are the conclusions supported by the results?	Yes/Can be improved/Must be improved/Not applicable
3. Point-by-point response to Comments and Suggestions for Authors
Comments 1: The corresponding author should ideally use an institutional e-mail address.
Resposne 1: Thank you for your suggestion. Unfortunately, the submitting author does not currently have an institutional email address. However, Professor Sekercioglu, who is one of the corresponding authors, has an institutional email address (fsekercioglu@torontomu.ca), which can be used for correspondence purposes.
Comments 2: Figure 1 currently reads more like a summary table than a figure. The authors could redesign it as a conceptual framework in which COVID-19 vaccination strategies are grouped into broader operational domains, such as access expansion, targeted outreach, surveillance of coverage gaps, and communication, with arrows showing how each domain could be adapted to measles catch-up vaccination, routine immunisation strengthening, and outbreak prevention.
Response 2: Agree. We have accordingly revised Figure 1 to better emphasize this point. Figure 1 (page 2) has been modified in response to your valuable suggestion. We developed a conceptual framework that groups the COVID-19 response strategies and illustrates how some of these strategies can be adapted to strengthen measles prevention efforts. Comment 3: The manuscript would benefit from a clearer discussion of the biological and epidemiological differences between COVID-19 and measles, particularly the much higher transmissibility of measles and the need for well-established two-dose measles-containing vaccine coverage to prevent outbreaks. Response 3: Thank you for pointing this out. We agree with this comment. Therefore, we have added a few comments on the Discussion paragraph (page 4).

Thank you very much for reviewing my manuscript. I sincerely appreciate the time and effort you devoted to assessing it and providing valuable insights to help improve my work and support the publication process. Your comments and suggestions are greatly appreciated.

I look forward to hearing your feedback.

Regards,

Stella Triboi

Reviewer 2 Report

Comments and Suggestions for Authors

The manuscript addresses a timely and important public health topic and is generally well written and easy to follow. The overall message is clear, and the examples provided from Ontario's COVID-19 vaccination program effectively illustrate how certain strategies could be adapted to support measles prevention efforts in Canada. However, in its current form, the paper remains largely descriptive and reads more as a narrative overview than as a true Opinion article. The discussion would benefit from a more critical analysis of which COVID-19 strategies are realistically transferable to routine measles immunization, which are not, and the practical challenges associated with their implementation. For example, the manuscript could discuss the fundamental differences between emergency COVID-19 vaccination campaigns targeting adults and routine childhood MMR immunization, or critically evaluate the feasibility and potential limitations of extending pharmacy-based vaccination or mobile clinics to routine measles prevention. Likewise, the various strategies presented are treated as equally important, whereas a discussion of their relative impact or prioritization would strengthen the overall message. Overall, the article has merit and addresses an important issue, but a more critical and original perspective would substantially enhance its impact.

Addressing these points would substantially strengthen the manuscript and increase its scientific impact. Therefore, I believe the manuscript will be suitable for publication after these revisions have been adequately addressed.

Author Response

For research article: Lessons from Ontario’s COVID-19 Vaccination Strategies: Implications for Preventing Measles Resurgence in Canada

Response to Reviewer 2 Comments
1. Summary
Thank you very much for taking the time to review this manuscript. Please find the detailed responses below and the corresponding revisions highlighted in red in the re-submitted files.
2. Questions for General Evaluation	Reviewer’s Evaluation	Response and Revisions
Does the introduction provide sufficient background and include all relevant references?	Yes/Can be improved/Must be improved/Not applicable
Are all the cited references relevant to the research?	Yes/Can be improved/Must be improved/Not applicable
Is the research design appropriate?	Yes/Can be improved/Must be improved/Not applicable
Are the methods adequately described?	Yes/Can be improved/Must be improved/Not applicable
Are the results clearly presented?	Yes/Can be improved/Must be improved/Not applicable
Are the conclusions supported by the results?	Yes/Can be improved/Must be improved/Not applicable
3. Point-by-point response to Comments and Suggestions for Authors
Comment 1: The manuscript addresses a timely and important public health topic and is generally well written and easy to follow. The overall message is clear, and the examples provided from Ontario's COVID-19 vaccination program effectively illustrate how certain strategies could be adapted to support measles prevention efforts in Canada. However, in its current form, the paper remains largely descriptive and reads more as a narrative overview than as a true Opinion article. The discussion would benefit from a more critical analysis of which COVID-19 strategies are realistically transferable to routine measles immunization, which are not, and the practical challenges associated with their implementation. For example, the manuscript could discuss the fundamental differences between emergency COVID-19 vaccination campaigns targeting adults and routine childhood MMR immunization, or critically evaluate the feasibility and potential limitations of extending pharmacy-based vaccination or mobile clinics to routine measles prevention. Likewise, the various strategies presented are treated as equally important, whereas a discussion of their relative impact or prioritization would strengthen the overall message. Overall, the article has merit and addresses an important issue, but a more critical and original perspective would substantially enhance its impact. Addressing these points would substantially strengthen the manuscript and increase its scientific impact. Therefore, I believe the manuscript will be suitable for publication after these revisions have been adequately addressed.
Resposne 1: Thank you for pointing this out. We agree with your comment and appreciate this valuable suggestion. Accordingly, we have added relevant text to the Discussion section (page 4) to further address and reinforce this point.

I look forward to hearing your feedback.

Regards,

Stella Triboi