Should measles vaccination be mandatory?

WATCH: Health officials say 10 people in Quebec are infected, on top of cases in Ontario and Manitoba. Since some people have refused to vaccinate their children against measles, it’s almost certain to spread more widely. Mike Armstrong reports.

Toronto is currently dealing with an outbreak of six cases of measles. Only one of these six people was vaccinated, prompting questions about whether the measles vaccine should be mandatory.

As it turns out though, Ontario actually has one of the most restrictive vaccination laws in the country. Along with New Brunswick, the province requires proof of vaccination for children to attend school. However, both provinces allow exemptions for medical, religious and personal reasons – meaning unvaccinated children can attend school if they present a signed form stating their parents’ objection.

“I think under those circumstances, that’s a reasonable way to proceed,” said Dr. Kumanan Wilson, a physician and senior scientist with the Ottawa Hospital and a professor of medicine at the University of Ottawa.

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“I think the policies are generally good for improving vaccination rates because obviously you’re going to have your anti-vaccine parents where it just won’t happen. They won’t vaccinate their kids under any circumstances. But there are those who just forgot. A lot of this is just logistical, they forgot and the policies are very good at catching that cohort,” he said.

Vaccination is voluntary and not required for school attendance in any other provinces, aside from Ontario and New Brunswick. All provinces have the power to require unvaccinated children to stay home in the case of an outbreak though.

Read more: Recent measles outbreaks in Canada

And although she says that ideally people would voluntarily seek out vaccinations, Dr. Monika Naus, medical director of immunization programs at the BC Centre for Disease Control, said, “I think that if you want to achieve high rates of vaccine uptake, there probably has to be some kind of mandatory scheme.”

People aren’t avoiding vaccinating their children because it’s too difficult to obtain the medical service, she said. More often, it’s because they don’t believe that vaccination is necessary or because they believe it will harm their child.

Read more: What’s in the measles vaccine?

A mandatory vaccination scheme which requires parents opt-out by submitting a form signed by a doctor that states that the risks and benefits of their decision were explained to them would be an improvement, she said. “I think in many instances that’s enough for a parent to think twice about choosing not to vaccinate their child.”

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Wilson also thinks that some parents who are on the fence could be motivated to vaccinate if it were explained to them that vaccinating their child will protect other vulnerable children who cannot be vaccinated due to medical reasons.

He cautions against an overly-restrictive vaccination program though. “The problem with having policies that are too aggressive is you might encourage people to go to alternative schools or go to home schooling. They may opt out of the system and they may cluster in areas and then that actually could fuel an outbreak if they cluster together.”

“It could also be viewed as an overly heavy-handed approach by government,” he said, “which might actually dissuade some of the more vaccine-hesitant.”

On the other hand, Naus said that having easy personal exemptions could result in lower vaccination numbers. “I think that in our province (British Columbia), that as long as those types of exemptions exist, we may not be able to improve upon our vaccine coverage rates.”

“We have bicycle helmet laws in probably many or most jurisdictions in Canada. We have laws around wearing seatbelts while driving,” she said. And if vaccination became mandatory in the same way, because people believe it to be a tried-and-true preventative strategy, she would consider that a success.

How other countries vaccinate

According to the National Conference of State Legislators, all U.S. states have laws requiring vaccinations for students, though an increasing number of states are offering personal belief exemptions in addition to exemptions for religious or medical reasons. Mississippi and West Virginia, which don’t currently allow any non-medical exemptions, have introduced legislation which if passed, would permit them.

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And, according to a study in the New England Journal of Medicine, non-medical exemptions were used more often between 2006 and 2011.

Australia has a unique approach: although vaccinations are not mandatory, parents who fail to immunize their children miss out on a variety of tax benefits and child care reimbursements that they would otherwise be entitled to. These aren’t tiny payments either: for example, the maximum child care rebate that parents are entitled to is $7500 AUS (about $7326) per year, according to the Australian Department of Human Services.

Parents can exempt their children from vaccination and still receive the benefit payments, but they have to submit a form signed by a doctor or other immunization provider, which states that the benefits of receiving a vaccine and the risks of not having it were explained to the parent. The government also permits exemptions for medical reasons.

It’s perhaps a little too soon to tell whether the policy has worked, as it was significantly strengthened in 2011 and again in late 2013. However, statistics from the government’s Immunise Australia Program show that 87 per cent of Australian children were fully immunized against several diseases by 24 months of age in 2014 (89 per cent had received the MMR shot) – compared to just 74 per cent in 1999.

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Naus thinks that Australia’s policy has generally had positive results and a similar scheme might be applied in Canada. However, “Some of the concerns that I’ve heard and that you can probably fathom are that it motivates parents who need the money more than it does parents who don’t need the financial incentive.”

Canada is actually doing quite well by comparison to Australia at the moment: statistics from the Public Health Agency of Canada show that 95.2 per cent of 24-month-old Canadian children were up-to-date on measles vaccinations in 2011, though that number varies significantly from community to community, even from school to school. And when it drops below 95 per cent vaccination, the group’s immunity to the disease is compromised.

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