Canada's vaccination laws: Is it time for a change?

As provincial policies in Canada remain ineffective in addressing the declining vaccination rates, there is a strong public support for mandatory childhood immunizations.


As measles outbreaks continue to grow in Canada and around the world, there have been more calls for making childhood immunizations mandatory. In a recent Ipsos poll conducted for Global News, 88% of Canadians approve of mandatory vaccinations for all school-aged children, including 64% who strongly approve of such legislation. Although Canadians are generally pro-vaccination, there are still variations in public views and policies governing immunizations in different provinces and territories. For instance, there appears to be less support for mandatory immunizations in Quebec, where only 48% of the residents strongly support this measure compared to 64% nationwide and where the belief that vaccinations should be a matter of personal choice is most prevalent (50%).


In Canada, provincial and territorial governments make decisions about and deliver health care services. Vaccine policies and immunization tracking, therefore, fall under the jurisdiction of each provinces or territory, and there are no national standards in place. This creates certain problems about achieving optimal vaccination rates for some vaccine preventable diseases. For instance, Canada’s measles vaccination rate is at about 89 per cent, according to a 2015 survey by Statistics Canada. This is not ideal, since the vaccination rate needs to be above 95% to protect the population from measles. Additionally, public health officials have identified some areas where the population is under-vaccinated and more vulnerable to the disease.



It is not surprising that many view that the implementation of stricter policies regarding childhood immunizations as a productive way to increase vaccination rates for vaccine-preventable diseases like measles. The overview of immunization policies in Canadian provinces presented below, however, shows that current regulations are often ineffective in addressing vaccine hesitancy and declining vaccination rates.


Ontario


Ontario's health care system requires that all children who attend school are vaccinated for diphtheria, tetanus, polio, measles, mumps, rubella, meningococcal disease, whooping cough (pertussis), and chickenpox (varicella). It is also required under the law that parents provide information about their children's immunizations to their local Public Health unit, and records are updated when children receive additional doses of vaccine according to the immunization schedule. Parents who seek non-medical exemption from vaccine requirements for their children due to conscientious objections or religious beliefs need to follow specific procedures under the Immunization of School Pupils Act. The first requirement is to complete an educational session that covers basic information about immunization, vaccine safety, immunization and community health, and laws about immunization in Ontario. After completing the session and receiving a Vaccine Education Certificate, parents must complete a Statement of Conscience or Religious Belief form and have it witnessed by a commissioner for taking affidavits, before all documents are submitted to the local public health unit. The purpose of this is to help people make an informed decision and learn the importance of vaccines before deciding to refuse them. Many people, who do not want to vaccinate their children, have misconceptions about vaccines, so having to take a course can debunk vaccine myths and educate them on the importance and effectiveness of vaccines. A written vaccine exemption is also required for children attending daycare. Although being vaccinated is not mandatory in Ontario, there is a series of steps parents have to undertake for non-medical exemptions that can encourages people to have their children immunized.


Newfoundland


A revised legislation will be introduced in 2019, which aims to provide "top to bottom" rethinking of how the government approaches health care. Although Dr. Darrell Wade claims this is “most progressive piece of public health legislation in the country”, it fails to address vaccination. Mandated vaccines are not part of the revised public health act. The health minister for Newfoundland, John Haggie, believes they cannot force people to get vaccinated regardless of the public health benefit, as it is an infringement of the Charter of Rights.

Prince Edward Island


The Province does not have any regulations in place for making vaccines mandatory. Information about immunization regulations are found under the Public Health Act. Although vaccines are not mandatory, there is some regulation in terms of immunization records. A health care practitioner or pharmacist who administers a vaccine reports the information to the Chief Public Health Officer. In addition, on the PEI website there is information about an app called CANImmunize, which can be a helpful tool in keeping track of personal immunization records and getting people and their children vaccinated on time.


Nova Scotia


In Nova Scotia, immunizations are regulated under the Province's Health Protection Act. This act aims for the public to be protected by preventing, detecting, and managing health threats without violating civil rights. Vaccines are very effective in preventing various health threats, however making them mandatory is seen as an infringement of civil rights. This makes the government hesitant in making vaccines mandatory. However, with the threats of contagious diseases like measles, steps towards stricter vaccination policies maybe more in line with Nova Scotia's Health Protection Act, than what currently exists.


New Brunswick


New Brunswick is distinct from other provinces as it also follows the same protocols as Ontario. In order for a child to attend school proof of immunization must be provided. Superintendents make reasonable efforts to follow up with parents who fail to provide proof to avoid the child from missing school. However if this persists then the superintendent must inform the parents in writing, that their child will be excluded from school. If the parent wants to exempt a child from vaccination for medical or non-medical reasons they are required to fill out an exemption form. The form also indicates that the child may be asked to leave school or day care if there is an outbreak of a preventable disease.


Quebec


Quebec, just as many other provinces in Canada, does not have a law for mandatory childhood immunizations. Nonetheless, there is a new requirement for mandatory registration of all persons vaccinated in this province. As of January 1st 2019, all vaccines administered must be recorded in the Québec Vaccination Registry and people cannot refuse to be included in these records. The expected benefits of the Registry include: protecting public health in the event of an outbreak of vaccine-preventable diseases, easy access to information about vaccination anywhere in Quebec, avoid giving people unnecessary vaccines, and ability to contact patients quickly if a batch of vaccines is recalled or if they must receive other doses of a vaccine. While this may be an important step forward, there is more to be done to fully address the potential public health risks if not enough people are vaccinated.


Manitoba


Vaccines are not mandatory in Manitoba and certain school boards are presently pushing towards making them mandatory. While there is no legislation to support mandatory childhood immunizations, the provincial government has opted to increase vaccines uptake in other ways. Examples of such strategies include: sending letters to the parents and mailing “immunization certificates” which lay out a child’s immunization history. However, these measures are not particularly impactful in actually getting people immunized.


Saskatchewan


Similar to other provinces, in Saskatchewan vaccines are administered with informed consent and childhood immunizations are done on a voluntary basis. The Saskatchewan Immunization Manual discusses important ethical issues and highlights the importance of vaccination. It also mentions while in Canada the risk of not being immunized may not as apparent, with all the news about recent outbreaks, such perceptions should be questioned and reconsidered.


Alberta


Currently, there is no legislation governing vaccinations in Alberta. Immunization remains voluntary, and no student is prevented from attending school based on their immunization status. Nonetheless, in situations of a disease outbreak, health authorities can preclude children from entering school facilities. For example, if there is a case or outbreak of measles at a school, students who are not immunized will be excluded from school until two weeks after the last case occurs. There is a momentum to push stricter policies forward, as the Alberta party has promised mandatory vaccination in schools if elected. However, not all political party leaders are on board. The current position of both New Democratic Party (NDP) and United Conservative Party (UCP) is that in making vaccines mandatory the government will be overstepping its bounds.


British Columbia


British Columbia’s health minister Adrian Dix recently announced plans to make vaccinations mandatory for all children attending school ( i.e., students in both public and private schools will be required to provide proof of immunization against measles and other diseases). Mandatory registration will be required for all students by September 2019 and is a response to the uproar after recent outbreaks of measles. Over 43,000 BC residents have signed petitions to make vaccines mandatory, as people are fearful due to current and past outbreaks of measles (e.g., BC had 343 cases of measles reported in 2014). If there are medical or non-medical reasons that individuals want to use for exemption from vaccination, they'll be required to follow a similar protocol to Ontario.



In terms of regulation, a common perception among Canadian provinces is that mandatory vaccination would pose a threat to civil rights. However, it seems like Ontario and New Brunswick have been more proactive in nudging people to immunize their children, without making it completely mandatory. People may still opt to exempt their children from vaccination, however, policies are aimed at helping people make educated decisions and decreasing the number of unvaccinated children in schools. Utilizing institutions, such as schools and workplaces, to enforce routine immunization schedules can significantly increase the number of people immunized. If other provinces enact measures similar to those in Ontario and New Brunswick, progress can be made towards greater vaccination rates, especially if the Government of Canada wants to achieve the goal of having 95% coverage of childhood vaccines by 2025. It is important that parents stay informed about policy and consult different resources to educate themselves on the science and public health benefits of vaccines.


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