B.C.’s Provincial Health Officer is panning the idea of making vaccinations mandatory for children to enter B.C. schools.
Dr. Perry Kendall doubts the strategy would dramatically improve the immunization rate of children entering school – currently 69 per cent of two-year-olds in Fraser Health have all recommended shots.
“I don’t think there’s a magic bullet,” Kendall told Black Press.
Compulsory vaccination policies typically come with exemptions for medical and religious reasons, although some U.S. states such as California allow any personal objection.
Ontario has a mandatory vaccination law with $1,000 fines for parents who don’t get a valid exemption for unvaccinated kids. Children who aren’t vaccinated against specified diseases can be sent home if there’s an outbreak.
Alberta keeps vaccinations optional but its schools reserve the right to exclude unvaccinated children during outbreaks.
Kendall said it would be relatively easy for B.C. to add a requirement to report vaccination status at time of enrollment – that alone can nudge fence-sitting parents to get their kids vaccinated or remind others who haven’t kept up with the schedule of shots.
A tougher Ontario-style law applied in B.C. might boost coverage by a couple percentage points, he suggested.
But Kendall said it’s debatable whether that would translate into any fewer infections from vaccine-preventable diseases.
“Last year we had over 400 cases of measles but they were in a community that refuses to be vaccinated,” Kendall said, referring to the 2014 Fraser Health outbreak centred on Chilliwack. “That community would have been unvaccinated even if we had a law in place because of [exemptions for] religious grounds.”
This year, he noted, Ontario is battling an imported measles outbreak despite its law, while B.C. is unscathed.
Kendall instead prefers better education and persuasion.
And he would target parents who are “soft” opponents whose concerns can be addressed one-on-one by medical professionals rather than entrenched anti-vaxers.
“The more pointed the message, the more some of these people seem to just dig into their belief systems,” he said.
A mandatory policy that bars unvaccinated students from school enrollment could actually backfire, Kendall warned, because it might result in those kids clustering together instead of mixing with and getting protection from vaccinated students.
“You might have certain private schools where no kids are vaccinated and then you lose any benefit from herd immunity.”
Kendall believes many parents whose kids aren’t up to date on vaccinations are busy or have lost track, and aren’t necessarily taking a strong anti-vaccine stance.
Smartphone reminder apps now offer help to keep parents on schedule, and Kendall is hopeful an automated phone reminder system programmed from doctors’ offices will soon launch as well.
Kendall is optimistic the public attention from the high-profile Disneyland measles outbreak will bring a significant jump in vaccination rates in B.C.
But B.C.’s top doctor says public health defenders “missed the boat” years ago when they failed to swiftly and effectively counter a debunked study tying vaccines to autism that was promoted by a TV celebrity and then took off on social media.
He said future outbreaks of misinformation must be fought hard and early on social media and website comments, but admitted there’s insufficient resources to do that well.
SFU health sciences professor and ethicist Jeremy Snyder said the big challenge is building trust in the scientific community among a public skeptical of professionals and suspicious of pharmaceutical firms.
He said it’s unclear what will convince them of the benefit and safety of vaccines.
“If we can’t figure it out then maybe that’s when we need to take a look at the more coercive means like compulsory vaccination,” Snyder said, adding there may eventually be a “very strong argument” for it.
Some family doctors in parts of the U.S. won’t accept into their practices families who reject vaccination.
Professional bodies discourage doctors from discriminating against certain patients, but Snyder said there is an argument that it protects other patients, particularly babies too young to be vaccinated.
“If you have a child showing up in your waiting room who has not been vaccinated and has measles, that’s putting all the other children at risk, especially those under one year of age.”