Published in the Toronto Star on March 12, 2015
By: Colin Busby and Nicholas Chesterley
Colin Busby is a Senior Policy Analyst at the C.D. Howe Institute in Toronto. Nicholas Chesterley is a Clarendon Scholar and DPhil Candidate at the University of Oxford.
The greatest issue facing public health officials in Ontario is not knowing the immunization status of preschoolers in the province.
Do Ontario’s parents really care what a few Hollywood celebrities say about whether to get their children vaccinated? They likely do not, or not as much as some people think.
Two things — improved access to clean water and vaccinations — account for the lion’s share of all longevity increases over the last century and a half. The benefits of vaccinations, however, are at risk of eroding. Using the province’s new database to record immunization status from birth is the first step to restoring key public health gains.
Ontario’s vaccination policy model can best be summarized as one of mandated choice — when their child enters primary school parents must provide proof that their child is immunized or submit a form requesting an exemption, which must be witnessed by a notary public. If parents do neither, their child may be suspended from school. Further, immunizations are normally given at the office of one’s primary care provider.
Despite mandated choice, Ontario still misses national immunization targets for most key vaccines.
To read popular commentary, one would think that vast numbers of anti-vaxxers are the cause. Although their opposition to immunization is a concern, this group appears to make up only a tiny percentage of the population — vaccine exemptions on school entry make up less than 2 per cent of the population.
Most parents are not aggressive flag-bearers for the anti-vax movement: they are busy people who sometimes do not get around to immunizing their kids due to time constraints, poverty or immigration status. They may also struggle in accessing their primary care doctor and have safety concerns for specific vaccines. As a result, they may have partially vaccinated their child and not completed the vaccination cycle.
In Toronto, around 75 per cent of elementary schoolchildren are fully immunized when entering school, but once they are reminded and suspended if they fail to get immunized or submit an exemption request, coverage increases to more than 95 per cent, on average.
So although the final few per cent is a concern, convincing the 20 per cent who were not immunized or partially immunized until reminded is much more important.
Arguably the greatest issue facing public health officials in Ontario is not knowing the immunization status of preschoolers in the province. Because parents keep an immunization booklet until their children reach school, Ontario only tracks immunization status upon school entry (around age 4 or 5). As a result, there are limited opportunities for public health authorities to support informed vaccination decisions or target responses to outbreaks.
Children in the province should instead be entered into an immunization directory at birth.
Ontario should also consider how Alberta and Newfoundland and Labrador use the home visit of a nurse not just to deliver information about the benefits and risks of vaccination but also as a way to track reasons for and approaches to vaccine hesitancy.
Furthermore, midwives should be brought further into vaccination plans; they should be included in discussions on how to provide information on the benefits and risks of vaccines in a manner consistent with other health professionals. Midwives today play a greater role in the birthing and post-birth process than in the recent past, and there is good reason to believe that they attract patients who may be wary about common medical practices.
Better designed vaccination policies could reach national and provincial targets while accommodating choice.
While maintaining mandated choice on school entry, a registry at birth would allow Ontario to plan for early interventions. This must be coupled with plans to improve easy access to vaccinations and opportunities for midwives to support the immunization process.
Anger directed at celebrity opponents to vaccines is an easy way to vent frustrations — which is not to be confused with the sole cause of today’s coverage problems.
Recent cases of measles in Ontario and outbreaks elsewhere highlight the importance of vaccination policy design. If the trends are not reversed, outbreaks could become a common source of stress for parents.
