Should it be Mandatory for Canadians to Vaccinate their Kids?

ca0811measles2_190338

Unless you are living under a rock, it cannot have escaped your notice that there are two very important things happening in the world of children’s communicable diseases. One is that there are an increasing number of devotees to the absurd position that vaccines do more harm than good and who accordingly choose NOT to vaccinate their children. Let’s (charitably) call them the anti-vaccination zealots.

The second is that there are now outbreaks of diseases like measles that had been all but obliterated in Canada.

The connection between the two is not coincidental.

However, it is likely that, despite the high profile of some of the zealots (many are celebrities with large numbers of “followers”; see the piece I wrote on Jenny McCarthy for example) there is another group of parents (let’s call them the less-than-well-informed) who have simply gotten complacent or who have picked up an irrational fear of vaccines based on popular myths and discredited work and pseudoscience.

They see and hear the Jenny McCarthy’s of the world spew their nonsense, but since they don’t know it’s nonsense (they only know that there SEEMS to be a legitimate “controversy” about vaccine safety – there isn’t!) they have dithered about and in the end have landed on the side of do not vaccinate. The “less-than-well-informed” parents have been aided and abetted by mainline media who have fallen prey to the wrong-headed notion of some “need for balance”.

Dr. Paul Offit, a world-recognized expert in children’s infectious diseases was at a health journalism conference a few days ago and addressed one of my pet peeves: this persistence of the notion that talk show hosts, editors, journalists, health reporters etc have to give “balanced” time to those who want to argue against vaccines.

WRONG!

This is not a political debate where you have to offer equal time – it is a conversation about science, facts, truth and evidence vs. mythology, quackery and pseudoscience. We DO NOT have to, and indeed we SHOULD NOT be giving equal time to the naysayers. All that does is legitimize the idea that there is a “controversy”.

THERE IS NO CONTROVERSY.

One of the better articles about Offit’s talk can be found here. I especially like his coining of the idea of “journalist jail” for journalists who may in the end cause great harm to someone by promoting the false idea that there is a legitimate debate on the subject when only one “side” of the debate is actually supported by science and evidence, while the other is not even remotely supportable on any such basis.

André Picard, writing in the Globe and Mail earlier this week (Measles outbreak shows importance of education) took the view that far better education is therefore needed for these folks who don’t seem to recognize what is the right thing to do. He said in part:

There is one overriding reason measles is popping up all over: Too few Canadians, especially children, are being vaccinated. Worldwide, 84 per cent of children have been vaccinated against measles. There is no reason it should not be 100 per cent in Canada. The majority of the unvaccinated are not anti-vaccination zealots. Rather, they are the blissfully ignorant and the worried well – people who worry more about the imaginary harms caused by “chemicals” in vaccines than the very real harms of infectious diseases. A little history lesson would serve these parents well.

The aforementioned Dr. Paul Offit, in an editorial, Remembering How to Fight Measles in the New York Time last week struck a similar note when he wrote:

Clinicians and parents have forgotten how terrifying measles can be. Earlier this month, Kristin Cavallari, a former reality-show star and the wife of the Chicago Bears quarterback Jay Cutler, told a national television audience that she had decided not to vaccinate her children. “I’ve read too many books about autism,” she said, though the link between vaccines and autism has been thoroughly disproved. Ms. Cavallari’s cavalier attitude teaches us that not only have we largely eliminated measles; we’ve eliminated the memory of the disease.

It is instructive that OIffit included physicians as part of the problem. I have oft heard that even doctors are re-thinking the issue. And of course, they are so well informed that you have to take their opinion seriously. Right? Um, not so fast. Being a doctor does not guarantee that one is evidence based. Some physicians that I have met  are among the most resistant, dogma-loving folks there are. An interesting blog post by Orac just today (Science Blogs – Respectful Insolence) about three PEDIATRICIANS who are themselves antivaccine makes the point very well.

In Canada, we don’t see the harms caused by measles any more and, as a result, take the benefits of vaccination for granted. The current outbreaks should set off alarm bells on two fronts. – André Picard, Globe and Mail

A look at the following infographic from the Public Health Agency of Canada may shed light on why we have become so complacent – we simply have not had to DEAL with these diseases for a very long time. Out of sight, out of mind for most of today’s parents. Their grandparents may remember the bad old days when polio and other virulent diseases took big tolls on health and even life. But we have forgotten. Look at how measles was almost a thing of the past:

 

resource

measles_6But that was then and this is now. Now we have what can only be considered outbreaks of diseases we had totally under control.

And many are angry at the parents who do not vaccinate, whether they are from the zealot category, the blissfully ignorant category or from the small religious category who “are opposed to vaccination, believing that to immunize is to evade the providence of God” (Maki and Barton, Globe and Mail, March 25, 2014). [Ironically I imagine that these same ‘don’t mess with nature’ people do not shun any of the other benefits of modern medicine – you’ve got to love those selective ‘Bible interpreters’.]

And the anger is spilling over. For example, this editorial – Foolishness behind record measles cases – in The Province (British Columbia) earlier this week started out thus:

The anti-vaccination crowd sure must be feeling proud of themselves these days. Thanks to their dangerous and ill-conceived views, B.C. is now in the middle of the worst measles outbreak ever recorded in the province. Worse is likely yet to come. There have been 320 cases of measles reported, mostly in the eastern Fraser Valley, and the outbreak has spread to the U.S.

It is NOT Mandatory to Vaccinate Kids in Canada

First off, what *is* the law in Canada? The Public Health Agency of Canada, addresses this question on its website: Is immunization compulsory in Canada? Does my child have to be immunized?

Immunization is not compulsory or “forced” in Canada, but we do have regulations that help ensure that as many people as possible are protected by vaccines from the diseases they prevent. Some provinces require certain vaccines to be given before a child can enter school, but these are not mandatory in the usual sense of the term. Rather, parents (or children, if they are old enough to give consent) are required to declare a choice of whether to have their child (or themselves) immunized or not. If they choose not to, the child may be told that he or she must stay home from school if there is an outbreak of disease. This rule is designed to keep unimmunized children from getting sick and to keep the outbreak from spreading. School entry regulations also give parents an opportunity to bring their child’s immunizations up to date. Health care workers may also be required to have certain vaccinations, such as hepatitis B vaccine and an annual ‘flu shot’. If they refuse, they may be required to stay away from work during an outbreak. This practice protects their patients, who could be in grave danger if they became ill with a communicable disease.

So, in Ontario for example, children MUST be immunized before they can enter the public school system. Sounds good until you consider that there are many grounds for exemption.

Some of these are very legitimate in my view – true medical reasons such as an allergy to a component in a vaccine. But this would surely be a tiny fraction of the population. Most of the exemptions are for grounds that I would argue are specious – whether it is religious beliefs  (yeah let’s all return to the state of affairs in “biblical times” when more kids died than survived and the life expectancy was, what, 35 years?) or worse – “reasons of conscience”. Broadly speaking that means that if a parent just doesn’t want to vaccinate, for whatever reason,they can invoke an exemption for a “reason of conscience”.

Funny that play of words on “conscience”…

To wit, as André Picard said at the close of his article:

We are rapidly approaching the point where, statistically, a child is going to die of the measles in Canada. That is unconscionable (emphasis mine) in the 21st century. We shouldn’t wait until that happens to be outraged. The time to crack down is now before any more entirely preventable harm occurs.

But We Live in a Free Society, Right?

I keep hearing people say that whether or not to vaccinate their kids is their right and privilege. After all, we live in a free society. In a free society one can’t be coerced to something against one’s will or belief (no matter where that belief comes from it seems).

Keep in mind that living in a “free society” has its boundaries and limits. One is NOT free to do anything one pleases. I am all for choices but choices have limits. Choices have responsibility attached to them. We have many laws that are in place to protect people, many of which actually eliminate choices altogether.

But the real point here is WHO IS MAKING THE CHOICES AND FOR WHOM. It’s one thing for an adult to make a very poor choice when he or she is the one who is going to bear the brunt of the consequences. It’s a whole other thing when we are making choices for innocent and defenseless children, who cannot make that choice for themselves, especially when the choice we make FOR THEM may abrogate the child’s right to a happy and healthy life.

Our rights to make choices on behalf of our children is not limitless. Just because you are a parent does not give you the right to abuse your child. You do not have the right to neglect your child. You do not have the right not to feed your child. You do not have the right (usually) to deny medical or life-saving treatment. You don’t even have the right in some jurisdictions to smoke in your own car if a child’s growth and health may be harmed. You do not have the right not to protect your child in a approved car seat when you are driving in your car. Even when it comes to medical decisions the courts have been known to intervene when a parent’s bad decision contravenes the child’s right to medical or other appropriate treatment.

Responsible parents would ever say “We live in a pretty safe neighbourhood so I don’t think we are going to use safety approved car seats anymore”.

Not only would they not say it, they wouldn’t even think it. And lo and behold if they did, there would be laws to hold them to account.

So how is it that we “allow” parents to say “there’s not really much incidence of communicable childhood diseases anymore, so I think I won’t bother to vaccinate my children”.

Just as there is incontrovertible proof and data that car seats save lives, so is there absolute proof that vaccines do the same. Yes it’s true that even with the proper use of a car seat, a child sometimes dies. Just as it is true that even with the use of very safe and effective vaccines, sometimes bad things happen. But to use either of those as an excuse not to do the right thing is just absolutely ludicrous to me and flies in the face of every piece of scientific evidence that we know.

So while some continue to prattle on about free societies and freedom of choice, they need to remember that it is kids that they are choosing for. Kids who depend on us to make the right calls. If parents want to harm themselves, that’s unfortunate, but so be it. But parents SHOULD HAVE NO RIGHT to harm their own kids, or my innocent kids either, in the name of some misguided beliefs in crap, mythology and pseudoscience

So, Why Can’t We Make it Mandatory to Vaccinate Kids in Canada?

mmrvaccineMy view is that we should make it mandatory, with the very sliver-thin exception of those kids who have a legitimate medical reason, such as an known allergy to a vaccine component, or an immune-suppression disease or similar. I believe we should strike down religious objections as a source of exemption and we especially should eliminate the “reasons of conscience” exemptions since they often seem diametrically opposed to the principle of public health and safety, and therefore are NOT in good (public) conscience.

Of course legally, I know that this would contravene the Canadian Charter of Rights and Freedoms which protects individuals against unwanted medical treatment. And I certainly would not want to open the flood gates on that one.

But (caution: I am NOT a lawyer!) it is my understanding that there are legal ways of limiting a Charter freedom (by duly passed legislation, under demonstrably justifiable grounds, for example) or by legal amendment to the Charter itself.I’m not saying it would be easy, but I do suspect it CAN be done. What it would need therefore is a lot more political and public will than I think we will ever muster.

So, for now, despite the fact that I feel, and I know hundreds of parents who passionately feel that their kids are at risk unless and until vaccination of every kid IS mandatory, I’m afraid we will have to depend instead on education, communication and making sure that mythology and pseudoscience are kept at bay.

Given that air-headed and wrong-headed celebrities will always garner far more attention that scientific truthsayers, I think we are doomed to relive the at least some of the horrors of past outbreaks for diseases, like measles, that we had at one time completely corralled.

But if you are an “anti-vaxxer” I just hope it’s not one of your own kids that ends up being the victim of your ill-formed rationale or your “reasons of conscience”.

Added Material

After I first posted this I realized that there was a piece I had wanted to put in. This interview on CBS News is just too perfect and on-point not to include, even if after the fact. It stems from an article from Time Magazine Science Editor Jeffrey Kluger earlier this week entitled Dear Anti-Vaxxers: You Want Pure Nature? OK, Die Young. The title may say it all, but I direct you to this video of an interview of Kluger on the CBS News program This Morning.  Excellent viewing and an excellent argument well presented.

 

 

 
If you enjoyed this post, please consider sharing it, leaving a comment or subscribing to the RSS feed to have future articles delivered to your feed reader.
   

Comments

Should it be Mandatory for Canadians to Vaccinate their Kids? — 7 Comments

  1. I find it unconscionable that you think it’s okay to force me or my children to submit to a medical procedure that carries with it the risk of injury and death.

    • Of course you do.

      Well I find it unconscionable that you would seemingly think so little of your children’s health to not protect them from the far greater risks of these diseases that the tiny risk of the vaccines.

      And I also find it unconscionable that you think it is okay to subject other children to the FAR GREATER risk of injury or death that comes from being exposed to your kids when they get one of these (still serious or even deadly) diseases. From a public health perspective, why is your kid’s very tiny risk so much more important than some other kid’s greater risk?

      • Dr. Wosnick, my youngest child has a permanent medical exemption for the MMR. I don’t expect the “herd” to protect him and we have plans in place (including vitamin A and C as shown in the medical literature) in the event that he does contract any disease.

        Re: vaccine safety, vaccines that my child received at 2,4,6 and 18 months logged almost 1,000 adverse events. You can read more about this in my reply to a CMAJ article: http://www.cmaj.ca/content/170/4/437/reply I think you will find many of the vaccine refusers have seen their children or their friend’s children have a bad reaction, most times completely ignored by the medical and health profession.

        • Thanks Rita for your comment. I certainly did not mean to imply that I think there may not be legitimate scenarios where a true medical exemption was appropriate. I can’t comment on your case of course but I imagine that this exemption is for very good health reasons and is in good faith.

          To me that stands quite apart from the (I believe) far more common scenario of irrational fears picked up from myriad sources who twist and misrepresent the facts and evidence to support their own beliefs. This kind of poorly reasoned (in my view) exemption is not at all the same as one for truly legitimate medical reasons that you and your physician have agreed upon.

          As for your CMAJ letter and your comment here, I was confused. When you say you were able to document almost 1000 adverse events, you gave a long (and admittedly scary) list but I have no idea what the breakdown was. As you know the list of possible adverse events for ANY medication can be very long indeed, but the more “mild” ones of course always predominate. Without a breakdown of how many in each category this list is interesting but hard to draw any conclusions from.

          And of course even if we were to know how many of the almost 1000 would be deemed “serious”, I have no idea what the denominator is, as in out of how many doses and how many kids treated.

          You may rightly feel that that even one adverse event if it is your kid is one too many, but we really need to know the prevalence of the events to be able to understand if this is acceptable risk or not.

          Nothing we do in life comes without risk. What our jobs are as parents and as citizens is to truly and accurately determine the risks and then decide based on evidence if it is worth the benefit or not.

  2. If your kid is immunized, why do you care whether or not mine is? After all the immunization your child received protects them from infection according to your theory.

    • This argument is always trotted out by those who oppose vaccination, but it is faulty logic.

      First of all there is risk to those who are too young to be vaccinated (yet). Second there is risk to those such as cancer patients or others with an immune compromised system.

      But even for older kids and healthy kids, you surely must know that even though vaccines are our very best defence, they are NOT foolproof, and they are NOT 100% effective, so even vaccinated kids are at some risk.

      According to the CDC, most childhood vaccines are about 85% to 95% effective in the population, and some some will not develop immunity at all.

      This is why public health has to be a shared responsibility in my view.

  3. Dr. Wosnick, surely you are aware that numerous studies show that people who are vaccinated against measles, or influenza, or even pertussis, are still shedders of these germs. A person’s vaccination status does not make them less likely to be silent carriers of or shedders of these viruses and bacteria. Just recently, Princeton students who were vaccinated against strains A, C, Y and W-135, and then twice vaccinated against MenB (via the Bexsero vaccine), shed and sickened the exact same Men B strain circulating at Princeton U. to a 19 year old woman named Stephanie Dow at Drexel U. The exact same Men B strain circulating at Princeton was determined to have been what killed Stephanie Dow. Vaccination does not stop a person from being an asymptomatic carrier of disease. In fact, studies show that vaccination may make such silent carriers more likely to shed the disease than the unvaccinated. How do you respond to this phenomenon?

Leave a Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>