Toronto Public Health calling on province to end non-medical exemptions for vaccines in schools

Toronto's medical officer of health is calling on the province to stop allowing children in Ontario schools to skip vaccines for non-medical reasons — but so far, Premier Doug Ford's government doesn't plan on changing the approach.

In a new report released on Monday, Dr. Eileen de Villa recommends Health Minister Christine Elliott consider changing the Immunization of School Pupils Act to only accept medical exemptions from a certified health-care provider.

"Before philosophical and religious exemption rates reach dangerously high levels in Toronto, it is important and timely for the provincial Ministry of Health to consider removing philosophical and religious exemptions from its legislation," de Villa wrote in the report.

It's a controversial suggestion that comes against a backdrop of plummeting vaccination rates in areas around the world and instances of disease outbreaks in cities across Canada and the United States.

For Toronto students, there has been steady increase in philosophical and religious exemptions over the last decade and a bit, de Villa notes. Those increased from 0.8 per cent for the measles, mumps and rubella vaccine in the 2006 to 2007 school year to 1.72 per cent last year.

The rising non-medical exemption rates elsewhere have led to major outbreaks of multiple vaccine-preventable diseases such as whooping cough and measles. 

Several outbreaks have been reported in Canada throughout 2019, including a measles outbreak in the Montreal area in June.

And in the U.S., more than 1,200 cases of measles have been confirmed in 31 states this year alone, according to the Centers for Disease Control and Prevention (CDC) — the highest number of cases reported in the U.S. since 1992.

"The majority of cases are among people who were not vaccinated against measles," the CDC noted.

Amid that outbreak, New York State eliminated the area's religious exemption to vaccine requirements for schoolchildren earlier this year, with Democratic Sen. Brad Hoylman calling the situation an "unprecedented public health crisis."

'No plans' to update approach: health ministry

Toronto's board of health chair Joe Cressy said de Villa's recommendations are meant to be proactive.

"This is based on science, and it's based on population health," he said. "A lot of people are at risk if we don't have herd immunity."

But a spokesperson for Elliott's office said there are "no plans" to update the province's approach.

Currently, under the Immunization of School Pupils Act, children are required to have proof of immunization for certain diseases to attend school in Ontario, unless there is a "valid medical exemption or affidavit of conscience or religious belief," the health ministry's Travis Kann noted in a statement.

Pushback to that policy has been rising in recent years.

In 2016, the Canadian Medical Association passed a motion to back the end of non-medical exemptions in Ontario and the other two Canadian provinces — Manitoba and New Brunswick — which have similar mandatory vaccination laws for schoolchildren.

Other provinces and territories leave those decisions up to individual schools or school boards.

Ottawa-based physician Dr. Kumanan Wilson said public health teams should be guiding the discussion, but he stressed the complicated nature of changing the rules and suggested a limited policy — one that is re-evaluated later — could be the best interim approach for the province.

"It's not a light undertaking to remove the ability of parents to make decisions regarding the health care of their children," Wilson said. "However, if public health circumstances require it, sometimes these types of decisions need to be made."

Kann said in Ontario, helping parents make "informed" choices is part of the process. Since 2017, parents have been required to complete an education session before submitting a request for a non-medical exemption.

De Villa agrees education is crucial. 

"Vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, is a growing concern in Canada," she wrote in the report. "It stems, in large part, from misinformation about vaccines that spreads on social media platforms and the Internet."

Her other recommendations include calling for major online media companies — including Facebook, Google and Twitter — to better regulate vaccine misinformation.

De Villa is also calling on the board of health to request all Toronto school boards and the Ministry of Education to adopt curriculum on vaccines and vaccine-preventable diseases for all elementary schools.

Her recommendations will be considered by the board on Sept. 23.