Officials with Ottawa Public Health are doing the right thing in keeping unvaccinated kids out of school until their vaccinations are up to date. Yet, the situation also brings up the problem of what to do with those children whose parents refuse to have them immunized. How far can and should we go as a society to force these families to do the right thing?
First, the cases in Ottawa. A City of Ottawa press release recently confirmed three related measles cases in Ottawa and Lanark County, involving at least one adult and one child, and Ottawa Public Health has since contacted 500 individuals who may have been exposed to the three infected patients, possibly at one of a select list of locales around town, including the Children’s Hospital of Eastern Ontario, a shopping mall on Carling Avenue and a restaurant in Kanata. (The City has posted online the list of places of possible exposure, including dates and times.)
“We’ve identified where the cases who’ve had measles went, and that certainly is where people may be at risk,” says Dr. Carolyn Pim, associate medical officer of health with OPH, told the CBC. “[But] if people are fully immunized, their risk is extremely low. The measles vaccine is very effective.”
Hence the problem in the case of children who for any of a number of reasons have not been vaccinated against measles or who have been incompletely vaccinated. In Ottawa, officials are saying that this group may be required to stay home from school for up to three weeks if it’s thought that they might have been exposed to the virus.
This is a good move.
The unvaccinated child stands a much greater risk of contracting measles, known to be the most contagious of the so-called childhood illnesses. And if infected, he or she becomes yet another pathway for the virus to spread throughout society. Thus, to prevent more of the population from getting sick (sometimes very sick – one in five children with the measles is admitted to hospital for the disease and one in 1,000 will die from it), it’s crucial that we keep as many of those in the un- and under-vaccinated group away from other young children, even during periods of minor outbreak such as the one in Ottawa. But do we need to do more?
Every year, Ontario school boards suspend thousands of students for having incomplete vaccination records. These efforts are meant to bring up vaccination rates which currently hover around 90 per cent across the country – healthy numbers, to be sure, but still not enough to create herd immunity and minimize the potential spread a disease to a larger population (95 per cent immunization is thought to be the magic number).
And every year, the majority of those issued suspensions actually do get immunized, since most of the time the problem is one of unintentional neglect on the parents’ part to bring their child in to get immunized.
But that still leaves a smaller percentage of children who for either medical reasons or reasons of belief are not being immunized. The Immunization of School Pupils Act allows parents to receive exemptions on medical grounds when there are contraindications against vaccination but also on religious or conscience-based grounds. And it’s this latter exemption that is likely to set off alarm bells for parents and has the potential to become a real problem if, that is, the unvaccinated-due-to-belief cohort were found to be the main vehicle in North American society for the further spread of diseases like the measles.
And, unfortunately, it has.
A study this year in the Journal of the American Medical Association shows that more than half of cases of measles in the U.S. in recent years occurred in individuals with no history of measles vaccination. And a full 71 per cent of those without vaccination had non-medical (in other words, belief-based) reasons for their non-participation.
Fairly directly, then, these numbers point to the belief-based objectors as the prime cause of measles outbreaks, a result which the study’s authors say should have “broad implications for vaccine practice and policy.”
How far can we go to push parents to immunize their children? That depends on how you weigh the pros and cons of allowing group immunization to stay well below the sought-after 95 per cent. And it depends on whether you feel you’re got enough proof that the risks of harm to both the unvaccinated child and to society at large are in fact real.
The question is, how much more proof do you need?