Policy Recommendations

Vaccines and Autism White Paper

In 1998, the Wakefield group published a paper linking the measles, mumps and rubella vaccine (MMR) to autism (Wakefield et al. 1998). This finding gave rise to mass hysteria causing parents to look negatively upon major disease-preventing vaccines. Twelve years later, the group retracted their findings. Britain’s General Medical Council identified that part of Wakefield’s research was funded by lawyers who were hired by parents involved in lawsuits against vaccine manufacturers (Eggertson, 2010). Nearly 10 years after the original paper was retracted, society has continued to question vaccinations, despite new literature and scientific evidence. In 2015, 66% of Canadian parents were concerned about the side effects of vaccines (Statistica, 2019). While Canadian family physicians in 2018, reportedthat 57% of patients refused vaccines due to the worry of possible long-term effects. 

The most significant method of protecting yourself from preventable pathogens is through developing acquired immunity from vaccinations (Government of Canada, 2019). Vaccines are made with a small quantity of killed or weakened germs that interplay with the immune system and stimulate the production of antibodies (Public Health Agency of Canada, 2019). The vaccine itself does not cause infection but induces the generation of memory-B cells to prepare for any future infections. Herd immunity can protect those vulnerable to disease, but is only possible when the majority of the population is vaccinated. Diseases like polio and measles have been eradicated in Canada as a result of vaccines. Although some major diseases have been eradicated, the impact of the Wakefield group paper (1998), has carried through to the present day. Canadian physicians have seen an increase in reluctance to vaccinate their infants. For example, throughout 2018, 36% of Canadian family physicians saw patients who were reluctant to receive the infant MMR vaccine. As a result, new policies must be implemented to address the unimmunized population in order to protect all Canadians. Some potential solutions to this ongoing issue would include:

1. Immunization Evaluation During Immigration Medical Examinations

So far, in 2019, Canada has become the home to 313,580 new immigrants (Statistica, 2019). Those new to Canada may be susceptible to diseases that vaccines can prevent due to a lack of immunization programs in their countries of origin (Government of Canada, 2015). Many countries outside of Canada have limited use of measles, mumps and rubella vaccinations, which are important vaccinations to Canadian citizens (Government of Canada, 2015). Immunizing those new to Canada is a taxing issue due to previous immunization records not existing, difficulty interpreting records due to language barriers, differing immunization doses and schedules, and the authenticity of such documents. The Canadian government suggests that physicians consider vaccination documents valid if vaccines were administered at ages and suggested intervals comparable with the Canadian immunization schedule (Government of Canada, 2015). 

Currently, before new immigrants are accepted into Canada, Citizen and Immigration Canada (CIC) require Immigration Medical Examinations (IME) to be conducted prior to arrival (Government of Canada, 2015). The IME includes a physical examination of eyes, nose, lung and heart, chest X-rays, blood tests for HIV and Syphilis, and urine analysis (CDBRA, 2018). This medical examination does not assess current immunization status or documentation. Upon arrival to Canada, the physician will determine if the immigrant has adequate immunization documentation, and if not, they will be considered unimmunized and start an immunization schedule based on their age and risk factors.  

Due to the anti-vax movement caused by Wakefield’s study, certain preventable diseases are on the rise. The Centers for Disease Control and Prevention (CDC) reported 342 cases of measles during April 2019 in the United States (CDC, 2019).  

As of currently, there is no timeframe where immigrants are required to undergo immunization evaluation by a physician. This allows the possibility they may go months adjusting to their new life before visiting a doctor and may infect at-risk populations, such as young children who have yet to get their immunizations. It is proposed that a new policy be put in place by the Government of Canada, that a prospective immigrant must have their immunization records evaluated during the IME and receive their vaccination schedule within 10 days of entering Canada. Integrating the evaluation of immunization records into IME prior to the immigrant’s arrival will allow for quicker vaccination schedules once in Canada, thus decreasing the likelihood of acquiring or transmitting diseases like measles to vulnerable citizens. The Government of Canada would have to fund the cost of adding immunization record examination to the Citizen and Immigration Canada IME. 

2. Public Outreach

The visual representation of data, called infographics, has become an increasingly popular method of presenting data. Infographics are an effective medium to transmit data because 90% of the information transmitted to the brain is visual (Conner, 2017). Visuals are able to improve learning and retention by four hundred percent. There are many different types of mediums to present data, but infographics followed by commercials have the ability to improve learning and the retention of information the most. For this reason, funding for the following public outreach topics will go towards infographics and commercials.

The necessity for increased funding towards additional education has been directly requested by families(Statistica, 2019). Approximately one-third of parents indicated that they did not have access to sufficient information and stated that their child’s healthcare provider was not easy to talk to. Families want to have unbiased detailed information about the benefits and side effects associated with vaccines. Therefore, this public health solution will target pregnant women and families with children five and under. The goal will be to provide factual, easy to access and unbiased information regarding vaccines.

I. For pregnant women: In Canada, there is currently a program funded by The Public Health Agency of Canada, and led by the Society of Obstetricians and Gynaecologists (SOGC). The goal of this project is to provide information and data about vaccine coverage rates among pregnant Canadians, and the various factors that influence their vaccine-related decisions. The project began in January 2017, and will carry on until March 2020 (SOGC, 2019). Upon completion of this project, new resources and educational programs for clinicians, healthcare providers and women can be implemented. The data from the SOGC project will identify women at risk, possibly based on age, location, race, and more. Based on the information from this project, high-risk women can be targeted for public outreach programs, including infographics and commercials. Future projects may also include additional educational programs for physicians responsible for pregnant clients. 

II. For parents with children up to and including the age of five: It is important to vaccinate children at young ages because this is when their immune system is not fully developed, Therefore they are most vulnerable to disease. (Government of Canada, 2019). Eight years after the retraction of the Wakefield (1998) paper, some parents were still reluctant to vaccinate their children. The percentage of Canadian family physicians with patients that were reluctant to receive child/adolescent vaccinations include human papillomavirus (52%), MMR (21%) and varicella (17%) (Statistica, 2019). However, from 2011-2015 there was a 97.3% incidence rate of vaccine-preventable disease in infants under the age of one (Statistica, 2019). For this reason, increased funding by the government of Canada should go towards educational programs aimed at parents with children 5 years of age and under. Increased infographics and commercials targeted at new parents, as well as educational information sessions held at elementary schools, are recommended. This targets another major group at risk of the adverse effects of refusing vaccines.

3. Mandatory Vaccines

Typically, a child will be vaccinated between birth and two months, four months, six months, between 12 and 18 months, and once more between the ages of four and six (Government of Canada, 2019). This schedule is based on their ability to build an immune response and when they are most at risk. Currently in Canada, vaccines can protect a child from 14 serious diseases, and can provide over 90% protection against these diseases (Government of Canada, 2019). 

Over the years, there has been a dramatic increase in vaccine hesitancy in Canada. Currently only three provinces in Canada have legislated vaccination policies (Walkinshaw, 2011). Ontario and New Brunswick require proof of immunization for MMR, diphtheria, tetanus, and polio, while Manitoba requires only the measles vaccination in children enrolling in school. However, each of these provinces accommodates an exemption clause, whereby a child may be excused due to medical, religious, or ideological grounds. In Ontario, non-compliance may result in a $1,000 fine and the removal from school (Walkinshaw, 2011). Similar laws seen in Ontario should be adopted in all provinces and territories across Canada, including the non-compliance fee. As for Manitoba, having only one vaccine mandatory might make parents feel that the others are not necessary, as they are not enforced, which is why it should be adjusted to include all. 

A poll conducted earlier this year found that 88% of the 1,001 Canadians surveyed would approve mandatory vaccinations, with the exception of medical reasons (Global News, 2019). Until this can be accepted throughout Canada, in the case of an outbreak, those who are not immunized must be removed from all social environments and kept at home where they are not a risk to others. In Alberta, where there are no governing laws regarding child vaccines, unvaccinated students may still be excluded from school should an outbreak occur, and may return two weeks after the last case (Walkinshaw, 2011). This is where proper vaccination documentation becomes even more important, and should also be upheld across the country.

As mandating vaccinations across Canada to some seems ‘unethical’ and against their freedom rights as Canadians, we also propose a vaccine injury compensation as seen in the US and UK. Implementing this would benefit not only those afflicted with the rare side effects of vaccinations, like Guillain Barre Syndrome, but may help those hesitant in getting the vaccine by giving them this incentive (CTV News, 2011). This would further present our confidence in vaccinations. “You did the right thing for your community; now, your community should do the right thing for you if something goes wrong,” reported an Assistant Professor in the Department of Public Health Sciences at the University of Toronto (CTV News, 2011). Moreover, parents whose children have their recommended vaccinations for their age should receive a financial reward or tax break, as another incentive.

Canada needs a policy change to increase vaccination rates. Vaccinations are a moral obligation for yourself and others, but the protection from preventable disease should be a right. Before the measles outbreak at two schools in Vancouver earlier this February, the immunization rate was 70%; it now sits at around 95% (Vancouver Sun, 2019). We should not have to wait for an outbreak to occur for the vaccine hesitant to immunize children. 

4. Implementing a Vaccine Tax

Globally, more than 3 million people die from vaccine-preventable diseases (VPD) each year, with half of these deaths seen in children less than 5 years old. In the 1990’s, complications from VDP’s were among the leading causes of death both in Canada and worldwide. Due to publicly funded vaccination programs, such diseases are now responsible for less than 5% of all fatalities in Canada (Government of Canada, 2017). Despite this decrease, other preventable diseases are still causing Canadian public health concerns. This is due to the various infections that can arise from these diseases presenting side effects such as pneumonia, meningitis, encephalitis, amputations and even death (Government of Canada, 2017). Such infections due to VPD have significant economic costs related to health care provider visits, hospitalization, and rehabilitation.

Although a great portion of Canadians immunizes their children, there is a substantial amount of people who remain against vaccinations. This choice leads to economic and societal problems causing a negative externality, which is when one person’s behaviour negatively affects others (Pauly, 1990). When a parent does not vaccinate their, they are not only risking the health of their own child but also vulnerable individuals such as those with low immunity, chronic diseases, newborn babies or the elderly (Boulanger, 2018). This is how the protection of individuals relies on the surrounding community to be immunized. Even in a case where the surrounding children are not affected, the unvaccinated child is prone to obtaining a preventable disease themselves. This means their visits to the doctors, hospitals or medications that they require are all funded from other Canadian’s taxes. Due to such negative externality, it would only be fair and logical to impose a new policy stating that ‘any parent who refuses to vaccinate their child should pay a vaccine tax’. A vaccine tax would mean that parents with non-vaccinated children will be required to pay higher taxes to account for their increased chance of using, or causing others to use the health care system. This fee would also take into account the disruption they are causing in herd immunity, which is risking the health of vulnerable individuals (University of Oxford, 2019). Exemptions can be made for medical reasons, but all other anti-vaccine populations are required to pay higher taxes. This is because only medical reasons such as epileptic individuals, can face life-threatening complications if vaccinated (Boulanger, 2018). In which case, these patients rely on their surrounding community to be immunized to prevent them from obtaining a preventable disease. Taking all these factors into consideration, imposing higher taxes for Canadians, with the exception of medical exemptions, would render that all anti-vaccination parents are penalized the same. Implementing this new policy would ideally bring awareness to the importance of immunizations and persuade the anti-vaccine population to vaccinate their children.

Herd immunity is an important concept within every community and can be easily achieved through the administration of vaccines, which prevent the spread of contagious and potentially deadly diseases. Unfortunately, due to a published study in 1998 by the Wakefield group, many parents began to believe vaccines would result in their child developing autism. This article was later retracted due to insufficient findings, yet a portion of parents remained unconvinced. To this day, anti-vaccine parents are putting not only their own children, but others at risk of obtaining dangerous diseases. Immunization is critical for the safety of everyone, which is why implementing any or all of the proposed policies mentioned is an action that should be taken. 

References

1. Boulanger, A. (2018, June 20). Vaccines: Who Should Avoid Them and Why. Retrieved from https://www.healthline.com/health/vaccinations/immunization-complications.
2. Canadian Deaf Blind Association (CDBRA). (2018). What medical tests are done in a CIC medical exam? Retrieved from: http://www.cdbraontario.ca/what-medical-tests-are-done-in-a-cic-medical-exam-cic-medical/
3. Centers for Disease Control and Prevention (CDC). (2019). Measles cases and outbreaks. Retrieved from: https://www.cdc.gov/measles/cases-outbreaks.html
4. CTV News. Vaccine compensation program overdue: experts. (2011). Retrieved from https://www.ctvnews.ca/vaccine-compensation-program-overdue-experts-1.641855
5. Conner, C. (2017). The Data Is In: Infographics Are Growing And Thriving In 2017 (And Beyond). Retrieved from https://www.forbes.com/sites/cherylsnappconner/2017/10/19/the-data-is-in-infographics-are-growing-and-thriving-in-2017-and-beyond/#32a4e3c4137c
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11. The Society of Obstetricians and Gynaecologists of Canada (SOGC). (2019). Research Activities. Retrieved from https://www.sogc.org/en/about/what-we-do/research-activities/en/content/about/research-activities.aspx?hkey=39254c0c-3d3f-4eb7-9f59-a0f8dfff74c5
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16. Statistica. (2019). Number of immigrants in Canada 2000-2019. Retrieved from: https://www.statista.com/statistics/443063/number-of-immigrants-in-canada/
17. University of Oxford. (2019, August 29). Herd immunity (Herd protection). Retrieved from: https://vk.ovg.ox.ac.uk/vk/herd-immunity.
18. Vancouver Sun. Immunization rates go up at two Vancouver schools where measles outbreak began. (2019). Retrieved from: https://vancouversun.com/news/local-news/teens-defy-parents-to-get-measles-vaccine-during-vancouver-outbreak
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