PAUL OFFIT, THE HEAD OF THE VACCINE EDUCATION CENTERAT THE CHILIAN’S HOSPITAL OF PHILADEPLPHIA”

 


Sharon Kirkey


LIBRARY AND ARCHIVES CANADA/NATIONAL FII.M BOARD
A Canadian boy receives his vaccinations in 1959. He would be among the first generation to know a country
where immunization had turned polio, diphtheria, smallpox and whooping cough into medical anomalies.

 

To send kids to school without vaccinations, parents in Ontario must first attend a class of their own. Conducted one- on- one or in groups as large as 50 at their local health units, the mandator.' “vaccine education” sessions for parents pursuing exemptions consists mainly of a video screening, with a nurse on hand to answer any questions. The 25-minute government prescribed film features a cheery musical soundtrack, footage of smiling families and animated characters — kids playing soccer, dogs, a rainbow — along with information to counter popular myths among “anti-vaxxers.”

But since it was introduced in 2017, thousands of mothers and fathers have dutifully watched the video, collected their “Vaccine Education Certificate” — then continued to duck the shots.

As one public health manager put it: “We had a zero per cent conversion rate.”

That’s not only a colossal waste of time and money, some health policy experts say, but the education sessions may actually entrench resistance among parents claiming exemptions based on religious belief or “conscience.”

With the resurgence of dreaded, entirely preventable illnesses like measles and whooping cough, there are renewed calls for compulsory shots, not only for school-aged children but for babies and toddlers as well, with no waivers or opt-outs except for medical reasons.

Right now, only Ontario and New' Brunswick require any proof of immunization for school attendance. But provinces allow nonmedical exemptions, and in Ontario they are rising: Among seven year – old’s registered for school in 2012-2013, philosophical and religious objections accounted for 89 per cent of all exemptions.

Until recently, parents dodging vaccines in Ontario were simply required to submit a sworn affidavit stating their objections. The bar was raised slightly with the amendment of the Immunization of School Pupils Act to require attendance at exemption classes.

The video featured at such sessions debunks the junk science spread by celebrities, as well as defrocked doctors such as Britain’s Andrew' Wakefield, whose 1998 study in The Lancet linking the measles, mumps and rubella vaccine with autism will go down as one of the most breathtakingly fraudulent papers in modern medicine.

But Ontario’s chief medical officer of health, Dr. David Williams, says the goal isn’t to scare, berate or coerce parents. It’s to make sure those who object to one or more designated shots are fully informed of what they’re risking. “We’re trying to give them what they need to know so they can make a good decision,” he said — the good decision, of course, being to vaccinate their children.

Instead, according to a National Post survey of the province’s 35 health units, the majority of parents double down after vaccine education sessions,   a phenomenon known as “confirmation bias.” Any new information tends to be interpreted in a way that supports what they already believe.

Of 314 parents who attended an education session between September 2017 and December 2018 at the Ottawa Public Health unit, for example, only one did not go on to submit a formal exemption form.

In Hamilton, 398 parents have received their “education certificate” since September 2017. “We are aware of only one parent who has changed their mind after the education session,” reports a city communications officer, Aisling Higgins.

At the Huron County Health Unit, “It has been our experience that generally parents who attend the vaccine education session continue to seek an exemption afterwards,” said spokeswoman Rita Marshall.

In Toronto, meanwhile, a survey of 105 parents who received vaccination education in 2017-2018 found that 79 per cent were still not intending to have their children inoculated, 13 per cent said they were unsure, and only eight per cent sai they would no longer seek an exemption.

That same school year, 4,572 out of 272,808 Toronto students were registered with a philosophical objection. That’s slightly higher than previous years.

Not all of Ontario’s health units are tracking how many parents continue to seek exemptions after sitting through an educational video. Some declined to comment at all, referring the Post to the ministry of health — which referred us back to the health units.

The video itself certainly covers vaccine basics — what’s in them and how they work. It explains how vaccines beat both smallpox (which disfigured and killed millions of children before it was declared eradicated in 1980) and polio ( 11,000 Canadians paralyzed between 1949 and 1954)- It makes clear that homeopathic vaccines, or “nosodes,” watery, massively diluted solutions that have never been proven to prevent infection, are no substitute for real vaccines, no matter how they’re marketed. And it refutes the autism myth perpetrated by Wakefield’s since-retracted paper.

But unlike Oregon’s vaccine education video, for example, there are no pictures of toddlers with life-threatening swelling of the neck (bull neck) from diphtheria, no audio of what a baby with whooping cough sounds like as she struggles to breathe through the thick secretions accumulating in her lungs. Nor are there any dramatic local narratives like that of the six-year old Oregon boy who, unvaccinated for tetanus, went into spasms and spent 47 days in intensive care after cutting his forehead while playing on a farm, his hospital bills totaling US$811,929.

As Paul Offit, the head of the Vaccine Education Center at the Children’s Hospital of Philadelphia, put it in a recent piece in Science Magazine, “I think we are compelled by fear more than reason. You have to make parents realize that their choice isn’t a risk-free choice.”

Avoiding a more graphic approach may be a mistake may be a mistake.

As Paul Offit, the head of the Vaccine Education Center at the Children’s Hospital of Philadelphia, put it in a recent piece in Science Magazine, “I think we are compelled by fear more than reason. You have to make parents realize that their choice isn’t a risk-free choice.”

Others, however, have found a “danger-priming” effect. One large 2014 study found that dramatic narratives and pictures of sick children increased misperceptions about the MMR vaccine. Some parents were even confused about the images they were shown of children with measles. They thought they showed the side effects of the vaccines.

To members of Vaccine Choice Canada, a group that believes measles is a “benign and beneficial illness” and that all the fuss over the recent outbreak in Vancouver is artificially hyped hysteria, Ontario’s education sessions are a “joke,” misleading, patronizing and inaccurate.

(The content is based on peer-reviewed science.)

“Parents stated that they have already extensively researched the topic of vaccine safety' and effectiveness and that they found it insulting to have the government force them to be ‘re-educated,’” says vice president Ted Kuntz, who, at the request of the Post, put out a question to parents on the organization’s social media platforms.

That’s hardly surprising, says Brian Koberlein, a senior lecturer of physics and a science communicator at the Rochester Institute of Technology'. “In general, when you learn a misconception, it’s difficult to let go of it,” he says. And a brief class isn’t going to suddenly win people over. It’s more like detention after school.

“Good parents don’t put their children in harms-way,” Koberlein says. “So, if you believe that vaccines are harmful, the thought of vaccinating your child can make you feel angry or scared. It’s hard to dispel those emotions in a single presentation.” Still, the effort may not be entirely futile, “because the more you hear the facts the better the chance that they will stick with you,” he says.

But Ubaka Ogbogu, a professor of health law at the University of Alberta, disagrees. In his view, vaccination education is a pointless waste of resources. “Education is a tool that should be used in conjunction with a policy that focuses on the best interests of the child,” he says, and that means mandatory vaccinations — “sans” any religious or conscientious objections.

In the U. S., three states — Mississippi, West Virginia and California — have done away with religious and personal belief exemptions for public school students. In Mississippi, the state or deputy state epidemiologist review's even medical exemptions. Today', the state has the highest
vaccination rate in the U.S.

In Canada, immunization rates are suboptimal. A 2013 UNICEF report on uptake rates ranked Canada 28th out of 29 high-income countries. A study' two years later found that only 89 per cent of two yea – olds in Canada were vaccinated against measles, mumps and rubella; only 77 per cent received the four recommended doses for diphtheria, pertussis and tetanus. The target for both vaccines is 95 per cent.

While anti-vaxxers and the “vaccine hesitant” remain in the minority, non-medical exemptions have doubled since 1985. Given enough of them, exemptions can seriously undermine herd immunity. Children who are not vaccinated are 35 times more likely to contract measles. They also put kids who cannot be vaccinated — those with cancer, heart or lung diseases, allergies or compromised immune systems — at risk.

The science, as Ogbogu and others point out, is unimpeachable. Vaccination saves lives. “But there is a lack of bravery or even political will to do what’s necessary',” he says. “It boggles my mind.”

Ogbogu believes children should be vaccinated at the earliest age safety allows.

If a parent fails to do so, he says, temporary' guardianship could be awarded to a non-objecting family member or to child welfare authorities until the child can be vaccinated and returned home.

“All you need is one province to take the lead, and, if the vaccination rate starts to improve, others may follow. Imagine if all the money wasted on this education program in Ontario was used to enforce a mandatory' policy?”

But Dr. Joan Robinson, a pediatric infectious disease specialist at the University of Alberta, isn’t convinced. In a debate with Ogbogu published in Alberta Views last month, she argues that sheer logistics are one obvious problem with compulsory' vaccination: About 0.5 per cent of parents in the province are firmly anti-immunization, she writes, and there are 50,000 births each year; that would mean 250 babies would need apprehension, likely not just for their first shot but all five necessary' for full inoculation.

More than this, Robinson told the Post, it’s not a very' Canadian approach:  It doesn’t feel like something that fits with the way' our society functions.” She also questions whether the courts would allow it. In 2014, an Ontario judge ruled that an 11- year- old aboriginal girl’s family had a constitutional right to pull her out of chemotherapy and treat her leukemia with traditional native and alternative remedies instead. She later died of her cancer.

“If they won’t apprehend to save a life are they going to apprehend for an immunization to prevent an infection the child may never be exposed to?” Robinson says.

A better way to improve vaccination rates, she argues, is to make the shots more convenient for working parents, and  to teach children earlier about the history' of scourges like small pox and polio “so that when they' become adults they' know the evidence that is out there.”

A number of countries have compulsory vaccination laws, however, among them Bulgaria, Croatia, the Czech Republic, France, Greece, Latvia, Hungary, Poland and Slovakia. This week, Italy began to enforce a law banning unvaccinated children from school.

Ogbogu believes mandatory' shots would survive a Charter challenge in Canada, for two reasons: First, it would likely be viewed as a reasonable limit on a parent’s right to freedom of religion and conscience, and it’s the rights of the child that are at stake; secondly', no protected right that parents enjoy is violated by a mandatory vaccination rule.

As noted, New York University bioethicist Arthur Caplan has argued, “choice has its limits — big limits. You cannot kill helpless babies by your choice. You should not end the lives of the frail, elderly, and immunologically vulnerable by your choice.”

A recent poll by Angus Reid also suggests the vast majority' of Canadians would be entirely comfortable with compulsory' shots for any child attending day'- care or school who can safely be immunized. About 70 per cent of respondents across the country' agreed with the statement, “vaccinations should be mandatory.”

California dropped nonmedical exemptions only after the 2015 measles outbreak at Disneyland — we shouldn’t wait for an emergency, says Ogbogu. As he points out, once there is a disease outbreak even parents opposed to vaccines tend to immunize their children. Vaccination rates went up at two Vancouver schools after the recent measles outbreak.

“You hold out and then you get the disease in the community and then you panic and do the right thing? That makes no sense to me.

 

To members of Vaccine Choice Canada, a group that believes measles is a “benign and beneficial illness” and that all the fuss over the recent outbreak in Vancouver is artificially hyped hysteria, Ontario’s education sessions are a “joke,” misleading, patronizing and inaccurate. (The content is based on peer-reviewed science.)

“Parents stated that they have already extensively researched the topic of vaccine safety and effectiveness and that they found it insulting to have the government force them to be ‘re-educated,’” says vice-president Ted Kuntz, who, at the request of the Post, put out a question to parents on the organization’s social media platforms.

That’s hardly surprising, says Brian Koberlein, a senior lecturer of physics and a science communicator at the Rochester Institute of Technology. “In general, when you learn a misconception, it’s difficult to let go of it,” he says. And a brief class isn’t going to suddenly win people over. It’s more like detention after school.

“Good parents don’t put their children in harms way” Koberlein says. “So, if you believe that vaccines are harmful, the thought of vaccinating your child can make you feel angry or scared. It’s hard to ispel those emotions in a single presentation.” Still, the effort may not be entirely futile, “because the more you hear the facts the better the chance that they will stick with you,” he says.

But Udaka Ogbogu, a professor of health law at the University of Alberta, disagrees. In his view, vaccination education is a pointless waste of resources. “Education is a tool that should be used in conjunction with a policy that focuses on the best interests of the child,” he says, and that meant mandatory vaccinations. — “sans” any religious or conscientious objections.

In the U.S., three states — Mississippi, West Virginia and California — have done away with religious and personal belief exemptions for public school students. In Mississippi, the state or deputy state epidemiologist reviews even medical exemptions. Today, the state has the highest vaccination rate in the U.S.

In Canada, immunization rates ‘All you need is one province to take the lead, and, if the vaccination rate starts to improve, others may follow. Imagine if all the money wasted on this education program in Ontario was used to enforce a mandatory policy?”

But Dr. Joan Robinson, a pediatric infectious disease specialist at the University of Alberta, isn’t convinced In a debate with Ogbogu published in Alberta Views last month, she argues that sheer logistics are one obvious problem with compulsory vaccination: About 0.5 per cent of parents in the province are firmly anti-immunization, she writes, and there are 50,000 births each year; that would mean 250 babies would need apprehension, likely not just for their first shot but all five necessary for full inoculation.

More than this, Robinson I told the Post, it’s not a very Canadian approach: “It doesn’t feel like something n that fits with the way our I society functions.” She also questions whether the courts would allow it. In 2014, an Ontario judge ruled that an 11-year-old aboriginal girl’s family had a constitutional right to pull her out of chemotherapy and treat her leukemia with traditional native and alternative remedies instead She later died of her cancer.

“If they won’t apprehend to save a life, are they going to apprehend for an immunization to prevent an infection the child may never be exposed to?” Robinson says.

A better way to improve vaccination rates, she argues, is to make the shots more convenient for working parents, and to teach children earlier about the history of scourges like smallpox and polio “so that when they become adult’s they know the evidence that is out there.”

A number of countries have compulsory vaccination laws, however, among them Bulgaria, Croatia, the Czech Republic, France, Greece, Latvia, Hungary, Poland and Slovakia. This week, Italy began to enforce a law banning unvaccinated children from school.

Ogbogu believes mandatory shots would survive a Charter challenge in Canada, for two reasons: First, it would likely be viewed as a reasonable limit on a parent’s right to freedom of religion and conscience, and it’s the rights of the child that are at stake; secondly, no protected right that parents enjoy is violated by a mandatory vaccination rule.

As noted, New York University bioethicist Arthur Caplan has argued, “choice has its limits — big limits. You cannot kill helpless babies by your choice. You should not end die lives of the frail, elderly, and immunologically vulnerable by your choice.”

A recent poll Dy Angus Kern also suggests the vast majority of Canadians would be entirely comfortable with compulsory shots for any child attending daycare or school who can safely be immunized. About 170 per cent of respondents across the country agreed with the statement, vaccinations should be mandatory.”

California dropped nonmedical exemptions only after the 2015 measles outbreak at Disneyland — we shouldn’t wait for an emergency, says Ogbogu. As he points out, once there is a disease outbreak even parents opposed to vaccines tend to immunize their children. Vaccination rates went up at two Vancouver schools after the recent measles outbreak.

“You hold out and then you get the disease in the community and then you panic and do the right thing? That makes no sense to me.”

National Post skirkey@postmedia.com@sharon_kirkey

With files from Ellen Samek, National Post

 

VACCINATED CANADA: THEN & NOW

 

 

 significant new study out of Denmark this month confirmed once again that there is no evidence the MMR (mumps, measles, rubella) vaccine causes autism. In fact, just the opposite seems to be the case: children who received the shot were seven per cent less likely to develop autism than those who did not. If the results of that study don’t do anything to slow the metastasizing of anti-vaccine sentiment, including in North America, you might find an explanation in last week’s other big news event: the opening of the annual SXSW conference in Austin, Texas, which began as a music festival for independent artists but has evolved into a massive film/tech/lifestyle/trade-show gathering of the hipster clans.

This year’s version has a Wellness Expo component, with 171 participating brands. Events include conversations with the founder of Caulipower (makers of a gluten-free, cauliflower-crust pizza) and a speech by the CEO of a company that sells, among other things, a chromium-infused “thermogenic elixir” at a price of $65 for a case of six 473ml bottles. And, of course Gwyneth Paltrow was there, launching a Goop pop-up store and having a fireside chat with Poppy Harlow of CNN.

The connection might not be obvious, but the surging popularity of the “wellness” movement is just part of a wide and deep strain of anti-science flakery in our culture that implicates almost all of us on one way or another. If we want to understand why we have so much trouble with vaccine denialism, it might be worth starting by admitting that we're all part of the problem.

It is impossible to overstate the impact of public vaccination programs. In an era that saw enormous advances on a number of fronts, mass immunization was probably the single greatest public health initiative of the 20th century. Aside from the MMR vaccine that had brought those diseases under control, we’ve largely eliminated smallpox, diphtheria, tetanus, hepatitis, whooping cough, and polio. Chickenpox is usually harmless, many of us had it as kids, but there’s a vaccine for that now too, along with one for HPV.

Yet slowly but surely, we’re turning our back on this success. The United States declared measles eliminated from its soil in 2000, but now the map of communities that are losing the critical mass of herd immunity grows by the day. Japan, Italy, France, New Zealand and Ukraine all face significant measles outbreaks, and in Madagascar over 1,000 people, mostly kids, have died since October.

In short, the anti-vaccine movement is not a joke, it’s not even some mostly-harmless hippy dippy fugue, even in the form of resistance that is currently being soft-pedalled by a blowback-shy media as “vaccine hesitancy.” The World Health Organization lists it as one of the top ten global threats to public health — alongside such apocalyptic horrors as antibiotic-resistant microbes and Ebola.

So where did the anti-vaccine movement come from? It is common, and tempting, to blame it all on Andrewr Wakefield, the physician who in 1998 published a paper claiming that there was a link between the MMR vaccine and autism. It was bunk of course — the paper was retracted, as was Wakefield’s license to practice in the U.K.

But if it were all Wakefield’s fault, you would expect that the belief that vaccines cause autism (or learning disabilities, or bowel disease, or any number of other alleged physical or psychological side-effects) should be fading away. Instead, it is growing. A news piece making the rounds last week detailed the awful story of an unvaccinated Oregon boy who contracted tetanus last year. Tetanus!

And, so it strains credulity to think that this is all the doing of a single disgraced British researcher. After all, in his 1986 memoir Going Solo, Roald Dahl talks about the agony of watching his seven-year-old daughter, Olivia, die of measles encephalitis just a year before a reliable vaccine was made available. Andrew Wakefield is a moral criminal, but he was pissing into what was already a seriously poisoned well.

Take the city of Calgary, which has just issued a measles alert, but is also struggling once again with the question of whether to put fluoride in municipal drinking water. It went into the system in 1989, but came back out in 2011. Now, yet another movement wants fluoride back in, though the pro-fluoride camp is facing an international misinformation campaign arguing that not only does it do nothing (to prevent tooth decay, it also causes learning disabilities and thyroid disease. On the whole, two-thirds of Canadians live in cities that don’t put fluoride in the water.

Or consider the federal government, which until recently was committed to spending $350,000 to send homeopaths to Honduras to treat Chagas disease, a deadly tropical infection that can only be cured with costly pharmaceuticals. When questioned about it, instead of backing down Global Affairs Canada reiterated its support for the program and for homeopathy in general. It took two weeks and a public campaign by doctors and health professionals to get die ministry to change course. Even then, it did so in a thoroughly scurrilous fashion, blaming the previous Conservative government for funding the program in the first place.

But it is not like the rest of us are patrolling the moral high ground here. Head over to any local drug store, where trained pharmacists are keen to assert themselves as our frontline healthcare providers, guiding us on the proper way to take regulated, controlled, and possibly dangerous medicine. Or, if you don’t care for expert advice or the hassle of getting a prescription, the natural supplement aisle offers hundreds of vitamins, minerals, herbs and oils, many of which are bad for you, none of which have been proved effective for any of their advertised claims. You might as well just burn your money for all the good any of it will do you, but it is a $12-to-$15 Billion industry in North America.

It’s a similar story in the supermarket, which is increasingly dominated by organic and gluten-free incantations. Forget that the cross-thatching benefits of organic (health, environment, taste) are mixed at best, and ignore the feet that well under one per cent of the population has celiac disease; organic this and gluten-free that are big businesses, with a bullet.

So to recap: We are collectively complicit, publicly through our governments and privately through our myriad consumption choices, in promoting and endorsing all sorts of nutritional nonsense, healthcare quackery, and  wellness” faddism. And at the same time, a great many of us are actively hostile to developments that make substantial improvements in our lives. Like fluoride in the drinking water. Like vaccines.

We’re in the midst of a moral panic right now about “fake news” and the rising tide of irrationalism that is drowning our public debate. But you can’t have your evidence-based policy and your Caulipower pizza; you can’t complain about the vaccine-free family down the street while railing against GMO food and preaching about the virtues of organic produce.

Vaccine refusal is swiftly evolving into perhaps the most serious public health problem of our time, but if you want to know why kids are yet again dying of measles more than half a century after a safe and effective vaccine became widely available, take a look in your medicine drawer, gym bag or refrigerator.

National Post

Andrew Potter is the author of The Authenticity Hoax:

How We Get Lost Finding Ourselves and, with Joseph Heath,

The Rebel Sell: Why the Culture Can’t be Jammed.