Are mandatory vaccines the solution to a looming health crisis — or fuel for conspiracies?
Legal experts debate whether 'coercing' vaccine-wary parents increases child vaccination rates
When his daughter was born premature in Edmonton in 2014, Ubaka Ogbogu had a lot to worry about - and measles was the last thing he wanted to add to the list.
At the time, Alberta was in the midst of a measles outbreak, which public health officials attributed to the province's relatively low vaccination rates and vaccine-wary parents.
It confounded Ogbogu that his newborn could possibly contract a highly contagious disease which can cause pneumonia, brain damage or even death, in a country where the vaccine is free and readily available.
"I know, as a parent, what I had to go through to protect my child who could not get vaccinated because she was immunocompromised."
With cases of infectious diseases like measles and whooping cough on the rise, public health officials are expressing widespread concerns about falling child vaccination rates across Canada.
As both a father and a public health scholar, Ogbogu suggests the solution is giving parents no choice but to vaccinate their kids, with exemptions for valid medical reasons.
"Most provincial governments have not really done anything on the issue [of mandatory vaccinations] and I think that's because of political cowardice," said Ogbogu, a University of Alberta law professor who specializes in health policy.
"The government has to take a position where it says, 'Public health is there for a reason and it's important for a reason. And we're going to insist on it.'"
Building a culture of compliance
While a recent poll suggests 70 per cent of Canadians agree vaccinations should be required for children entering school, only Ontario and New Brunswick have mandatory school immunization policies.
Both provinces allow parents to opt-out of vaccines for religious or philosophical reasons.
Ogbogu argues it's reckless to not use the most effective tool for tackling infectious diseases. He suggests nation-wide mandatory vaccinations are the best way to build a culture of compliance, which he likens to road safety laws that require motorists to stop at an intersection.
"I stop at a red light because I understand it's the culture here, a culture that's been created by law. When you make [vaccinations] mandatory, you shouldn't allow for any exceptions - unless it's for a medical exemption."
We need to be respecting people, by having conversations with them about the science.- Steven Hoffman, York University law professor
Ogbogu argues there are laws in Canada which require the state to intervene, if parents deny a child the necessities of life, such as food, shelter or medical treatment.
In his opinion, vaccination laws should be just as stringent.
"An unvaccinated child is a threat to the community ... especially to persons, who for medical reasons, cannot get vaccinated," said Ogbogu.
Fuelling conspiracy theories?
However, mandatory vaccinations can backfire, according to another prominent Canadian health law scholar.
"When governments impose anything on anyone, there can always be feelings of resentfulness," said Steven Hoffman, a professor of global health at Osgoode Hall Law School in Toronto.
"In this case, the scientific case for vaccination is so monolithically strong, I'd be worried that forcibly coercing people into this very helpful activity could undermine support for doing it in the first place."
Not only might immunizations be difficult to enforce, Hoffman believes if lawmakers impose health policy, it could have "unintended consequences of further fuelling conspiracy theories."
Instead, he argues the job should be left to health professionals.
"We need to be respecting people, by having conversations with them about the science."
'Populism is the problem'
It would help if public health officials could better explain how vaccines work and their value historically, says Hoffman.
He points to a Toronto Public Health program, where health professionals follow up with parents of children who, according to school records, have not been immunized. He fears the outreach program will fall victim to recent Ontario health cuts.
"What it results in is greater cost in the long run, because all of this just moves to hospitals, which are much more expensive when dealing with disease outbreaks [rather] than an easy vaccination."
Ogbogu believes a national compensation program for the rare cases of adverse effects, as is offered in Quebec, would also boost public confidence.
He agrees more resources for public education would allay some parents' fears, but maintains education alone doesn't improve vaccination rates.
Ogbogu acknowledges mandatory vaccination may prompt anti-vaxxer protest, but says it also prompts questions, which could be addressed by a public education strategy.
"Vaccination is not a problem. Populism is the problem. We're living in an age where people are just not convinced that things that are evidence-based should guide your life," he said.
"The only way to change that is to re-emphasize and insist on cultural values that protect cooperation in society."