CMA vows to stop non-medical exemption for vaccination

By Barbara Sibbald | CMAJ | Aug. 23, 2016

CMA delegates took a stand against non-medical exemptions from vaccination despite warnings of a backlash.  (Dmitry Naumov/iStock)

Eliminating non-medical exemption from vaccination for school-age children could backfire, leading to even more vaccine hesitancy and refusal, argued some delegates at the Canadian Medical Association (CMA) annual meeting in Vancouver. Despite vocal opposition, a motion narrowly passed in support of the elimination of non-medical exemption for vaccination in Ontario, New Brunswick and Manitoba, where children must be vaccinated in order to attend school.

The topic has been debated since Britain introduced non-medical exemption in 1889, said mover Dr. Tommy Gerschman of British Columbia. “After more than 200 years, we need to stop worrying about a backlash.”

The evidence supporting vaccination is excellent, added Dr. Blake Woodside of Ontario. “Sometimes we have to make a rule like you can’t smoke inside, you can’t drink and drive, you have to wear a seatbelt. … Sometimes those attitudes need help to change over time … despite the short-term backlash.”

But mandating vaccination could backfire entirely, countered former CMA president Dr. Anna Reid from the Northwest Territories, speaking on behalf of international immunization expert Dr. Noni MacDonald, who was unable to attend today’s session. Evidence from the United States indicates mandatory vaccination led to decreased vaccination rates. The small population opposed to vaccines becomes more strident, “and that spreads to people sitting on the fence,” said Reid.

A 2012 literature review in BMC Pediatrics estimated that less than 2% of parents refuse vaccines outright, though up to 30% are hesitant to vaccinate their children. At a public health meeting in June, MacDonald urged health care providers to have a calm and fact-based conversation with vaccine-hesitant parents. “Listen and listen again, make sure you understand the concerns, and then tailor your information to fit.”

My son has a primary immunodeficiency and ended up in the ICU with a vaccine-preventable disease. It was one of the most painful things I’ve ever had to watch.

Doctors need to be trained to counsel families and deal with the plethora of issues around vaccine hesitancy, added Dr. Thomas McLaughlin of Ontario. “I have seen pertussis … I have seen kids die of vaccine-preventable diseases,” he told delegates.

CMA Past-President Dr. Chris Simpson agreed that mandatory vaccinations could ignite confrontations and also lead parents to withdraw their children from school. He advocated for mandatory registries of vaccine status so action can be taken in the event of an outbreak.

In an emotional plea, Dr. Lesley Barron, a general surgeon from Ontario, spoke in favour of the motion. “My son has a primary immunodeficiency and ended up in the ICU with a vaccine-preventable disease. It was one of the most painful things I’ve ever had to watch.”

Delegates rejected a motion to refer the issue to CMA’s board of directors for a decision. “We were encouraged to be bold and to be brave. Referring to the board abdicates our responsibility,” said Dr. Eric Cadesky of BC.

In the final vote, 58% of delegates were in favour of the motion to eliminate non-medical exemptions from vaccination.

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