Since the beginning of the school year, 9,261 Toronto students have been suspended for not having up-to-date vaccines. Immunizations against nine diseases are mandatory at Ontario public schools, and Toronto Public Health (TPH) is currently rooting out negligent parents.
Ideally, TPH would like to review every student’s record annually, but that’s a huge job. This is the first time in eight years that it’s set out to check up on all 322,275 public school students. So far, 104,000 children have been found to have incomplete or outdated shots. Most are actually fine, they just need to provide proof – three increasingly stern letters are sent to parents before students are suspended.
That might seem heavy-handed. Then again, there’s currently a global outbreak of measles, a highly infectious disease: There were 5,000 cases in Europe in 2016, 24,000 in 2017, and more than 80,000 last year. Toronto is pretty much measles-free – TPH knows of just one current case, an unvaccinated infant who was infected in another country – and it’s the health unit’s job to keep it that way.
That’s important. The problem is a lack of commitment to vaccine-tracking by the Ministry of Health. That’s caused a communication breakdown between doctors (whose oversight is provincial) and public health units (which are municipal) – and drawn-out, unnecessary headaches for a bunch of the city’s parents, most of whom have held up their end of the bargain.
After administering a vaccine, health providers currently fill out three sets of paperwork: noting immunizations in their own records, sending a bill to the province, and providing paper copies for parents. They don’t currently have to inform public health units. The former Liberal government was going to make that mandatory, despite the Ontario Medical Association’s objection to the added bureaucracy. Then the Conservatives won and paused the reporting rollout, sticking parents with second jobs as secretaries.
Again, it’s a worthy cause. Thanks to widespread access to the Measles Mumps Rubella vaccine (MMR), measles transmission between Canadians was eliminated in 1998. Until now: A mini-outbreak in Metro Vancouver has led to 18 recorded cases this year, 17 of them among students at a set of coastal schools with low vaccination rates.
Immunization isn’t mandatory at B.C. schools, and herd immunity is delicate. In the 2016-17 school year, 91 per cent of seven-year-old Ontario students had received their MMR shot. That sounds high, but dipping under 90 per cent makes the population vulnerable to an outbreak. And nowhere, including Toronto, is immune to the misinformation contributing to the global epidemic.
Last month, anti-vaxxers bought space on 50 city billboards to broadcast misleading information about the risk of immunizations, and emphasize that school boards do allow occasional exemptions. Public outcry got the billboards taken down quickly, but who knows how much doubt and fear they stoked in the meantime. The 90-plus-per-cent uptake shows that Toronto parents believe in vaccines. They also wouldn’t mind helping with tracking, if the process wasn’t a mess.
This is the first year that parents can update records online, which should make things easier. But the provincially-run Immunization Connect Ontario Network (ICON) is a government website, so, unsurprisingly, it’s fairly buggy.
Some parents complain that their child’s ID number isn’t recognized, or that they can’t save a record and come back to complete it later. Others are being rejected for entering vaccination dates before their child’s appropriate birthday, although immunizations are allowed up to four days early. Also, TPH is currently advising parents that everyone who did their due diligence in late December will have to do it again. That might be why some families get a second or third letter they don’t deserve.
The result is carving out time during the workday to call TPH or family doctors to sort everything out, maybe more than once. All this, and the vast majority of the time, the immunization is up to date, and parents have already submitted their records to their child’s school. When asked when a system linking health-care providers to public-health units and schools might be ready, the Ministry of Health dodged the question.
Measles is no joke: It killed 110,000 people in 2017, mostly children under five in countries not as rich or lucky as this one. Others were left blind, deaf or with swollen, feverish brains. That’s why Torontonians vaccinate their children. Too often, the punishment for that good behaviour is a ride on a bureaucratic carousel.