Intended for healthcare professionals


Ontario suspends unvaccinated children from school and proposes mandatory classes for parents

BMJ 2015; 351 doi: (Published 15 December 2015) Cite this as: BMJ 2015;351:h6821
  1. Owen Dyer
  1. 1Montreal

A new law proposed by Ontario’s health minister would require parents seeking their children’s exemption from being vaccinated on religious or philosophical grounds to first attend an education session on the risks of avoiding vaccination.

The province, Canada’s largest, has struggled for years with low vaccine coverage among schoolchildren, particularly in and around Toronto, where in many schools less than 70% of students are up to date with their recommended vaccination schedule.

In recent years public health authorities have instructed schools across the province to suspend children who are seriously behind in their vaccination schedule or cannot provide evidence of being up to date. This week Ottawa Public Health, whose district covers about 6% of Ontario’s population, sent out 5000 letters issuing suspensions, the first of many that are likely to be issued in the coming three months.

The proposal to make parents attend a course before being allowed exemption is part of the province’s new strategy called Immunization 2020, the first update to the rules since a 1982 law required vaccination for school attendance.

Ontario’s health minister, Eric Hoskins, said, “The changes we’re proposing, if passed, would require parents who choose not to vaccinate their children for non-medical reasons to attend an education session delivered by their local public health unit, prior to signing the exemption form.

“Parents or guardians would have to acknowledge that they received this education about the very real risks their children face if they chose that decision. These changes not only protect these children, they protect all children, including those who cannot protect themselves. It takes all of us to protect each of us.”

Hoskins, a physician and epidemiologist, was the founder of the charity War Child Canada and spent three years treating vaccine preventable diseases in Sudan.

Health authorities in Ontario attribute much of the blame for the province’s low vaccination uptake on the widespread currency of claims made by vaccine sceptics.1 Canada and the United States have witnessed a public backlash against antivaccination groups and parents since several resurgences of measles were linked to families of vaccine refusers returning from holidays. One outbreak struck Ontario. Measles had previously been declared eradicated across Canada and the US.2 3

In addition to the mandatory classes, the Immunization 2020 plan also includes an online tool to remind parents when vaccinations are due, and public health courses are to be taught in schools. The new rules are considered highly likely to become law and should be in force by September 2016.

Meanwhile, suspensions will remain the principal enforcement tool. Each suspension lasts 20 days or until documentation of full coverage is provided to the relevant health authority. Children targeted for suspension are only a fraction of those whose vaccination records are incomplete. Ottawa Public Health said in a statement that families of suspended children “have received multiple notices from Ottawa Public Health, a phone call and email from the Board, and communication directly from the school prior to them receiving a suspension notice.”

The sanction is highly effective, typically sending thousands of parents scrambling to specially opened “catch-up clinics,” while thousands more call the health department to provide proof of previously unreported vaccinations.


Cite this as: BMJ 2015;351:h6821


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