Mar 09, 2019 Volume 393Number 10175p959-1070, e33-e34
Canada’s mandatory vaccination reporting plans
An outbreak of measles in Vancouver, BC, Canada, has prompted new considerations about mandatory vaccination and reporting as tools to manage outbreaks and increase vaccination coverage. The city is dealing with the outbreak—caused by an unvaccinated child introducing measles after travel to Vietnam—at a time when UNICEF reports an ”alarming global surge of measles cases”. In the USA, measles incidence increased by 559% to 791 cases in 2018, prompting congressional hearings to manage the growing public health threat.
BC plans follow the model of other Canadian provinces and US states, many of which also require immunisation records for school entry. Parents who refuse for religious or philosophical grounds are often required to attend a course on the risks of not vaccinating their children.
Mandatory reporting, which involves parents or schools providing information to public health authorities about the immunisation status of all children—is vital for knowing who is immunised and to what extent. When an outbreak occurs, central registries help quickly establish which students should be excluded. But mandatory reporting is not a panacea, says Althea Hayden, medical health officer in Vancouver. With sufficient funding, mandatory reporting can increase vaccine uptake among the willing who might be unaware that their children are not vaccinated or haven’t had easy access to vaccinations.
But outbreaks generally take hold in small pockets of under-vaccination, says Hayden, and mandatory reporting is not an effective strategy for motivating the vaccine hesitant. Indeed, even coupled with education, mandates for immunisation can entrench anti-vaccine views and be counterproductive to public health goals. Whole-government strategies are needed. The longstanding practice in Canada and the USA of linking vaccine uptake strategies to schooling should be reconsidered. Many contemporary outbreaks are started by unvaccinated travellers. Authorities might need to consider requiring vaccination for passports, as Argentina has announced, and for entry requirements, as with yellow-fever vaccination.