Why Are Non-Medical Vaccine Exemptions Still Legal?

It’s against the law to drive without a seat belt. Why can we opt out of vaccines?

In Canada and much of the US, it's against the law to ride in a car without wearing a seatbelt. If a police officer catches you, you'll get a ticket, and probably have to pay a fine. There are also laws on the books that make sure parents take proper care of their kids: An Alberta couple was just found guilty of failing to provide the necessaries of life to their toddler, who died of meningitis after they treated him with horseradish smoothies and other natural remedies.

So why, across Canada and in many parts of the US, can parents opt out of getting their kids vaccinated for non-medical reasons? Nobody would successfully argue that they have moral objections to wearing a seatbelt (try that one out on a cop), and when you choose not to buckle up, you're mainly just putting yourself at risk. But those who decide not to immunize their kids can potentially spread disease to other vulnerable individuals, like sick people who can't be vaccinated because of valid medical concerns, and young babies who haven't yet gotten their shots. It has consequences for everybody. So why is this still a thing?

Ontario recently introduced new legislation that would send parents who refuse to vaccinate their kids to an "education course" with a public health worker. If that law passes, it will be the first jurisdiction in Canada to do something like this. But that doesn't change the fact that people in that province can still opt to skip vaccines for philosophical reasons.

California, meanwhile, has outright banned vaccine exemptions based on personal beliefs (though antivaxxers are finding creative ways around it). Vermont has also put an end to philosophical exemptions, and some states, like Mississippi, have never allowed it. But the majority still allow this type of excuse for skipping a vaccine.

In Canada, only Ontario and New Brunswick have comprehensive laws governing the vaccination of school kids: they require proof before kids can go to class, and in the event of an outbreak, non-immunized students might have to stay home. Even in these provinces, parents can do the paperwork to get out of vaccination for personal reasons.

The number of parents who seek out personal belief exemptions is actually very small.

One's personal beliefs haven't always been a good enough reason to skip a vaccine. When legal requirements around vaccinations and public school attendance first came on the books, most places only allowed a medical exemption, but right away parents began fighting back. Over the years, many states added a religious or personal belief exemption, or both. It wasn't until 2003, for example, that Texas expanded an already existing religious exemption to include parents who have a personal stance against immunization.

There's evidence to suggest that more parents are seeking out this type of exemption in Ontario, too. In a 2015 paper in paper in CMAJ Open, researchers there looked at students aged 7 and 17, for school years from 2002/03 to 2012/13. While the number of medical exemptions to vaccines actually dropped, the other kind—for religious or moral reasons—saw a bump.

More worrying, in a 2011 survey, half of Canadian parents reported feeling that newer vaccines are less safe than older ones, and 43 per cent said they're more worried about vaccine safety than they were five years earlier, the same CMAJ Open paper says.

The number of parents who seek out personal belief exemptions is actually very small, according to Dr. Sarah Wilson of Public Health Ontario, author of the paper.

"At the provincial level, it's less than 2 percent," she said.

Across Canada, about 90 percent of toddlers have gotten their vaccines against polio, measles, mumps, and rubella, says a 2015 report. The 2 percent who do opt out aren't spread evenly across the province, so that number is probably higher in some neighbourhoods and schools, creating hot spots that are vulnerable to outbreaks. Other research has found that those who oppose vaccines tend to cluster together—drawn by a pastor, a community centre, maybe even a daycare (like this one in Ottawa) that advertises itself as "vaccine-free."

As for whether philosophical exemptions should be outright banned, Wilson is careful to express what she calls her "personal view." Forcing parents to "accept a medical intervention" on behalf of their kids just isn't palatable, she said.

"It's difficult for me to think that in doing so, we could really be fostering that ongoing relationship with parents that we need for success of immunization programs," she said.

Jurisdictions like Ontario seem keen to educate parents who might be reluctant to immunize their kids. That's the logic behind sending them to a meeting with a public health worker, instead of legally pushing them to do something they aren't comfortable with.

Because, really, it's just a very small number who are hardcore antivaxxers. Most of those who skip or delay vaccines are what health workers call "vaccine hesitant": they might have doubts or questions, but they aren't taking a political stance. And those are people that public health officials can work with. Anyway, like we've seen in California, ditching the "personal belief" exemptions altogether isn't a perfect solution: determined individuals will find a way to avoid vaccines, whether there's a law in place or not.

Forcing someone to get a vaccine would just alienate the undecided. In most parts of North America, philosophical exemptions are something we'll have to live with.

Why Is This Still a Thing is a column exploring the anachronistic, seemingly-outdated technology that surrounds us. New columns appear every Friday.