Toronto’s top public health official is urging the Ontario government to consider halting the practice of letting schoolchildren skip vaccinations because their parents claim religious or philosophical objections.

Dr. Eileen de Villa made the controversial recommendation to end all but medical exemptions — along with numerous other measures aimed at combating the spread of misinformation about vaccines that threaten to lower overall immunity — in a report released Monday.

Vaccination in Ontario is mandatory for schoolchildren but parents can invoke exemptions for their kids based on medical, religious or philosophical grounds — something Ontario has no plans to change, Health Minister Christine Elliott’s office said Monday.

Also among de Villa’s eight recommendations: the health board asking advertisers and social media sites to clamp down on misleading antivaccination information; providing “financial incentives” to local health-care providers to get kids immunized; strengthening supports for people who experience serious side-effects from vaccines including a provincial compensation program; and ensuring schools have programs to educate children about vaccines and help boost immunization levels.

But the most controversial, and potentially politically contentious, will be de Villa’s call for Ontario to “consider removing philosophical and religious exemptions under the Immunization of School Pupils Act and only accept medical exemptions completed by a certified health care provider.”

“Vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, is a growing concern in Canada,” so Toronto public health needs a “comprehensive strategy” involving parents, health care providers, students, educators and all levels of government, the report states.

“Vaccines are safe, effective and one of the most important contributors to improving health worldwide and preventing the spread of infectious diseases ...,” it says. The report adds that Toronto elementary and secondary schools have experienced a “small, but steady increase in philosophical and religious exemptions, from 0.8 per cent for the measles, mumps and rubella (MMR) vaccine in the 2006/07 school year to 1.72 per cent in the 2018/19 school year” — a trend seen provincially.

The exemption rate remains low compared to some U.S. jurisdictions but “before philosophical and religious exemption rates reach dangerously high levels in Toronto, it is important and timely for the provincial Ministry of Health to consider removing philosophical and religious exemptions from its legislation.”

Councillor Joe Cressy, the public health chair, said other provinces and states have looked at scrapping exemptions after a disease outbreak. Toronto doesn’t want to wait for that to happen.

“Fundamentally this is about population health, society’s health, collective rights that are jeopardized if herd immunity (mass vaccination effectiveness) is compromised,” he said in an interview.

“We’ve seen a steady, consistent increase in the number of non-medical exemptions. It has not reached a breaking point yet — that’s why we want to proactively prevent the outbreak from happening rather than waiting until after the fact.”

Last April, de Villa noted that growing reluctance or refusal to vaccinate had been identified by the World Health Organization as a top-10 global health threat.

Her associate medical officer of health, Dr. Vinita Dubey, who wrote the new report, warned then that “measles is spreading in North America, Europe and around the world, primarily because vaccination rates have fallen in these areas.”

With an estimated one-fifth of Canadian parents hesitant or unsure about vaccines’ safety and effectiveness, de Villa said, public health has a “major role” in educating the public and to “protect the health of the community by maintaining high vaccination rates.”

Travis Kann, spokesperson for Elliott, said the provincial government is “committed to a strong and effective immunization system in Ontario,” and the health minister continually evaluates the “best available evidence” to improve vaccine uptake and reduce the risk of outbreaks.

He noted that Ontario parents opting to exempt children for religious or philosophical reasons are required to attend an education session on vaccinations and that, in case of an outbreak, unimmunized students with valid exemptions can be told to temporarily stay home.

“Currently, there are no plans to update this approach,” Kann wrote in an email.

Public health staff were tasked with writing the report over the protests of some people who told them public health should not try to drown out their message that vaccination carries risks, and that parents have the right to decide for their children.

Last February digital billboard ads briefly appeared across Toronto, funded by a group called Vaccination Choice Canada, urging parents to be wary of preventative jabs.

Dr. David Fisman, a professor of epidemiology at U of T’s Dalla Lana School of Public Health, favours a clampdown on kids being allowed to attend local schools unvaccinated.

“I regard maintenance of robust levels of immunization as a child protection issue, and also as a public good that falls apart when people opt out for bad reasons,” Fisman told the Star.

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Unvaccinated children endanger others who, for medical reasons, can’t benefit from vaccines and are vulnerable, he said. “We have abundant evidence that vaccines are very safe and highly effective, and we need to let evidence and science drive policy on this issue.”

Robin Pilkey, chair of the Toronto District School Board, said “we respect the medical officer of health’s perspective on this policy and will obviously support whatever direction is provided” by the health and education ministries.

Maria Rizzo, chair of the Toronto Catholic District School Board, said she fully supports the de Villa’s recommendation.

“I don’t think there’s a place for ideology or philosophy or religion – those basically have no place in determining public policy in terms of vaccinations. We can’t put our children at risk in our communities, and we know that vaccines save lives.”

She said public health notifies the board when students aren’t up to date on their shots, “and it’s usually that parents don’t know, or they haven’t done it or forgotten,” not that they oppose vaccines.

In the past, some Catholic boards – including her own – debated whether to allow public health to administer the HPV vaccine to Grade 8 students. The vaccine protects against the sexually transmitted infection linked to cervical cancer.

Rizzo noted that vaccine is not mandatory, and in particular helps low-income families who can’t afford several hundred dollars in costs to go elsewhere for their children to get the shot, in grades 7/8.

Measles outbreaks have been reported this year in the United Kingdom, Europe, Japan, and several parts of the U.S. Public health says there are five confirmed cases in Toronto so far in 2019 — the typical number the city sees in a year.

The push to end or curtail exemptions is growing in North America. New Brunswick has proposed ending religious and philosophical exemptions, making vaccination mandatory for all children in schools and daycares except those with medical reasons, such as a weakened immune system.

New York lawmakers voted to eliminate that state’s religious exemption in June, amid the worst U.S. measles outbreak in decades.

California is now scrutinizing doctors who grant more than five medical exemptions in a year and schools with vaccination rates of less than 95 per cent — considered a threshold for “community immunity” to protect those unvaccinated for medical reasons or because they are too young.

Measles is a highly contagious virus that can live for up to two hours in an airspace where the infected person coughed or sneezed, according to the U.S. Centers for Disease Control and Prevention.

Infants are at greater risk of contracting the disease, because they generally aren’t immunized until they are about a year old — the vaccine is not approved for use in babies younger than six months.

Correction — September 16, 2019: This article was edited from a previous version that misspelled the given name of Dr. Eileen de Villa. As well, the article misstated the name of University of Toronto’s Dalla Lana School of Public Health.

With files from Francine Kopun and Kristin Rushowy

David Rider is the Star’s City Hall bureau chief and a reporter covering city hall and municipal politics. Follow him on Twitter: @dmrider

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