The upshot: A successful vaccination effort can only protect a small part of society

“Vaccines Are Medicine!” is the rallying cry of global antivaccine activists in Toronto, Canada. The campaign’s impact is obvious: Toronto has a significantly lower unvaccinated rate than Toronto’s neighbors, and other countries in the…

The upshot: A successful vaccination effort can only protect a small part of society

“Vaccines Are Medicine!” is the rallying cry of global antivaccine activists in Toronto, Canada. The campaign’s impact is obvious: Toronto has a significantly lower unvaccinated rate than Toronto’s neighbors, and other countries in the region aren’t faring much better.

Why is this happening? The situation is simple, but it’s also extraordinarily dangerous. Toronto is seeing its third wave of measles—an infection once reserved for populations in rich industrialized countries. Toronto will also see a fifth wave, and should it make it to the Toronto Niagara region, it could infect up to 200,000 people.

In Toronto, the number of people with unvaccinated children or in homes where they live has continued to increase, while measles infection rates have, for the most part, remained low. A lot of that is because people are vaccinating and for an extended period in the first three waves, that second and third wave was included in the annual vaccination schedule.

But if measles cases began to rise in Toronto for any reason and the city’s healthy population remained uncared for—and many did—we’d expect a spike in illness. Vaccination rates are at best sporadic and variable—that’s what makes the reduction in measles risk in Toronto notable, even though measles isn’t much of a risk anywhere else in Canada. That leaves measles, and other contagious illnesses, to prey on unpvaccinated families.

Vaccines have successfully prevented many diseases including measles, and they remain as important for preventing disease as they’ve ever been, but vaccine skepticism has increased in recent years, and this in turn can make vaccines less effective. Some people don’t want to be vaccinated because they’re allergic to vaccines, but this represents less than 5 percent of the population. In reality, most people who are hesitant aren’t really anti-vaccine—they’re rejecting authority, and resistance against authority is, for the most part, driven by fear of change and uncertainty. A recent survey suggested the reason parents with children at large schools are avoiding vaccines is that they’re worried that mandates for vaccines will cause “unintended consequences.” That’s a pretty broad interpretation of what “unintended consequences” may be—wasn’t being given a vaccine today going to cause any health consequence not already thought of?

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The suspicion of vaccines is so widespread, in fact, that a staggering 88 percent of the U.S. population refuse to vaccinate their children, and the U.S. requires vaccinations for six major diseases. In 2017, “The New York Times” reported that approximately 240,000 children were infected with measles and 416 people died from the infection. If only 10 percent of those children were alive today, we’d see that 400 additional people died due to those unvaccinated kids.

Today, the vast majority of parents are vaccinating their children, and society as a whole is much safer because of this. Now we’re dealing with increased vaccine hesitancy, so what’s the city to do? Vaccine programs in public schools require parental consent, and in order to find parents willing to give that consent, the city’s health department has resorted to advertising in parent and other health-care professionals’ newspapers, among other tactics.

We’re “Losing the Vaccine Wars” in the U.S., to borrow a phrase from a California expert, and that makes sense in Canada, where ongoing drops in vaccine rates won’t be reversed. Parents who choose not to vaccinate their children should be met with sensible, evidence-based interventions, like more information about the risks of the diseases they choose to leave unvaccinated. But cities need to understand that there are existing pockets of anti-vaccination, and as that population gets further combined into networks—and as the city’s doctors keep educating those networks—an established vaccination rate will be more and more difficult to sustain.

Parents who opt out of vaccination and aren’t willing to accept the reality of widespread vaccine rejection, then, are forcing the disease onto their communities, and cities must respond. We don’t want the city of Toronto, Canada, to be a city with measles.

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