Item - 2019.HL9.2

The Board of Health:

1.  Requested the provincial Minister of Health to:

a.  In keeping with the recommendations from the Premier's Council on Improving Healthcare and Ending Hallway Medicine:

1.  ensure that the digital health immunization record is available to the local health care provider, patient and/or guardian, and local public health unit;

2.  set immunization coverage targets for the newly forming Ontario Health Teams and all primary care providers to promote accountability and monitoring of vaccination rates at the local level;

3.  enable Health Quality Ontario to create personalized reports for local health care providers on vaccination rates in their practices; and

4.  provide financial incentives to promote vaccinations for local health care providers. 

b.  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.

c.  Consider developing a provincial Vaccine Injury Compensation Program to strengthen vaccine safety and support those few individuals who may have a serious side effect from a vaccine.

d.  Increase the functionality of Panorama, where the digital health immunization records are housed, to allow:

1.  reporting of vaccines directly into Panorama at the time the vaccine is administered;

2.  analysis at the local level to determine areas of low vaccination coverage, including geographic and equity disparities; and

3.  reminder notifications to be sent automatically when a vaccination is due for a child.

e.  Request the College of Physicians and Surgeons of Ontario to share with Toronto Public Health the email addresses of Toronto physicians to allow Toronto Public Health staff to provide timely resources to physicians to address vaccine hesitancy.

2.  Requested Health Canada to:

a.  consider developing a national Vaccine Injury Compensation Program to strengthen vaccine safety and support those few individuals who may have a serious side effect from a vaccine; and

b.  introduce legislation to restrict inaccurate and misleading anti-vaccine messaging that is targeted to the public.

3.  Requested the Registered Nurses' Association of Ontario to develop a best practice guideline on vaccine hesitancy and misinformation for nurses.

4.  Requested all Toronto school boards and the Ministry of Education to adopt Kids Boost Immunity or develop a similar curriculum on vaccines and vaccine-preventable diseases for all elementary schools.

5.  Requested Health Canada and the Public Health Agency of Canada to increase the transparency of the safety of vaccines by:

a.  providing a publicly-available and searchable online database of aggregate reports from the Canadian Adverse Events Following Immunization Surveillance System; and

b.  reviewing the information provided in the Product Monograph of vaccines to streamline the content and provide only clinically-relevant safety data.

6.  Requested Advertising Standards Canada (Ad Standards) to revise their Canadian Code of Advertising Standards to discourage advertisements that contain false and misleading statements against vaccines.

7.  Requested major search engines and social media organizations, including Facebook, Google, Pinterest, Twitter, and Instagram, to adopt the Priorities for Action from the Salzburg Statement on Vaccination Acceptance, namely to:

a.  develop principles that distinguish "levels of evidence" in the vaccine information they provide so that they can improve identification of disproven/inaccurate, false claims about vaccine safety for their users that have led to the return of childhood diseases, just as they do for sexually explicit, violent, and threatening messages; and

b.  include information from robust scientific sources, particularly as unscientific misinformation puts vulnerable babies, cancer patients of all ages, and immune-compromised individuals at unnecessary and avoidable risk of serious complications, long-term disability, and the potential for death.

8.  Directed that the report (September 9, 2019) from the Medical Officer of Health be forwarded to the Association of Canadian Advertisers, the Association of Local Public Health Agencies, the Canadian Association of Broadcasters, the Canadian Marketing Association, the Canadian Medical Association, the Council of Ontario Medical Officers of Health, the Ontario Medical Association, the Ontario Nurses' Association, the Ontario Public Health Association, and Public Health Ontario.

The Associate Medical Officer of Health gave a presentation on Moving to Acceptance: Toronto Public Health's Strategy to Address Vaccine Hesitancy.

Vaccine hesitancy, the reluctance or refusal to vaccinate despite the availability of vaccines, is a growing concern in Canada. It stems, in large part, from misinformation about vaccines that spreads on social media platforms and the Internet. This staff report responds to the request for the Medical Officer of Health to report to the September 2019 meeting of the Board of Health with a strategy to address vaccine hesitancy.

To respond to this growing threat and address the root causes of vaccine hesitancy and maintain high vaccination rates, Toronto Public Health has developed a comprehensive strategy that involves health care providers, parents, students, educators, and government agencies at the provincial and national levels. The strategy includes communication and education resources on multiple platforms that are accessible and user-friendly. It also includes recommendations to the provincial government to improve the availability and integration of electronic immunization systems and policy changes to improve vaccine acceptance. To strengthen the transparency surrounding vaccine safety, the establishment of a Vaccine Injury Compensation Program should be considered as well as more publicly-accessible data on adverse events following immunization. Finally, recommendations are made to regulate social media platforms and search engines and to enhance advertising standards in Canada to prevent and reduce the circulation of misinformation about the safety and effectiveness of vaccines.