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Archive for the ‘Child Health’ Category

Shaking hands is, for now, socially unacceptable and ‘keeping your distance’ is the new normal in all public settings. Following the strict advice of our Chief Medial Officers of Health, the vast majority of citizens, groups and organizations are complying with ‘physical distancing’ to contain the spread of the deadly COVID-19 virus.  If the new public health conventions become ingrained and persist beyond the immediate crisis, the fundamental change in social norms outside the household sphere will profoundly alter life in public settings, particularly in K-12 schools and classrooms.

Seeing images of public schools in Taipei, Taiwan, in full operation during the COVID-19 heath crisis, is jarring, if not downright shocking. Based upon hard lessons gleaned from the 2003 SARS pandemic, Taiwanese authorities, including school heads, were quick to recognize the crisis and activated stringent emergency health management plans to keep schools running instead of simply closing them down.

School life during COVID-19 was transformed into a virtual health protection zone. Students at Daija Elementary School in Taipei were asked to disinfect their hands and shoes before entering the school building, while a security guard took their temperature, and, once in class, the children were seated in separated rows wearing masks.  What set that school apart, and drew international attention, was the sight of elementary children eating their own lunches while sitting behind bright yellow dividers on their desks.

With the frightening pandemic upon us, education planners and policy-makers need to look beyond the immediate crisis and start making plans for the resumption of in-person schooling, likely months from now.  A whole generation of students, parents and families, having survived the ravages of the virus, may be not only more receptive to online learning, but expecting, a different kind of K-12 day school education.

School practices intended to promote social distancing may well be an unintended legacy of the current crisis.  If and when influenza pandemic control measures become higher priorities, social distancing conventions that increase space between people and reduce the frequency of contacts may well overturn progressive teaching methodologies and spell the end, in real time, of clustered seating, learning centres, and interactive small group learning.

Today’s student-centred, interactive classroom based upon ‘hands-on’ learning was, it is becoming clear, greatly advanced by the widespread adoption of vaccines and school-based vaccination and related health programs. The emergency health risk posed by COVID-19 is more reminiscent of the scourge of childhood diseases, unchecked by vaccines, up until the 1960s. While class sizes were larger then, the traditional classroom exemplified social distancing  because children were seated in individual desks, spaced apart, lined-up before moving from place to place, and taught personal hygiene in elementary classes.

Classroom design and seating since the 1970s has tended to focus on creating settings that supported ‘active learning’ and reputedly ‘progressive’ teaching methods, such as learning circles, cooperative learning, and project-based groupings.  Scanning the North American physical classroom environment research, it’s striking how may action-research projects were undertaken to demonstrate that teaching children sitting in rows was detrimental to student engagement, widely considered an end in and of itself.

Neglected research on physical proximity and anxieties about crowding will get a much closer look in the post-COVID-19 era of education. Coming out of household quarantine and re-entering school, students, parents and teachers will be far more conscious of infectious diseases and the physical conditions contributing to its transmission. Ministries of education, school districts and principals will likely give a much higher priority to providing face-to-face teaching and learning in classrooms meeting stricter health protection standards.

Academic studies of “peers in proximity” and the few analyzing the “mixing patterns of students in school environments” do provide us with signposts for deeper dives.  One 2015 Dutch study of interpersonal processes in the classroom, conducted by Yvonne Van den Berg, demonstrates how  “a careful management of physical distance between classmates” can improve classroom climate, but it focuses almost exclusively on rectifying identified imbalances in social status in classes where students choose their own seats.

The role of children in the community spread of respiratory diseases such as H1N1 and COVID-19 identified by medical health authorities has attracted relatively little attention from education researchers based in graduate schools of education. One Canadian health policy study, produced in 2013 by University of Toronto researcher Laena Maunula may have compounded the problem. It claimed that public health messages were “dangerous” because they reinforce “bio power” and “governmentality” (i.e., a coercive state reducing citizens to ‘trained subjectivities.’)

For more promising disease prevention studies, we have to look to Europe and the pioneering work of two research teams, led by Marcel Salathé of the Salathe Lab at EPFL in Lausanne, Switzerland, and Juliette Stehlé of Marseille, working with the University of Lyon-based National Influenza Centre. Utilizing wireless sensor network technology, they have studied the social networks in both primary and secondary schools which facilitate infectious disease transmission. Logging the data for CPIs (close proximity interactions), the researchers honed-in on the problem presented by schools as high potential sites for pandemic spread. Follow-up studies by American health researchers applied this research and concluded that extensive alternative school-based interventions regulating free student movement, as an alternative to school closure, can significantly reduce contacts and potential exposure to infectious diseases.

A more recent 2018 Rand Corporation study, building upon the close proximity studies findings, examined American school influenza pandemic policies and practices. It found that, while strictly limiting student interactions in hallways and classrooms reduced transmission rates, only four of 50 U.S. states ( Georgia, Tennessee, Utah, and Virginia) had firm policies authorizing the full range of social distancing regulations. Ontario’s 2013 Health Plan for an Influenza Epidemic, much like those south of the border, relied upon school closures and made no provision for resumption of school after a pandemic outbreak.

Near future schools reopening after the hiatus will not look or feel the same, given the prospects for a second wave.  Taiwanese schools during the current pandemic might represent an extreme akin to a dystopian village, but post-COVID-19 K-12 public schools will in all likelihood incorporate some of those rigid protocols, at least until student, parent and teacher anxieties subside in the coming years.

*An earlier version of this commentary appeared in The National Post, March 26, 2020.

What will classrooms look like following the prolonged COVID-19 pandemic?  Will the heightened awareness of the threat of epidemic diseases impact upon attendance monitoring, classroom design and layout, and teaching methodologies?  Will the post-COVID-19 classrooms look more like those in Taiwan during the pandemic?  How much e-learning will survive when face-to-face, in-person teaching resumes in the coming months? 

 

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The global footprint of coronavirus – COVID-19 – is expanding and national governments as well as regional school districts are making the difficult decision to shutdown the schools. On March 11, 2020, the World Health Organization officially declared it a “pandemic” and all of Canada’s education ministers participated in a teleconference to discuss the situation and potential policy responses, specifically following the annual March break for students and teachers.

Political leaders at the highest levels, working closely with public health authorities, are weighing their emergency measures options to combat the pandemic, ranging from school closures to mass quarantines. Closing schools may be politically expedient, but its effectiveness in curbing transmission is far from clear.

School closures have already interrupted the public education of some 300 million students across the globe. The first nation to close schools was Hong Kong, back in January, then Japan on February 27, and now many more jurisdictions have followed suit, including Italy, South Korea, Iran, France, Pakistan, New Delhi, the New York City region and northern Washington State.

Deciding to close schools in the case of COVID-19 is particularly challenging for one major reason. In the initial wave, the novel coronavirus, unlike HIN1 in 2009, had not affected children at high rates. Out of 44,672 initial confirmed cases in China, fewer than 2 per cent occurred in children under 19 years of age, and no deaths were recorded among those younger than 10 years old. That may be a low estimate because the attack rate for children, at a later stage in Shenzhen, was 13 per cent.

Closing schools, in some previous epidemics, has proven helpful in reducing transmission of seasonal flu among children. One 2013 British Medical Journal report, based upon a systematic review of epidemiological studies, concluded that school closures contained rates of transmission, even in the absence of other intentions. Yet determining “the optimal school closure strategy” remained “unclear” because of the wide variation in its forms of implementation.

Tracking the impact of school closures has proven tricky for researchers.  Some closures were limited to individual schools and, in other cases, whole school systems. Closing before the peak of the outbreak or well into the outbreak suggests that decisions are being made as either a precaution or a reaction to rising student influenza-related absenteeism. In some cases, schools close so children can receive antiviral medicines or vaccines, or in conjunction with a strategy of “social distancing.”  Such wide variations in implementation strategies makes it a challenge in determining which change actually affected transmission.

The body of research on school closure impacts during epidemics is surprisingly large, encompassing the 1918 Spanish flu epidemic, the 2002-03 SARS pandemic, and the 2009 HINI flu outbreak.

Yet the results of those school closures have been mixed. Closing schools for more than two weeks has been linked to lower transmission rates in Hong Kong (seasonal and pandemic flus) and in England (H1N1), but not so in Peru (pandemic) or the United States (during seasonal flu epidemics).

The 2008 Hong Kong outbreak, the 1957 epidemic experience of France, and the 1918 pandemic records in some U.S. cities demonstrate that shutting schools can have no discernible impact, especially if decisions come too late in the cycle of the outbreak. Relying upon older parents or grandparents to be caregivers during closures may actually increase mortality rates among more susceptible populations.

Public heath experts caution educational leaders and school principals against basing decisions on the North American H1N1 experience. “The sensitivity of the 2009 pandemic to school closures probably relates to the high attack rates in children compared with adults,” the BMJ study pointed out. “Outbreaks in which children are less affected” such as COVID-19, “might be less sensitive to school closure.”

Closing schools also has broader socio-economic impacts and unrecognized health effects. There are trade-offs in being overly cautious by closing schools, including potential lengthy disruptions in student learning and compelling parents to stay home from work. Students from lower socio-economic neighbourhoods would also be deprived of school meal programs and cost-free supervised athletics activities.

The most authoritative study of school closure impacts, in the August 2009 issue of The Lancet, actually assesses broader community impacts. If all U.K. schools closed, some 30 per cent of health and social care workers would be taken out of commission, compounding adverse effects on the financial health and viability of communities.

School authorities would be well-advised to consider the potential duration of closures in their emergency response plans.  While it is probably wise to err on the side of caution with school-age children, the longer the closure lasts, the more problematic it becomes, especially in the absence of e-learning bridge programs.

Closing schools for more than two weeks to combat COVID-19, as in the case of Hong Kong, could have a detrimental effect upon the school schedule, year-end-examinations, and the conventional grade- promotion system. It’s possible, perhaps likely, that students will be seriously set back by missing so much instructional time.

Implementing “e-learning plans,” including digital and distance learning, is recommended by the U.S. Center for Disease Control and Prevention (CDC), but there’s a major problem with that constructive proposal in its guide for school administrators. It’s feasible in e-learning ready school systems like those in Hong Kong, United Arab Emirates, and the State of Ohio, but not yet in our provincial school systems.

Few Canadian school districts are prepared or trained to implement e-learning days system-wide, and they have, with few exceptions, resisted piloting e-leaning modules during winter season storm days.  Scrambling to implement hastily prepared distance learning or online courses will not prove effective at all. Nor are schools fully equipped to administer year-end assessments online or to report the results electronically to students and parents.

Closing schools may be expedient in assuring the concerned public that actions are being taken to control the spread of the contagion. This is especially so now that managing the fears and anxieties of children and families is emerging as a priority during the COVID-19 pandemic.

Given the lower attack rates for children and the weight of research evidence, it’s much harder to make the call to dismiss classes and suspend school for what may well be an indeterminate period of time.

 Should schools be closed to contain and reduce the transmission of the 2019-20 coronavirus?  What does past experience closing schools during epidemics tell us?  Should schools be closed early in the cycle as a precaution or in reaction to escalating attack rates among children and their teachers? How prepared are school districts to implement e-learning as a bridge in the teaching-learning process?  If schools do close, the question is — for how long given the unpredictability of the spreading contagion?  

*An earlier version of this commentary appeared in The National Post, March 11, 2020. 

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Students are now coming down with seasonal colds and the flu.  What was predicted to be a normal flu season in schools turned ou out to be highly unpredictable with the arrival of a ghost menace – the fear of coronavirus, now labelled COVID-19.  Public anxieties were fed by a popular media inundated with frightening stories about the spectre of coronavirus, rivaling that associated with the outbreak of SARS in 2002-2003. The latest scare also sparked a disturbing undercurrent of suspicion, with racist undertones, directed at Canadians of Chinese ancestry.

The common flu remains a bigger threat than coronavirus but you would never know it from the media coverage.  Some 25,854 confirmed cases of the regular flu have been reported since late August 2019, and, so far, the coronavirus, has only infected a dozen Canadians. Some 12,200 Canadians are hospitalized for influenza each year and about 1,000 die across Canada. In 2002-2003, for comparison purposes, 44 people died of SARS in Canada.

Normally calm Public Health authorities are now forecasting an uptick in cases throughout February into March. Teachers and principals will be on the front lines because schools are well-known breeding grounds for germs and infections.

This flu season it is going to be worse because, according to the Public Health Agency of Canada (PHAC), the country is seeing an unusually high number of Influenza B cases, which tend to cause more severe illness in children. Of the 33,615 reported Canadian influenza cases (up until February 8, 2020), 11,905 were classified as Type B, with 57 per cent of those patients under 20 years-of-age. Reported Influenza B cases were also more common in the Maritime provinces of Nova Scotia and New Brunswick.

Face masks are disappearing from pharmacy shelves as people are either wearing them outside or hoarding them in the event of a global pandemic. Nova Scotia’s Chief Medical Officer of Health Robert Strang claims that the masks are not guaranteed to offer protection and may encourage people to touch their faces, actually spreading the germs.

The global outbreak is Chinese in origin and that most regrettably still carries insidious connotations. It may have originated in Wuhan in China’s Hubei Province, where some 57 million citizens were placed in a state of lockdown and isolation, but exaggerated fears and anxieties have spread worldwide. The two-week ordeal of international tourists trapped on the quarantined and virus-ravaged Diamond Princess cruise ship anchored in Yokohama, Japan, further fed public anxieties.

Combating and surviving the flu season in school used to be so much easier. Counselling students and teachers to stay home, drink fluids, and get rest used to suffice in weathering the seasonal onslaught. Most of us fooled ourselves into thinking that miracle cures for the cold and flu like Cold-FX were actually working and toughed it out with Tylenol, Hall’s cough drops, and, on a bad day, toilet tissue kleenex.

Today’s principals, teachers, and students come to school prepared with new weapons in the ongoing war against contagion. Wiping down desks with disinfectants and packing little bottles of Purex in pockets and purses is now standard practice. A few even don surgical masks to keep colds in, or ward them off, walking to and from school.

Fear and panic are running high in Ontario and British Columbia school districts where many of the students are Chinese Canadians or recent arrivals of Chinese descent. Vocal and active parents are clamouring for schools to increase screening of Chinese students suspected of being carriers and sending home children whose families have recently returned from China.

Coronavirus-induced tensions are most acute in York Region, north of Toronto, particularly in Richmond Hill and Markham, where 40 per cent of the population is of Chinese origin. A coronavirus-inspired petition targeting Chinese families launched in late January in York Region, north of Toronto, was quickly endorsed by parents in 145 local schools and generated some 10,000 signatures. In the York Region District Board of Education, Board Chair Juanita Nathan and Education Director Louise Sirisko, were compelled to send out a memorandum to all schools in direct response to the level of concern and anxiety being felt by families of Chinese heritage.

While the province of Nova Scotia is home to some 3,500 Chinese-born students, the only public display of concern was by Max Chen, a second-year Chinese student at Cape Breton University. After searching in vain for surgical masks to send home, he voiced his concern that the province’s public health officials were unprepared to deal with a potential outbreak at the university.

Public health officials, educators and academics are fearful of schools and universities becoming swept-up in an us-versus-them cycle of racism directed at those who look different. Spreading of misinformation and ignoring facts from public health agencies is symptomatic of deeper, sublimated problems.

A leading SARS impact researcher, York University’s Harris Ali, who studied the stigmatization of the Chinese population in Canada, put it best. Gaslighting the Chinese as carriers of the contagion, he claims “feeds into already pre-existing underlying biases or prejudices.”

Global pandemics turn flu season into a mass psychological experience that can overshadow the actual health risks of transmission. Calming and dispelling exaggerated fears as well as sanitizing desks have now become the essential skills in a 21st-century educator’s repertoire. That may be a clear indicator of the high anxiety temper of our times.

Why was the current flu season so unpredictable in our schools?  Were Canadian public health authorities ready for the surge in Influenza B, the strain most commonly infecting young people of school age?  Are principals and teachers fully prepare to deal with students showing signs of coronavirus?  What are the challenges posed by containing the spread of viruses while ensuring that students and families of Chinese ancestry are not unfairly targeted in the broader community? 

*An earlier version of this commentary was published in The Chronicle Herald, February 15, 2020.

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“DO NOT USE” signs plastered all over school drinking fountains have a way of getting the chilling message across. For the past thirty years, those signs have appeared, periodically, on fountains in thousands of Canadian K-12 schools. Most of us walk by, unaware – until recently — of a simmering public health crisis.

What was a largely dormant issue has come back with a vengeance.  The November 4, 2019 release of the findings of the massive year-long Canadian investigation, spearheaded by the Institute for Investigative Journalism, has raised new concerns over exposure to lead in home tap water and school/daycare drinking water supplies.

The “Tainted Water” series of news reports were alarming because many in education had assumed it was behind us. The benchmarks changed in March of 2019 when federal health authorities reduced the acceptable levels of lead from 10 parts per billion (ppb) to 5 ppb. Out of 12,000 tests conducted since 2004, in 11 different Canadian cities, one-third – 33 per cent—exceed the new health. safety standard. The latest investigation, based upon some 260 water tests conducted in 32 cities and towns and validated in accredited labs showed that 39 per cent of samples, or two out of five, exceeded the 5 ppb guideline for healthy water.

The current health alarm is serious, but needs to be considered in proper North American context.  Three to four million American children were found to have toxic levels of lead in their blood back in the 1980s. Levels of contamination were far higher in those days. The U.S. EPA reported that thirty-three of the 47 states testing drinking water had levels exceeding the then acceptable standard of 20 ppb.  Back then, most people, including young children, were exposed to multiple environmental sources, including paint on old housing walls, drinking water, ambient air, dust, soil, and food, particularly canned goods.

The 1988 U.S. Lead Contamination Control Act imposed strict new regulations on American schools requiring them to clean up their act by testing drinking water, abandoning lead-lined water coolers, and remedying any contamination found in taps and water intake pipes. It faced stiff legal challenges and a great deal of non-compliance and was eventually struck down in 1996 by a federal appeals court.

The first real school drinking water scare did produce a ripple effect and reactive responses which reverberated in school districts, from province-to-province, across Canada. What survived was a 1991 EPA established standard that required periodic tests for lead and copper levels in public water systems virtually excluding schools and day cares drawing water from their own wells. While the limit was reduced to 15 ppb, it applied to municipal water feeds rather than internal sources of contamination. In the case of schools, most of the lead still originates in lead pipes, water-cooler linings, and in led metal fountains and taps.

Medical science has advanced significantly over the past three decades, but implementation of health regulations lags, especially when it comes to testing for lead contaminants in schools and daycares. Coast-to-coast, the Canadian investigators identified a patchwork of lead regulations, weak oversight, laxity in conducting tests, and the relative absence of regular testing of homes, schools or daycares drawing water from wells.

When Health Canada cut the acceptable level of lead levels in half, it sent provincial and school district authorities scrambling, particularly outside the major metropolitan centres,  The new regulation came with warnings that, even at concentrations as low as 5 ppb, high levels of exposure can damage the prefrontal cortex, cause prenatal growth abnormalities, and contribute to anti-social behaviour and child behavioural problems. It has also been identified as a risk factor for hypertension, chronic kidney disease and tremors in adults.

Thousands of Canadian children in schools and daycares are at risk of ingesting lead in drinking water and most were totally unaware of that until the release of the latest journalistic expose. Provincial authorities, with the possible exception of Ontario and British Columbia, are playing catch-up, compared to a number of American states more proactive in testing and public disclosure.

The EPA promotes its “3Ts” approach – Training, Testing and Taking Action, complete with home and school water quality testing kits.  Since August 2016, New York State has required all school districts and boards to “test all potable water outlets for lead contamination, to remediate contamination where found, and to notify parents of children and the public of the results.”

The 2016 public health crisis in Flint, Michigan, intimately connected with the toxicity of water did not seem to register up here in Canada. Periodic warnings were issued to no avail by provincial public servants, according to newly-released government documents obtained through formal freedom-of-information requests.

Cleaning-up school drinking water standards is back as a top education priority. Whether it will last in a system best by competing immediate demands for reduced class sizes, more resource supports, and improved working conditions remains to be seen. Deferred maintenance has a way of coming back to bite school systems.

*An earlier version of this commentary was published in The Chronicle Herald, November 16, 2019 

Why is lead still in school and daycare drinking water, thirty years after the initial revelations?  Was the 2019 lead in the water scare the result of Health Canada’s decision to dramatically reduce the acceptable standards? How effectively did school and day care authorities respond?  Without a nation-wide investigative report, how much would we have known about the extent of the problem? 

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Measles outbreaks in the spring of 2019 in the American Pacific Northwest and British Columbia were part of a global revival of an infectious disease that had already affected thousands in Asia, Africa and Eastern Europe. In the wake of that outbreak, the BC Ministry of Health under Adrian Dix acted to require all parents to provide local public health units with their child’s immunization record before beginning school in September 2019. Twelve measles cases in Saint John, New Brunswick, in June 2019, prompted the Chief Medical Officer of Health Dr. Jennifer Russell to intervene to protect as many as 2,000 people exposed to the disease, ordering up 20,000 more doses of MMR vaccine, protection against measles, mumps and rubella.

Lagging childhood immunization rates are emerging as a major public health concern.  Periodic outbreaks of measles and mumps have alerted the public to the fact that childhood diseases, once virtually eradicated by vaccines, are reappearing in and around schools.

Vaccines remain one of the safest and most effective tools we have to protect ourselves, our families and our communities from infectious diseases. Those are not my words, but those of the Public Health Agency of Canada. The current reality is that we are not meeting our national immunization goals and too many children as well as adults remain unprotected and liable to experience illnesses from vaccine-preventable diseases that can cause serious health complications, some of which carry a risk of death.

Each year in April Health Canada raises the alarm during National Immunization Awareness Week and education programs are announced in an attempt to raise vaccination rates. Our Chief Medical Officer of Health, Dr. Robert Strang, makes regular appeals, most recently in August of 2019, to encourage parents to keep their children’s immunization records up-to- date.

The current strategy is not working in Nova Scotia where only 71 per cent of 7- year-olds are immunized for measles and mumps, some 15 per cent lower than the national provincial average and ranking last among the provinces. In New Brunswick, where it’s considered a “crisis,” the measles and mumps coverage rate at age 7 is 92.3 per cent.

While provincial health and school authorities in New Brunswick, British Columbia and Ontario are tackling it head on, Alberta and Nova Scotia are still vacillating on how to improve its abysmal childhood immunization rates. While Health Minister Randy Delorey dithered, PC Leader Tim Houston introduced a private member’s bill to try to force the government’s hand.

Sparked by the spring 2019 measles scare in the Saint John region, New Brunswick Education Minister Dominic Cardy has championed legislation that would make vaccinations mandatory for children without medical exemptions in provincial schools and day cares.

Taking a proactive approach to combating the resurgence of childhood diseases is becoming common right across Canada. Three years ago, Ontario introduced stricter childhood vaccination regulations and in British Columbia legislation requires the reporting of immunization records. Ontario has far higher rates of reported childhood immunization at age 7 than Nova Scotia. Yet, since 2016, that province has required student vaccinations be up to date unless a parent or guardian can provide medical, religious or philosophical reasons why their child has not received a vaccine. Even when exemptions are granted, families are required to watch a 30-minute video on the importance of vaccines and then sign a document saying they viewed the presentation.

Public health authorities hold sway in Nova Scotia, unlike in New Brunswick, where a proactive Education Minister is leading the charge to meet childhood immunization targets so schools do not become sources of contagion.

Nova Scotia Health Minister Delorey may be deterred by fears of stirring-up the radical anti-vaxxers and setting back the cause. He should be taking his cue from New Brunswick’s courageous Education Minister. Confronting a posse of opponents, Cardy called out the group as conspiracy theorists who “influence, mislead and deceive” parents into thinking their children are at risk if they are vaccinated.

Prominent among the N.B. protesters were former Halifax chiropractor Dena Churchill who recently lost her licence to practice because of her anti-vax campaigning, and California pediatrician Dr. Bob Sears, a well-known anti-vax advocate funded by Vaccine Choice Canada.

Vaccine adverse reactions do happen, but, on balance, immunizing children prevents far worse harms caused by the unchecked spread of childhood infectious diseases. School attendance is compulsory and, in that context, so should immunization aimed at safeguarding children’s health.

Minister Cardy stood his ground defending his legislative changes aimed at achieving the goal of 95 per cent coverage. Growing anti-vaccination sentiment, he claimed, was being fed by social media, and threatened to discourage parents from vaccinating their children, reducing immunization rates below a critical threshold that allows a community to resist an outbreak.

Playing nice does not seem to be working at raising childhood immunization rates. Scare stories spread by anti-vaxxers should not go unchallenged. Claims that vaccines are harmful, in Cardy’s words, are “not supported in fact.” “If you believe in evidence-based decision-making, you have to look at the evidence and the evidence is incontrovertible.”

Childhood diseases such as measles, mumps, diphtheria, pertussis, and rubella can do great harm if left unchecked by regular vaccination. With childhood infectious diseases making a comeback, is now the time to be vacillating on child immunization? Does the school system have some responsibility to ensure that immunization rates are high enough to prevent mass outbreaks in the community?  Should it all fall on provincial and local health authorities? 

  • An earlier version of this research commentary appeared in The Chronicle Herald, October 31, 2019.

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