Ontario Vaccine Deliberation OCTOBER 2017 DISCOURSE, SCIENCE, PUBLICS UNIVERSITY OF GUELPH ONTARIO VACCINE DELIBERATION This booklet was prepared by the Ontario Vaccine Deliberation research team (listed in alphabetical order): Lucie Marisa Bucci Michael Burgess Apurv Chauhan Sara Crann Maya Goldenberg Meghan McMurtry Kieran O’Doherty Wade Pickren Don Willison October, 2017 Guelph, Ontario, Canada 2 ONTARIO VACCINE DELIBERATION What is the Purpose of this Booklet? This booklet is meant to stimulate and inform discussion and reflection for the Ontario Vaccine Deliberation. While it includes a variety of perspectives, it cannot encompass the diversity of all possible perspectives. Reading it is the first step of being involved in a 4-day public deliberation event on childhood vaccination in Ontario (see What is a public deliberation? on page 4). This booklet is not intended to be either for or against vaccines. In this booklet, you will find information on a range of issues related to childhood vaccination, such as history about the development of vaccines, the science behind vaccines, and both the good that has come from vaccines as well as some of the things that have gone wrong with vaccines. The information presented in this booklet, and the discussions that will take place in October, are focused on early childhood vaccinations (see Ontario’s publicly- funded immunization schedule on page 11). People draw on different types of information to support their opinions. There is a range of available information about vaccines on the Internet, in the media, in academic journals and other sources, and it is difficult to know which information to trust. The scientific information presented in this booklet has been collected from peer-reviewed publications – that is, information that has been verified by experts in the field. When deciding what scientific information to include, we used, as much as possible, meta-analyses to report current scientific perspectives. A meta-analysis is the ‘gold standard’ in scientific research because it is a study that analyses the findings of multiple studies. This analysis allows for greater statistical power, which leads to greater confidence in conclusions presented by the meta-analysis. The information included in this booklet is not based on unsubstantiated articles found on blogs or other websites, published in low-quality or predatory academic journals, or retracted scientific papers. We hope that you will find the information presented interesting, and that it will answer many of your questions. It may also raise new questions for you. Bring these questions, as well as your insights and perspectives, to the deliberation to which you have been invited on October 14, 15, 28, and 29. There, you will meet Ontarians from all walks of life who, like you, have been selected to represent a wide diversity of perspectives. 3 ONTARIO VACCINE DELIBERATION What is a Public Deliberation? A public deliberation is a community discussion about a particular topic that is based on the idea that members of the public, such as yourself, should have a voice in the issues that affect them. Public deliberation is a democratic process that includes citizens, not just policy makers or experts, in important policy decisions. The importance of deliberative democratic discussion Deliberative democratic events, such as the event you will attend in Waterloo, shift the discussion about important societal issues from telling people what they need to know about an issue to recognizing that individuals in society are sources of information and have important things to say about policy. We hope to both educate and seek advice in this deliberative democratic event. Our intention is to help inform effective policy by bringing together people who have different backgrounds, opinions and life experiences, and encouraging them to work together on challenging issues. By bringing together the knowledge, perspectives, and advice of a group of Ontarians, we can make recommendations for policy that reflect diverse social realities. We believe this will add to the trust we can put in the outcomes of these processes. 4 ONTARIO VACCINE DELIBERATION Table of Contents What is the Purpose of this Booklet? ................................................................................................ 3 What is a Public Deliberation? ............................................................................................................ 4 Introduction ........................................................................................................................................... 6 What is ‘Immunization’, ‘Vaccination’, and ‘Immunity’? ................................................................ 7 A Brief History of Vaccination ........................................................................................................... 8 Controversies on Childhood Vaccinations ....................................................................................... 9 Current Vaccine Requirements and Exemptions for School-Age Children in Ontario .......... 10 Reasons for Vaccine Hesitancy ......................................................................................................... 13 Public Health Perspectives on Vaccines .......................................................................................... 14 Complementary and Alternative Medicine Perspectives on Vaccines ........................................ 15 Scientific Perspectives on Vaccines .................................................................................................. 16 Vaccine Production and Quality Control Process ......................................................................... 17 Adverse Events Following Immunization (AEFI) ........................................................................ 18 Vaccine Injury Compensation ........................................................................................................... 19 Summary ............................................................................................................................................... 20 Glossary of Terms .............................................................................................................................. 21 5 ONTARIO VACCINE DELIBERATION Introduction Canadians hold different beliefs about many things. We pride ourselves on our diversity of culture, religion, race and opinion on a range of topics. In spite of this diversity, we are governed by laws and policies that are intended to treat us equally. Deliberative democracy is based on the idea that we should all have the opportunity to provide input about decisions on issues that affect us all. This is especially so for issues that are considered controversial. Childhood vaccination is one such issue. In Canada, public health experts rely on vaccines to protect children from serious diseases (see Herd Immunity box). Most Canadian parents vaccinate their children. However, some parents may also have concerns about the efficacy and What is Herd Immunity? safety of vaccines and the recommended immunization schedule for children. These Non-vaccinated individuals, concerns have led some parents to delay including infants and people with vaccinating or choose not to vaccinate their medical conditions that make them children. unable to receive vaccines, are protected by the “herd” or There are different reasons why parents may be “community” of vaccinated people. hesitant about vaccines. They may not feel they can trust the medical community, or they may have concerns about vaccine efficacy and safety. Recently, several celebrities have been strong advocates against vaccines and this may influence some parents’ decisions to delay or refuse vaccination for their children. Parents trying to make a good decision for their children find arguments in favour of and against vaccination in media reports, magazines, radio, TV, and the Internet. Healthcare practitioners and the scientific literature may also provide different messages about the efficacy and safety of vaccines. This different information complicates the decision-making process for parents. 6 ONTARIO VACCINE DELIBERATION To move forward on this important topic – that is, to develop collective positions and recommendations about vaccines that take into account the diverse perspectives on vaccines in our society – we need to have a reasoned and respectful conversation. Unlike many other decisions that we face in daily life that affect only ourselves, vaccination decisions that we make as individuals also affect our children, our families, and our communities. It is therefore important that policies about childhood vaccination take into account as many perspectives as possible. Moreover, we want this conversation to include as wide a range of relevant perspectives as possible. Listening to and working with people with different perspectives is important for creating inclusive and fair policies that both respect personal choice and protect the public’s health. What is ‘Immunization’, ‘Vaccination’, and ‘Immunity’? The words “immunization” and “vaccination” are often used interchangeably. Immunization is the strengthening or fortifying of a person’s immune system against infectious disease microorganisms by controlled exposure to those microorganisms or a closely related agent. A person can gain immunity against a contagious disease by (1) surviving the illness or (2) exposure to a dead or weakened