By Melissa Fralick
On November 23, 2017, Acting Medical Officer of Health for Hastings Prince Edward Public Health, Ian Gemmill issued exclusion orders for students with valid exemptions from the pertussis vaccine based on two confirmed cases, one at CHSS in Madoc, and one at TES in Tweed. The named students were to be excluded from school until December 5, 2017 for Madoc, or December 13, 2017 for Tweed unless they received immunization or were diagnosed with pertussis and completed 5 days of antibiotics. Two of my children, one from each school, grades 9 and 6, have been unfairly victimized by this abuse of authority, not to mention their right to medical privacy and an education. As a result my daughter was coerced into getting immunized and my son has become a victim of bullying not only by our medical officer of health but his peers at school due to Ian Gemmill’s misleading statements to the media.
Public Health Ontario has stated that “vaccination is not recommended for outbreak management, but the outbreak provides an opportunity for patient education and to update the whole family’s vaccination status.” They also acknowledge that the vaccine only has an 80-85% efficacy and that it wanes quickly. Infants are most at risk from pertussis infection and it is usually under-diagnosed in adolescents and adults. Thus, “it is a relatively poorly controlled vaccine preventable disease.”
The Ministry of Health and Long Term Care has stated that exclusion is not a proven effective strategy for management of pertussis cases; however in high-risk situations (where there are vunerable persons) exclusion until five days after the start of antibiotic therapy or if no treatment is given, until after 21 days with negative results from culture or PCR should be at the discretion of the medical officer of health.
Studies have shown that the current vaccine does not provide mucosal immunity and wanes quickly after 3 years. Although we have less severe disease there has been little to no impact on infection and transmission, which explains why we have no herd immunity even with a 95% compliance rate. Ian Gemmill has co-authored a paper discussing these issues titled “Reining in the “100-day cough”: unfinished business“. Another good paper on the problem is “The Pertussis resurgence: putting together the pieces of the puzzle“. In addition to the current vaccine having little effect on the transmission of infection there is evidence that B. pertussis is evolving at a faster rate than prior to the introduction of the acellular pertussis vaccine, meaning the vaccine is no longer as effective in preventing disease even in fully vaccinated individuals.
It makes sense for the above reasons that Public Health Ontario and the Ministry of Health and Long Term Care do not recommend immunization or exclusion for outbreaks or management of pertussis cases, yet we have a medical officer of health ordering coercive and restrictive measures to be taken against a specific group of individuals that interfere with their personal rights and freedoms. The Health Protection and Promotion Act grants a medical officer of health authority to make orders to respond to outbreaks of communicable disease if it is their opinion that an outbreak is or may occur AND “that the communicable disease presents a risk to the health of persons in the public hospital or institution, and that the measures specified in the order are necessary in order to decrease or eliminate the risks to health associated with the outbreak” – Section 29.2(2). Since pertussis is endemic in the community, excluding these students will not decrease or eliminate the risk to themselves or others. Everyone is exposed, vaccinated or not, everywhere in the community, not just at school.
Ian Gemmill’s actions are excessive considering the etiology of the pertussis bacteria and the ineffectiveness of the vaccine. He has clearly overstepped his authority. Excluded children are no more likely to transmit infection than any vaccinated individual. The fact they allowed students to return immediately upon compliance with immunization also sends a misleading message. Coincidentally, my younger child was being treated for a stubborn sinus infection with the same antibiotic and dose required for treatment of whooping cough at the start of this exclusion order. After 5 days of treatment, and at my insistence that if he had been infected he would be cleared by now, he was only allowed to return to school while still taking the antibiotics, until December 8. He will not be allowed to return to school until December 13 unless I keep him on antibiotics unnecessarily or get him immunized. This is despite the fact they’ve declared the outbreak over in Madoc on the 5th and have had no additional cases in Tweed.
This abuse of authority is clearly discriminatory. Ian Gemmill’s comments in the media have fueled a slanderous environment for my child at school. Global News reports “If students aren’t immunized, Gemmil says, by law they must be removed from school.“To make sure that we [don’t] have people spreading it in schools, we’re going to have those students out for two incubation periods so it’s going to add up to a couple or three weeks for them,” he said.”
This is inconsistent with what is known about pertussis vaccine, that it doesn’t prevent transmission. Yet my son returned to school, on antibiotics, to be treated like a carrier by his peers. Kids saying to stay away from him and telling him to get vaccinated. Gemmill’s misleading comments to the media combined with his irrational order of exclusion are perpetuating a dangerous myth that vaccines provide true immunity and the unvaccinated are responsible for outbreaks. The vaccinated public believes they are protected and are protecting vulnerable infants, when they are unknowingly contracting and spreading the infection due to a false sense of security .
Gemmill’s actions do not serve the communal good. My daughter has been bullied into taking a vaccine she didn’t want or need because her education is important to her and she was feeling vulnerable to social pressures. My son has been bullied and denied access to school, including a trip he was looking forward to, despite having a valid exemption for a vaccine they acknowledge is failing.
Thanks to Melissa Fralick for allowing us to share her story on our website.