VANCOUVER - Most British Columbians support policies aimed at encouraging vaccinations, such as requiring parents to report their child's immunization status when they enter school, but punitive measures are less popular, a new study suggests.

Lead author Julie Bettinger, an investigator with the Vaccine Evaluation Centre at BC Children's Hospital, said governments across Canada would benefit from seeking input on attitudes toward vaccine-preventable diseases before implementing policies that could backfire.

Ontario and New Brunswick are the only provinces requiring proof of vaccination for school entry, though both allow exemptions for medical, philosophical or religious reasons.

In response to a recent increase in the number of measles cases in British Columbia, the province has indicated it will make it mandatory for parents to report their child's immunization record starting in September, but the measure will not require children to be vaccinated in order to attend school.

More than 80 per cent of 1,300 people surveyed online in April 2017 were in favour of such a policy being adopted in B.C., Bettinger said of the study that was published Wednesday in CMAJ Open and includes a subset of about 300 parents with young children. About 42 per cent of respondents had no children.

Less than 40 per cent of those surveyed supported penalties, Bettinger said, noting that could include fines like those introduced in Italy, where parents may risk paying up to 500 euros, or about $750, if they don't provide a doctor's note showing their children received 10 compulsory vaccines before starting school.

The policy in Italy is based on a law enacted in 2017 following a measles outbreak and means children up to age six could be banned from attending school if they are not vaccinated against the highly contagious viral illness that spreads through the air by coughing and sneezing.

Parents and younger survey responders, even if they did not have children, favoured rewards such as a tax break or credit if kids received all age-recommended vaccinations, Bettinger said.

“Interestingly enough, they were less likely to support the idea of banning children, who were not immunized, from school,” she said.

“Ideally, these types of results would encourage others in some of our other provinces to find out what people think there as well and if they're really interested in seeing immunization rates increase, implement policies that are acceptable to the majority of people,” she said, adding that would prevent backlash such as in Italy and elsewhere.

Legislators in Washington state passed a bill last week removing personal belief from a list of exemptions parents have used to shun immunizing their children. Medical and religious exemptions could still be used.

In neighbouring British Columbia, an increase in the number of measles cases to 27 since February prompted Health Minister Adrian Dix to launch a three-month measles immunization catch-up drive this month for children in kindergarten to Grade 12 as the province aims to ensure they have up-to-date vaccinations. The first is provided at age one, followed by the second between the ages of four and six.

“All of this will assist us in the fall when we bring in the mandatory registration program for all schools, both public and independent,” Dix said, adding his ministry will provide more details next month to ensure parents have the information they need to get their children vaccinated.

“What I want to make sure is that we don't just have a short-term increase,” Dix said of vaccination rates, adding 82 per cent of seven-year-olds in B.C. were vaccinated against measles in 2018, down from 90 per cent in 2014, following 342 cases of the disease.

“It's a sustained approach to raise the rates,” he said of the catch-up campaign, adding the government will report monthly statistics on the number of children who have been immunized, starting in the first week of May, and those numbers will provide some information on the public's attitude toward vaccination.

Symptoms of measles include fever, cough, runny nose and a rash that starts on the face and spreads to the chest. If the disease is not treated early enough, complications such as pneumonia and hearing loss can result in children.

Measles was declared eradicated in Canada 1998 but there is no national immunization registry as the disease makes a comeback, sometimes spread by those who have travelled elsewhere, including Vietnam, the Philippines and the Washington state area, Dix said of some of British Columbia's recent cases.