🍁 Vaccines · Provincial Policy

Vaccine Exemptions: Ontario vs Alberta

Ontario requires school vaccinations and counts every exemption. Alberta requires nothing, so it has no exemptions to count. In 2025, Alberta's measles outbreak was about three times worse per person.

By Terry Polevoy, MD, FRCPC · Retired pediatrician, Waterloo, Ontario · November 2026

~2%

Ontario children with a non-medical exemption, "stable since 2019" (CMOH 2024 report)

n/a

Alberta exemption rate. No school requirement, so no exemption system.

446

Alberta measles cases per million, 2025 outbreak

158

Ontario measles cases per million, 2024–25 outbreak

Two provinces, two different systems

Only two provinces still require proof of vaccination for school: Ontario and New Brunswick. Ontario's Immunization of School Pupils Act (ISPA) requires every student to be vaccinated against nine diseases or to have a valid exemption on file with the local health unit. Students who have neither can be suspended for up to 20 school days.

Alberta has never had a law like this. A provincial ministry statement in 2011 put it plainly: "Immunization in Alberta is voluntary; therefore no student is denied entrance into a school facility based on their immunization status." The only exception is an outbreak. If measles turns up in a school, an unimmunized child can be kept home until two weeks after the last case.

Cartoon: two schoolhouses. At the Ontario school a crossing guard asks children for a vaccine record or exemption; at the Alberta school the doors are open over a No questions asked mat and a cartoon measles virus walks in with the students. Caption: One province checks. One doesn't. — One province checks. One doesn’t. Editorial cartoon, QuackeryWatch. Click to open full size.

This means the two provinces aren't measuring the same thing. An Ontario parent who refuses vaccines has to make a formal, recorded decision. An Alberta parent who refuses doesn't have to tell anyone, so Alberta has no exemption rate.

	Ontario	Alberta
School vaccination law	Yes. ISPA, 1982 (current version 1990)	None
Diseases covered	Diphtheria, tetanus, polio, measles, mumps, rubella, pertussis, meningococcal disease, varicella (students born 2010 or later)	None required; all routine vaccines offered free
Medical exemption	Yes. A physician or nurse practitioner certifies a contraindication or prior immunity.	Not applicable
Non-medical exemption	Yes. Conscience or religious belief, sworn before a commissioner. Parents must complete an education session first (since 2017).	Not applicable. Refusal goes unrecorded unless a parent signs a decline form after records are matched.
What happens if a record is missing	Suspension from school for up to 20 days	Nothing. Health officials may contact the family.
Exclusion during outbreaks	Yes, for unvaccinated or exempt students	Yes, for unimmunized students (measles: until two weeks after the last case)
Where coverage data comes from	Health-unit school records, reported by Public Health Ontario	Provincial immunization registry (Interactive Health Data Application)

Ontario: a slow, steady rise in exemptions

Ontario's non-medical exemptions have been creeping upward for more than 20 years. In 2002–03, 1.05% of seven-year-olds had a conscience or religious exemption for measles vaccine. By 2017–18, 2.5% did. Over the same period, medical exemptions fell to a few tenths of one per cent.

Sources: Wilson et al., CMAJ Open 2015 (2002–03 to 2012–13); Public Health Ontario, Immunization Coverage Report 2017–18 (2013–14 to 2017–18). Part of the jump at the dashed line probably reflects the switch to a new provincial records system, not only a real increase.

The provincial average hides some local hot spots. In 2017–18, about 11% of students in the Elgin St. Thomas and Oxford County health units had a non-medical exemption to at least one required vaccine. Those two health units later merged into Southwestern Public Health, which became the centre of Ontario's 2024–25 measles outbreak. Local numbers since the pandemic are higher than the provincial "about 2%":

Wellington-Dufferin-Guelph: 4.9% of students had a non-medical exemption in 2024–25.
Hamilton: 4.1% of seven-year-olds, up from 2.8% in 2018–19.
Simcoe Muskoka: 4–4.5% for measles, compared with 3–3.5% before the pandemic.

Ontario's bigger problem wasn't exemptions. It was missing records. Health units stopped enforcing the ISPA during the pandemic, so records fell behind. Public Health Ontario's figure for seven-year-olds fully vaccinated against measles dropped from 86% in 2019–20 to 70% in 2023–24. Much of that gap is children who were vaccinated but whose shots were never reported. Once enforcement resumed, thousands of suspension notices went out every winter. In March 2026, Toronto Public Health went the other way and paused suspensions for the rest of the 2025–26 school year.

Alberta: refusal goes uncounted

Alberta has repeatedly turned down school-entry requirements:

2011: Alberta Health said the province hadn't considered making school immunization mandatory, because coverage was over 90% by the end of grade one.
2016: The NDP government's Bill 28 let health officials compare school enrolment lists with immunization records. Families with missing records would be asked to send the record, get the vaccine, or sign a form saying they chose not to immunize. At the time, records were missing for an estimated 15–25% of school-age children. The government ruled out making vaccines mandatory.
2019: The Alberta Party campaigned on requiring vaccines for publicly funded schools. That proposal didn't go anywhere.
2021: During COVID, Education Minister Adriana LaGrange told school authorities that students aren't required to have any vaccination to attend school, and that schools can't deny a student an education because of immunization status.
2024: Alberta wrote a legal right to refuse a vaccine into provincial law. See Southern Alberta’s Vaccine Gap and Canada’s Own Rewrite: Alberta.

Cartoon: a puzzled public health nurse with a magnifying glass stands between a full filing cabinet labelled Ontario Exemptions, with drawers for 2019 to 2024, and an empty, cobwebbed cabinet labelled Alberta Exemptions, under a map of southern Alberta covered in red measles dots. Caption: You can't count what you never ask. — You can’t count what you never ask. Editorial cartoon, QuackeryWatch. Click to open full size.

Coverage fell in the meantime. In 2015, 87% of Alberta two-year-olds had their first measles dose and 81% of seven-year-olds had their second. By 2024, those figures were 80% and 72%. In 2024, only 24% of seven-year-olds in Two Hills County were fully vaccinated against measles.

The 2025 measles test

Both provinces had their worst measles outbreaks in decades. Each outbreak killed a premature baby who was born with measles.

Ontario: 2,375 cases, from October 2024 to October 2025. Cases were reported in 26 of the 29 health unit regions.
Alberta: about 2,000 cases in 2025 (1,960 confirmed when the per-million rate below was calculated), the province's highest count since 1979. More than 150 people were hospitalized, and 15 needed intensive care. Most cases were children and teenagers, nearly all unvaccinated. For a while Alberta had more confirmed cases than the entire United States.

Source: per-million figures calculated by The Gauntlet (University of Calgary), January 2026, from provincial counts.

Cartoon: a hockey arena scoreboard reads 2025 measles, cases per million: Home Ontario 158, Visitors Alberta 446. A worried mother and child in Canada toques look up while a grinning measles virus in a referee's shirt holds up three fingers. Caption: Nearly three times the rate. — Nearly three times the rate. Editorial cartoon, QuackeryWatch. Click to open full size.

Canada lost its measles-elimination status in November 2025. Alberta's outbreak ended in July 2026, and the Public Health Agency of Canada declared the national outbreak over in October 2026.

What the comparison can and can't tell us. Ontario's school law didn't prevent a large outbreak. Its records system was badly disrupted after the pandemic, and in both provinces measles spread mainly through rural communities with low vaccination rates. Still, the province that requires a recorded decision for every student had about one-third the outbreak rate of the province that requires nothing. Ontario's system also shows public health where unprotected children are before an outbreak, at the level of individual schools. Alberta health officials have to find those children after the virus does.

Where the public stands

A May 2025 Angus Reid poll, taken during the outbreaks, found that 69% of Canadians thought children should need proof of vaccination to attend school or daycare. In Alberta, 60% agreed, up from 48% a year earlier. In 2019, Toronto's Medical Officer of Health asked the province to end non-medical exemptions. Ontario's health minister's office said it wouldn't, citing respect for parents. Neither province has changed its approach since.

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Sources

Wilson SE et al. Trends in medical and nonmedical immunization exemptions to measles-containing vaccine in Ontario, 2002/03–2012/13. CMAJ Open 2015. PMC4596119
Public Health Ontario. Immunization Coverage Report for School Pupils in Ontario: 2017–18 School Year (May 2019), Appendix 4.
Ontario Chief Medical Officer of Health. 2024 Annual Report (Sept 2025).
The Globe and Mail. Ontario immunization campaigns increasingly failing to reach some (May 2019).
Wellington-Dufferin-Guelph Public Health. Board of Health report on ISPA (Nov 2025).
TorontoToday. Ontario's measles data is years out of date.
CBC News. Toronto Public Health calling on province to end non-medical exemptions (2019); CP24: Toronto Public Health will not suspend students this year (Mar 2026).
CMAJ News. Mandatory vaccinations: the Canadian picture (Oct 2011).
Global News. New legislation to allow Alberta to cross-reference children's immunization records (Nov 2016).
Red Deer Advocate. Alberta K-12 students will not be required to be vaccinated (2021).
The Walrus. How Alberta Became the Epicentre of Canada's Measles Outbreak (2025).
CBC News Calgary. Why are measles case counts climbing so high in Alberta? (May 2025); Alberta's measles outbreaks are now the worst in nearly half a century (June 2025).
Global News. Premature baby dies from measles in Alberta (Oct 2025).
Middlesex-London Health Unit. Ontario measles outbreak declared over (Oct 2025).
The Gauntlet. Alberta rolled the dice on personal choice. Measles won (Jan 2026).
CP24 / Canadian Press. Measles outbreak over after 2 years (Oct 2026).
Global News. Measles surge boosts support for mandatory school vaccines: poll (May 2025).