Doctors are being advised to report parents to authorities with the power to seize children if they refuse vaccinations and a child is at serious risk of harm.

The Canadian Medical Protective Association (CMPA), the body that gives doctors legal representation, says that, in “exceptional circumstances,” a parent’s decision not to vaccinate may necessitate a call to child welfare.

“In our view, exceptional circumstances where it may be appropriate for a physician to contact a child protection agency would be one where, due to the child’s specific clinical circumstances and local presence of the disease in question, not getting vaccinated threatens the life or long-term health of the child,” Dr. Doug Bell, the group’s associate executive director, said in an email to the Post.

The legal advice on vaccine hesitancy comes amid reports doctors are encountering more parents wanting to delay, space out or outright reject inoculations. But invoking child welfare also has some asking how far the state should intervene. Should parents be punished for not vaccinating?

In Canada, vaccination rates are generally high, ranging from 79 per cent for pneumococcal, to 91 per cent for polio. However, a 2013 survey found 1.5 per cent of children in Canada have never received a vaccine, while a recent UNICEF report comparing uptake rates of immunizations ranked Canada 28th out of 29 high-income countries.

Meanwhile, outbreaks of vaccine-preventable diseases, like recent measles resurgences in Alberta and B.C., are becoming more frequent.

Experts say it’s hard to pin down the prevalence of vaccine “refuseniks.” However, surveys suggest one in five Canadians believe the scientifically debunked view that vaccines cause autism, while almost five per cent of parents believe homeopathy and chiropractic manipulations, among other “alternative” remedies, can eliminate the need for inoculations.

In the U.S., president-elect Donald Trump has been accused of stoking anti-vaxx fears with tweets linking a “massive shot of many vaccines” with autism. This week, Trump tapped vaccine skeptic and environmental activist Robert F. Kennedy Jr. to head a committee on vaccine safety.

The CMPA, the doctors’ liability insurer, stresses that physicians should be “empathic and respectful” when working with vaccine-hesitant patients or parents, and “keep lines of communication open.”

If a recommended vaccine is refused, it should be documented, including the reasons for the refusal, the organization says.

No parent in Canada can be forced to have his or her child vaccinated. However, “Technically, if the right conditions existed, it may be legally appropriate for a physician to report a child,” said Timothy Caulfield, Canada research chair in health law and policy at the University of Alberta. Under provincial child welfare laws, the best interest of the child is paramount, he said.

Generally there must be a serious threat — and usually imminent — to the health of the child

However, “generally there must be a serious threat — and usually imminent — to the health of the child,” Caulfield said.

For example, Canadian judges have consistently ruled that Jehovah’s Witnesses do not have the right to deny life-saving blood transfusions for their children. Two years ago, the Ottawa Children’s Aid Society intervened after a father insisted on treating his toddler’s leukemia not with chemotherapy, but with cannabis oil.

However, it’s not clear whether vaccination would be construed as a “medically necessary” treatment, experts say.