Canada’s Measles Setback Is a Symptom of a Larger Illness
It’s a frustrating and disappointing day for public health in Canada. We have officially lost our measles elimination status, which we have held since 1998. This status has symbolic value: it signaled to Canadians and the world that the disease was under control. But it has material value, as well, since the elimination of measles means much less child suffering and much less public health expenditure. The implications of losing this status, while not immediately dire, are nevertheless troubling, expensive, and indicative of larger problems.
What Does it Not Mean?
First, elimination is not eradication. It does not mean there are no cases of the disease. Instead, it means no sustained (endemic) transmission for at least 12 months. Officially, it also means that we have a strong surveillance programme and the capacity to detect and control importations. Losing that status means the country no longer meets these criteria, because sustained transmission has occurred.
Losing elimination status does not mean that measles is about to become entirely endemic (i.e., constantly present), but it certainly raises the risk of that outcome. It does not mean that all parts of Canada are about to see measles outbreaks, since outbreaks will depend on local immunity levels.
And it certainly does not mean that vaccination does not work. Quite the opposite, in fact, as meeting our vaccination targets is the only way to regain elimination status.
How Did This Happen?
Public health is an institution built upon multiple pillars, including government, scientists, the biopharmaceutical industry, educators, and the public. Frankly, the loss of elimination status is primarily the public’s fault. We, as a population, have not stepped up to become immunized in sufficient numbers.
Herd immunity against measles requires about 95% of the population to be vaccinated. Yet, in British Columbia, the most recent (2023) data show that only 82% of 2-year-olds have received a single dose of the MMR vaccine, and only 72% of 7-year-olds have received both doses. Multiple provinces have seen declines in childhood MMR coverage in 2023, as compared to 2019.
For the week ending Oct. 25, the latest available at the time of writing this article, the federal government reported 29 new measles cases nationwide, led by Saskatchewan (11 cases) and BC (9 cases).
What Are the Meaningful Implications?
Back when we had elimination status, new cases imported from travellers were quickly snuffed out because they could not take hold in highly immunized populations.
But now that our population has significant immunity gaps, new cases are more likely to spark genuine outbreaks, leading to sustained infection. In short, once elimination is lost, the risk of the disease re-establishing endemic transmission increases.
Not only is this dangerous, since measles has a serious history of hospitalizing, disabling, and killing children, but it’s also expensive. Public health in Canada is already cash-strapped. Now, it will have to incur additional costs to trace and contain new outbreaks, lest they escalate into larger concerns.
Remember, before vaccination, Canada saw hundreds of thousands of measles cases per year, leading to hundreds of child deaths, at a time when our population was a fraction of what it is today. Measles is a killer of children, leading to a very high rate of disability, as well.
To be clear, we are not going back to the levels of the pre-vaccination era. Most people still wisely choose to vaccinate their children. Rather, measles is so incredibly contagious that even a few hold-outs mean that we do not meet the herd immunity threshold, and outbreaks become more sustained and commonplace.
In short, losing elimination status will be expensive and dangerous if it is not regained quickly.
And what of Canadians traveling abroad? We will be, understandably, subject to increased scrutiny by border agents of foreign nations, who will view us as potential sources of infection.
What Are The Policy Options Now?
Canada will need to scale up catch-up vaccination campaigns, especially in under-vaccinated communities. We are already pressed for resources, suffering extreme vaccine communication fatigue, and under constant duress from the brigade of anti-vaccine activists flooding the zone with misinformation. The job just got much harder.
Presently, any parent can receive a vaccine exemption in most provinces on philosophical or religious grounds. While threatening people’s religious convictions might be anathema to a free and open society, it might be worthwhile to review these exemption criteria. At the very least, some creativity must be deployed to develop a set of vaccination incentives that could outweigh religious objections.
Nudge economics teaches us that minute inconveniences and inducements can lead to dramatic behavioural changes over time. Making vaccines even easier to get, while imposing additional administrative burdens on those seeking exemptions, might be sufficient to encourage enough uptake to get us over the herd immunity line. Clearly, doing nothing is not an option.
Finally, we must commit ourselves to combating the single deadliest threat to our democracy and civil society: misinformation and disinformation. Whether the result of deliberate, organized chaos agents or of well-meaning but poorly informed amplifiers of untruths, online falsehoods are the stench-laden rot within the body politic. Its expression in the health domain is its most obvious and easily identifiable manifestation.
What meager resources remain in the health basket must be applied to identifying, containing, and extinguishing clearly false information that threatens population health. The rise in the USA of RFK Jr and his followers is both an indicator and an accelerator of the larger trend of dangerous pseudoscience finding mainstream acceptance in both open discourse and in the halls of power.
It’s time for a national conversation about how much of this the Canadian public is willing to tolerate and which levers would be deemed acceptable to put an end to it.
The loss of elimination status is not an epidemiological inevitability; it is a policy failure we can still reverse. Rebuilding trust, investing in public health infrastructure, and countering disinformation are not optional luxuries. Rather, they are prerequisites for a functioning democracy. The question now is not whether measles will return, but whether Canada still has the will to learn from its mistakes before it does.
