If the U.S. loses its measles elimination status, could Canada be next?

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The U.S. could lose its measles elimination status for the first time in almost 20 years this week, and experts say declining vaccination rates and the threat of outbreaks may put Canada at similar risk in the future.

"Honestly, I'm astonished. I never thought it could happen," says Dr. Natasha Crowcroft, director of the Centre for Vaccine Preventable Diseases at the University of Toronto. 

"I think if the U.S. can lose its status, then any country in the world can."

Measles was officially declared "eliminated" in the U.S. in 2000, meaning the disease is no longer "constantly present" in the country. But there have been 1,241 cases in 31 states this year to date — the greatest number reported since 1992.

Most of those cases are tied to New York, where 654 people — mostly concentrated in the city's Orthodox Jewish communities in Brooklyn and nearby Rockland County — were diagnosed with measles since the outbreak began on Oct. 1, 2018.

New York City declared its outbreak over on Sept. 3 and Rockland County's ended on Sept. 25. If one more case occurs before Wednesday, the U.S. will join countries such as the United Kingdom and Greece in losing its measles elimination status. 

"The United States and the United Kingdom have beautifully illustrated for us how exactly we can get to that point," says Dr. David Fisman, a professor of epidemiology at the University of Toronto's Dalla Lana School of Public Health.

"And it's by being soft on immunization and telling people that they can do whatever they want."

Is Canada at risk? 

There are currently no active reported cases of measles in Canada, but there have been 111 cases reported this year.

B.C. saw an outbreak of measles in February with at least 19 confirmed cases, in addition to a 2014 outbreak in the Fraser Valley that saw hundreds of cases across the province. 

Quebec has seen outbreaks as well, with more than 750 confirmed cases in a 2011 outbreak and 119 confirmed cases reported in 2015 in the province's Lanaudière region that were tied to a Disneyland outbreak in California.

The Public Health Agency of Canada says this country will continue to see cases of measles related to travel, because of the circulation of the disease in many parts of the world. The last reported case here was in early September. 

"Unfortunately, there's no real reason to think this same thing could not happen here," says Dr. Joan Robinson, a pediatric infectious diseases physician at the University of Alberta.

"Our measles immunization rates are roughly similar to those in the U.S. and measles is a highly contagious virus."

The latest national information on child immunization coverage shows that 90 per cent of two-year-old children in Canada have received at least one dose of the measles vaccine.

Experts say a 95 per cent vaccination rate for measles is ideally needed for "herd immunity" in the population to prevent outbreaks.

"Once you introduce measles into any of those [communities], it just takes off and it just keeps going and going and going," says Dr. Noni MacDonald, professor of pediatrics at Dalhousie University and a specialist in pediatric infectious diseases.

"It's very worrisome. We've just not been blessed at the present time with a huge outbreak. But we don't have 95 per cent uptake uniformly across our country."

'Vaccine hesitancy'

One proposed solution to the risk of outbreaks is to end the exemption of vaccinations for non-medical reasons.

Toronto's medical officer of health, Dr. Eileen de Villa, made that very recommmendation at a board of health meeting earlier this week to combat "vaccine hesitancy." She was met with dozens of angry protesters. 

The World Health Organization has identified vaccine hesitancy as one of its 10 threats to global health in 2019, defining it as "the reluctance or refusal to vaccinate despite the availability of vaccines." 

Robinson says forcing parents to vaccinate their children may not be effective in combatting the growing anti-vaccination movement.

"Parents who are somewhat vaccine hesitant but normally would still immunize their children might get so angry about this issue that they then decide that they're actually at least not going to immunize them until they're old enough to go to school," Robinson said.

"I think it could actually all backfire."

Fighting misinformation

Jill Promoli's two-year-old son Jude died from a strain of influenza in May 2016 despite having had the flu shot months earlier. 

Since then, the Mississauga, Ont. mother has faced hundreds of attacks from anti-vaccination groups on social media for her own advocacy efforts on the importance of immunizations through her organization "For Jude, For Everyone."

"The things that we were hearing in that meeting on Monday are the things that were constantly in my inbox, showing up on Twitter and anything I post on Facebook," Promoli said. 

"It was a little bit jarring on Monday to be at that meeting because even though I'm used to reading these things online, in the real world when I'm walking around, most people, the vast majority of people, understand that vaccination is safe." 

Dr. Sohail Gandhi, president of the Ontario Medical Association, believes there should be a nationwide policy against non-medical exemptions. He says the majority of those concerned about vaccines are misinformed parents trying to protect their children.

"Unfortunately, sometimes, when you're reaching for an answer and there isn't one, you reach for the wrong answer and that's a huge, huge challenge for us, as physicians, to deal with this. How do you educate in a situation like that?" he said. 

"We all need to do a better job of reaching out to those people, and we also need to do it with with some sympathy and a little bit of compassion."

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