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.”
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.
“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.”
Health Canada says Canada 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.”
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.”
One proposed solution to the risk of outbreaks is to end the exemption of vaccinations for non-medical reasons.
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.
“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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