Front Burner - Explaining the Vancouver Measles Outbreak

Episode Date: February 21, 2019

With eight confirmed cases, Vancouver is facing Canada's worst measles outbreak in years. Dr. Natasha Crowcroft on why the infectious disease is having a worldwide comeback.

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Someone Knows Something with David Ridgen, Season 5. Now available. Go to cbc.ca slash sks. Hello, I'm Jamie Poisson. As of this week, eight people in different Vancouver schools have been diagnosed with the measles. It's the biggest Canadian outbreak in years. Students and staff who are not immunized are being told to stay home. There are still more than two weeks left before those exposed are out of the woods. The Prime Minister tweeted out that vaccines prevent outbreaks like this and save lives.

But back in 2002, Canada and the U.S. were declared measles-free, and the rest of the Americas followed in 2016. So what happened? Today I'm talking to Natasha Crowcroft. She's an infectious disease expert at Public Health Ontario, and we're exploring essentially why measles are making a comeback. This is FrontBurner. A man named Emmanuel Bilodeau believes his family is actually at the center of this outbreak in Vancouver.

In January, Emmanuel took his family on a vacation to Vietnam. And on the plane ride home, he says his 11-year-old started running a fever. Bilodeau talked to our colleagues at CBC in Vancouver. And he says after the fever, other symptoms started showing up. The rash really amplified. Like, it really was all over. Like, in his mouth, inside his hand, like, his back. Soon, his other two kids developed symptoms.

The fevers and rashes. It turns out the kids had something a lot worse than a cold. She showed the rashes to the nurse, and she's like, I think he's got measles. And since his son contracted the measles, the disease has spread to other schools his children attend. Years ago, Bilodeau and his ex-wife decided not to vaccinate their kids against measles. He says he wasn't an anti-vaxxer. But what he read back then about the MMR vaccine, it worried him. With all the stories we were airing back then, like, you know, MMR is connected with autism.

So we were, like, a little concerned with all that. Now he says there is no connection between the MMR vaccine and autism. And if a doctor had told him to get the shots for his kids, he would have done it. With the information I have today, no, I would go get my kids vaccinated for sure. Like, you know, I wouldn't think twice. My guest today thinks there are some lessons to learn in this case. Dr. Crowcroft, how are you? I'm very well, Jamie. Thank you very much for asking.

Can you give me a sense of just how dangerous the measles can be for a child? If you get measles, then on average, we're working at somewhere between one in two to one in 5,000 children might die. A lot of people say, well, that doesn't sound too bad. You know, one in two to one in 5,000 isn't that common. Now, something like one in 15 or so will get a severe case of measles. So they'll get pneumonia or encephalitis, which is a form of brain swelling, that they may well recover from that. But the actual risk of the really severe death is about 1 in 2,000 to 5,000. The problem with that statistic is that it doesn't take into account the fact that if you don't have any vaccination around, then nearly everyone gets measles.

It's almost impossible not to get measles. And what is it about the virus that makes it so contagious? It's one of the most infectious diseases we know, and it's spread in the most efficient way possible, which is by just hanging around in the air. You can catch measles by going into a room that somebody who had measles has just left. In fact, if they left, we say up to two hours before, it's left hanging in the air for up to two hours. You can just breathe it in. You know, if somebody just walked by someone else with measles, you know, if you go on holiday to a place where there's a lot of measles around,

you may never know who it was who gave you measles when you come home again. You were on the committee that declared North and South America measles-free back in 2016. So can you take me through what's happened here? It was a long journey to get to 2016 and be able to declare that measles had been officially eliminated from the whole of the Americas. Problem is, you can't stop there. You can't let your guard down. And measles is one of those viruses that unless you keep up a nearly perfect immunization uptake amongst everyone. Eventually, it'll pop up again. Until measles is really gone from everywhere in the world, we can just never let our guard down.

What parts of the world are considered hotbeds for measles? I think hotbeds is an interesting word. There are some countries where there's an awful lot of measles, but the people who live there are very unlikely to show up in Canada, or very few people come to Canada. This is why we're very, very concerned about Europe, because Europe currently is a hotbed, and it's also very connected to Canada. New figures from the World Health Organization show the number of cases have tripled in Europe to over 80,000. Now, most of these we know come from Ukraine in the east, but over 5,000 in Serbia, significant numbers in France, close to 3,000 and over 2,500 in Italy.

If there are big outbreaks of measles anywhere in Europe, they do tend to pop up in Canada. And we saw that in 2011 where Quebec had this huge outbreak of measles. Now the province has seen more than 700 cases. Could this be a major outbreak? Health officials say it already is. And that was very closely linked to measles outbreaks that were going on in France at the time. And why is Europe such a hotbed for measles right now? Well, the big challenge which WHO, the World Health Organization, has flagged is vaccine

hesitancy. We're just not winning the hearts of people and convincing them that immunization is the safest, most effective way of protecting their kids. That is really the big challenge. We need to have nearly a perfect immunization program to prevent measles, which means we can't afford to have big groups of people who just don't believe in immunization. There are plenty of schools in the Vancouver Coast health region that are nowhere near that threshold. Vaccination rates for the measles range

from a high of 89 percent in Vancouver's south to a low of 74 percent in the city centre. But the data isn't perfect. It only accounts for parents who have reported their kids' vaccination status. And these people, you know, can we go over the reasons why they're so against vaccinations? I mean, I know the big one is that people believe that these vaccines can cause autism, even though the Centers for Disease Control and others have said there's no link between vaccines and autism.

Yeah, so there's lots of different reasons why people are anti-vaccination. So one group is this group who are really anti being told what to do. And there are other groups who are much more into nature and they don't want anything artificial around their kids and they just want nature to take its course and they think nature's best. So those are very different philosophies, but they can have a shared idea that they can't trust anybody in authority or they don't want to do what the government tells them to do.

So there are some interestingly diverse views where people end up doing the same thing, even though their view of the world is very different. So I wouldn't put them, in other words, I wouldn't put everyone in the same group. And then there are people who, like most people, they're just trying to do the best thing for their kid and they hear something that worries them a bit. And so they don't get them vaccinated. And it's not that they're vehemently anti-vaccine. It's more that they're, you know, they've heard something and they're just not sure. Sometimes they postpone and delay and they don't get around to it. And that group of people, one day they may just have a conversation with a neighbor or a friend or with their doctor. And then they'll suddenly say, okay, right, I'm ready to vaccinate

my kids now. Yeah, that's a very different group of people. And that's also the group that we try to reach, because, you know, they're not inherently, absolutely anti-vaccination. They're just trying to do the best thing for their kids, and they don't understand what they're hearing, and they're worried. Do you get the sense that that group is growing? Yeah, I get the sense that that group is growing and I don't know how to address it because it's part of a general problem which we have with trying to figure out what's really going on or what's true right now about anything. You know, how do we find out what's true when you hear things from different parties that contradict each other? Who do you trust in this situation? I mean, the very story about MMR vaccine being linked to autism, when it first came out, there was no evidence to support it, no good quality scientific evidence. And

since that story came out, which is now more than 20 years ago, there's just been piling up more and more evidence that there's absolutely nothing in this story. There's no evidence at all of any kind of link between vaccines and autism. A British medical journal is retracting a highly controversial study that linked vaccines to autism in children. The UK licensing body declared that he had been unethical by accepting money from lawyers who were suing the vaccine makers and that his research methods were unsound. Yet the idea is still out there. So this is a real challenge just to try and address this

idea that people have just decided must somehow be true because they keep hearing it. We'll be back in a second. what millions around the world already have. Audible has Canada's largest library of audiobooks, including exclusive content curated by and for Canadians. Experience books in a whole new way, where stories are brought to life by powerful performances from renowned actors and narrators. With the free Audible app, you can listen anytime, anywhere,

whether you're at home, in the car, or out on a jog. The first 30 days of the Audible membership are free, including a free book. Go to www.audible.ca slash cbc to learn more. Is it fair to say that the increase in people who are not vaccinating their children is sort of tied to these broader issues that we're dealing with as a society around information, essentially, you know, the spread of fake news and the ability for ideas

to spread widely on the internet and social media. Do you see this all kind of gelling together? I do, absolutely, yeah. I mean, if you're a parent and you look on the Internet for information, the first thing you're going to find is often anti-vaccination. You know, I take my hat off to some of the groups who are campaigning against vaccination because they have some of the best websites. They tell the best stories. People like myself working in public health, our websites in general tend to be a bit dull, a bit earnest. Oh, really? Public health websites are boring? People like, you know, I get on the radio and I say, like, you really should get your kids vaccinated.

And, you know, anyone who's anti-vaccine is going to listen to me and say, what is she talking about? You can't trust her. She works for, you know, a government type agency. I just want to pick up on something you said that the other side in this, I don't want to call it a debate, but the other side here, the side that's against these vaccines, that they have the best stories. What did you mean by that? If I tell you that 72 children died from measles in Europe last year, you know, that's a statistic. It's 72 individual tragedies that I can't convey the scale of that. 72 is, you know, it's awful. It's strange, but that statistic doesn't really carry

the same weight as an individual who you know, who says, I believe this happened to my child and look at my child who's with me right now. And this is how they, you know, tells a story about their own child and what happened to them. That on a very human level, you can't ignore that individual passionate parent who really believes. All the science and all the facts and all the numbers just don't really weigh up in that scenario. So one of the things that's happened in recent years, which I think has been really interesting, is there have been parents who've come forward who didn't vaccinate their kids and then their kids got sick. Now, those stories work really well when you have a parent who says this has happened recently. I decided not to have my kids vaccinated for whooping cough.

And then they got whooping cough and they got really sick. And I don't want this to happen to anyone else. Tara Hill says she used to be anti-vaccine, but now realizes that was a dangerous decision. We had just defected from the anti-vaccination camp for whooping cough. It was too late. I mean, it's so ironic. I just hope that we can use this very painful experience to encourage other people like us to maybe re-examine the issue. You know, diseases that they then wake up and realize, oh my goodness, I was trying to do the right thing. And these are all parents who are trying to do the right thing. They all think they're trying to protect their child, but it hasn't worked out as they thought it would.

And then they find out for themselves how horribly wrong it can go. And then they also then have the courage to stand up and say, actually, I was wrong about this and I don't want anyone else to go through this. I know we talked about these groups of people who are opposed to vaccination for various reasons, maybe that they don't like to be told what to do or that they believe that perhaps their children could get autism. Another thing I wanted to talk to you about, which I think sort of fits into this conversation we were having about information and online information, is that anti-vaccine sentiment, it seems to be also associated with right-wing political movements these days. So Donald Trump has expressed criticism about vaccines. And we've had so many instances, people that worked for me just the other day,

two years old, two and a half years old, a child, a beautiful child, went to have the vaccine and came back and a week later got a tremendous fever, got very, very sick, now is autistic. I only say it's not, I'm in favor of vaccines. Do them over a longer period of time, same amount. And then also Marine Le Pen in France and a major party in Italy is against mandatory vaccinations. What are your thoughts about what's happening there? I mean, I think it's part of the whole situation we're in where people don't know who to trust, because if our leaders are being anti-vaccination and not supporting the health care sector, which is the World Health Organization, the national public health bodies like the Public

Health Agency of Canada, you know, the provincial bodies, everybody supports immunization who really knows what they're talking about. When a politician makes a statement that vaccines aren't safe or they have concerns, they do incredible damage. If you go back to, and this is going back many years, so when Prince William was born, there was a problem with the whooping cough vaccine scare in the UK. And Princess Diana went public about having her children vaccinated. And that was a huge boost. Princess Diana helped the UK with that issue they were having with the whooping cough vaccine

at that time where people were worried. It was a very similar kind of scare story to the MMR and autism scare story. She went public. She said, oh, I'm getting my son vaccinated because it's the right thing to do. I take my hat off to her for that. That was one of the many good things she did. You mentioned before that a country would need to be at near perfect vaccination for there not to be measles outbreaks. Do we have a sense of how many people in Canada are vaccinated and then how many people would need to be vaccinated in order for us to avoid what's happening in Vancouver right now? The Canadian target for vaccination is 95%. The latest data I've seen for Canada for the first

dose only is 89% of children being vaccinated by the age of two. Where I am working in Ontario, the last data we have for seven-year-olds was 91%, and for 17-year-olds was 94%. we have for seven-year-olds was 91%, and for 17-year-olds was 94%. And the different figures measuring at different ages, none of them hit 95%. That's interesting for me to hear you say that, because intuitively, it feels like the way to get to 95%, or even higher, would be to make this some sort of law. There's a petition in British Columbia right now that's circulating to just make this mandatory. I started a petition to get vaccines mandatory for public school enrollment. I'm 20 weeks pregnant as it is,

so I am concerned about my own child. But on a broader scale, there's so many other people that I know that are affected by this, that are immunocompromised, going through chemo. I have very mixed feelings about legislation in general. The specific idea of making anything mandatory, I'm not in favor of because I think that just presses all the right buttons with the people who are anti being told what to do, which is everyone really like no one actually really

likes being told what to do. That word mandatory is a real trigger for some people. I've also had a recent experience where I was involved in publishing a paper with a group of colleagues which had the word mandatory in the title. It was an exploration of legislation on vaccination. And that really triggered a firestorm. And we had one person in particular who became so abusive that we had to call the police. So that word, if you want to cause trouble, that's a good word. And I wonder if that's one of the reasons that the right-wing parties have responded in the way they have. Like in Italy, part of the issue they had was that the previous government had brought in legislation. So I think the government was reacting to that.

We don't want to do anything that makes people react the wrong way. We need to win over hearts and minds, not force people to do things. I know it's probably hard to predict, but do you see this country certainly seeing more outbreaks in the near future, like what we're seeing in Vancouver right now? I think that as long as the rest of the world is struggling, we will continue to see outbreaks. I don't know whether we'll see more. I feel like every time there are outbreaks, everybody wakes up and generally the uptake goes up a bit.

I think our biggest risk is that people, in six months' time, they've forgotten about this outbreak and they get a bit complacent again and then coverage goes down again. So that would be a concern. I am very worried about the rest of the world because it's so difficult to maintain these levels of coverage of vaccine uptake. And given the way that Canada is so highly connected to other countries, you know, unless India, the Philippines, China can really get on top of measles. We're going to carry on seeing these outbreaks happening. How fragile the peace is with measles, you can't let your guard down.

Dr. Crowcraft, thank you so much. Thank you very much, Jamie. That petition in BC Dr. Crowcraft and I mentioned, it wants Vancouver schools to make measles vaccinations mandatory, except with medical exemptions. As of late Wednesday, it had over 35,000 signatures. That's it for today. I'm Jamie Poisson. Thanks for listening to FrontBurner.

For more CBC Podcasts, go to cbc.ca slash podcasts. It's 2011 and the Arab Spring is raging. A lesbian activist in Syria starts a blog. She names it Gay Girl in Damascus. Am I crazy? Maybe. As her profile grows, so does the danger. The object of the email was, please read this while sitting down. It's like a genie came out of the bottle and you can't put it back. Gay Girl Gone. Available now.