The Agenda with Steve Paikin (Audio) - Why Aren't More Kids Vaccinated Against Measles?

Episode Date: May 13, 2025

Public Health Ontario's measles report has been rapidly rising since the outbreak began in October. With this highly contagious disease spanning to new parts of the country, why are some parents still reluctant to get their children vaccinated? The Agenda invites André Picard, health reporter and columnist for The Globe and Mail; Dr. Jeffrey Pernica, pediatrics infectious disease position at McMaster Children's Hospital; Dr. Dawn Bowdish, professor of medicine at McMaster University and Jill Promoli, public health advocate to discuss.See omnystudio.com/listener for privacy information.

He was like a father figure to me. Unfortunately, found myself in a very vulnerable position. This is a story about a psychiatrist in Toronto accused of abusing two of his patients, which he denies. It's also a story about a system that is supposed to protect patients. From TVO Podcasts, I'm Krisha Collier, and this is The Oath. Subscribe today wherever you listen. Measles is on the rise in Ontario and new cases have been reported across Canada.

Why does this highly contagious disease continue to spread? And why are some parents still reluctant to get their kids vaccinated? Joining us to discuss what the concerns are, we welcome, in Vancouver, British Columbia, Andre Picard, health reporter and columnist for the Global Mail. In Hamilton, Ontario, Dr. Jeffrey Pernica, Pediatrics Infectious Disease Position at McMaster Children's Hospital.

And with us in studio, Dr. Dawn Bowdish, Professor of Medicine at McMaster University and Executive Director of the Firestone Institute for Respiratory Health, and Jill Promoli, a public health advocate. Welcome to you all. It's a very important discussion, a very timely one. Andre, I'd like to start with you.

Ontario has been called the epicentre of measles in this country. What is happening across this country right now with measles? Well, we do have this huge outbreak in Ontario and a smaller one in Alberta and then sporadic cases everywhere. So this is really this is the worst outbreak in in decades in 30 years. Proportionally, if you look per capita, Ontario's outbreak is about 20 times worse than what's happening in all of the US. So you can't really overstate how bad things are.

And it hasn't been taken too, too seriously, I think, by public health officials. Well, hopefully we'll get a chance to discuss that in more detail. But 20 times worse than the United States is pretty shocking to hear. I want to show you some of the numbers of what's happening in Ontario. These numbers are as of May 6, according to Public Health Ontario. From October 18, 2024 to May 6, 2025, Ontario reported a total of 1,440 measles cases in 17 public health units across the province. This represents an increase

of 197 cases across the previous data extraction on April 29th. Most of the cases have been in southwestern Ontario. Nearly 77 percent have been in infants, children, and adolescents. Of the confirmed cases, 101 people have been hospitalized, and eight have ended up in the intensive care unit. Jill, we only had seven cases in Ontario in all of 2023. You hear that and you think what? I mean, we have to recognize that this is alarming.

What's so frustrating about this is that we do know how preventable measles is. This is actually one of the easiest things to prevent because the vaccine is just so effective. Measles is one of those diseases that is very stable. So when we do have such an effective vaccine like what we have for measles, we know that when people do get vaccinated, they're very unlikely to get measles

and to end up, to have us in a situation like this. The vaccine is about 97% effective with both doses, and so when most people are vaccinated against measles, we simply don't see it moving through our communities. But now with so many holes in our safety net, we're seeing so many more people who are at risk of being exposed. And now so many people are getting sick.

And it is affecting a lot of people. Dawn, we've heard that 95% of the cases we're seeing now are amongst infants, children, and adolescents. And also they're unvaccinated patients. Why are parents not getting their children vaccinated? It's complicated and there's not an easy answer to it, but we actually do collect data on why parents make the decision.

And despite what people think, there's actually a very low percentage, only about 2% of Canadians don't vaccinate their children at all. Other people are very much looking for vaccinations for their children, but the family care crisis and the primary care crisis has been really problematic. Unlike adult vaccinations where you can go to pharmacies

or there are other routes, pediatric vaccinations are almost entirely done in family practice. And so what we're seeing is issues with people having access and having to sort of patch together public health unit visits and trying to find a primary care doctor in addition to the ongoing misinformation campaigns that we're seeing. And that combination has meant that even the most well-intentioned parents are sometimes challenged to do that. As well, we have issues with just knowing if you've been vaccinated or not.

Canada is unique in OECD countries in that we don't have a national vaccination registry. So we have those yellow cards. We have yellow cards. And in most countries, you can go online, type in your health card number and find out what your vaccination history is. But here, if you're from a province or if you've had some vaccines out of the country or you don't know what the vaccines were when you were a baby, there's really very little you can do without a lot of conversations to try to find that information. What about the pandemic? Because I know before the pandemic, I was on top of my children's vaccines.

Now I'm kind of like, I don't really know that they will. Absolutely. So we saw that there was a big dip in childhood vaccinations during the pandemic because people weren't going to the family doctor. And because pediatric vaccines are so well regimented if you fall off that schedule it's easy to sort of lose the plot and not know where you are in that status so that absolutely had an impact and and getting people back and caught up has been a real challenge. Jeffrey Dawn said that only two percent of Canadians don't get vaccinated.

I think there's this kind of maybe misunderstanding that a lot of people aren't getting vaccinated because of maybe being vaccine hesitant. What role does vaccine hesitancy play in what we're seeing here with measles in Ontario? That's a great question. And I think Dawn did a great job in talking about the larger phenomenon, right? And I would just agree with her that there are many people who don't get their children vaccinated not because they are necessarily worried about the vaccine themselves, but because of you know typical access issues

parents don't always remember which vaccines their kid is supposed to get when lots of doctors, you know, didn't have visits as Don described during the pandemic and so never caught their kids up. Some families don't have the resources or time to get to the, you know, their primary care clinician during the day. And then there are other issues that impede vaccinations. And we all know about these, right?

Like kids don't like getting vaccines because they hurt. And so often that is another layer of something preventing that child from being vaccinated. So I would agree with Dawn in that it's really important to try to deal with those issues first and then... Oh, actually, and there's one other thing that I should have mentioned before we get to the vaccine hesitancy, but often people and even clinicians think that there is a contraindication to vaccines when there is not, right? And so

it's widespread to believe that when a child has a cold, they can't be vaccinated. That is not correct. Sometimes things happen after vaccinations that are perceived to be, you know, contraindications to vaccination but are not. Like for example, I do get referrals for patients that had excessive crying after a vaccine, for example. And while that is a difficult thing for the child, for the family, that is not a reason not to get vaccinated again, simply because obviously the benefit of being prevented against a particular infection outweighs the potential harm of having crying against the vaccine.

And so there's that layer as well. And then there is vaccine hesitancy, right? Which is, as has already been alluded to, a difficult thing to manage. It has been around for literally hundreds of years since, you know, vaccination began in the late 1700s, early 1800s, and lots of things feed into it. I think there's lots of people who want to be natural, whatever that word means, and is worried about things in vaccines going into

like a perfect child body. There was always concerns about who's making money. You know, initially it was doctors and now we have a public health care system and so people are worried about big pharma making money. And I think, you know, concerns like this, there's fallout from the mandate, being forced to do something by the government that you do not believe in. And all of this is amplified by what is on the internet, namely, people and organizations seeming to, you know, amplify this often for their own, you know, profit and benefit. Andre, I saw you nodding. Yeah, absolutely. I think these points both John made and we just heard are great points.

I happen to believe that the vast majority of patients want the best for their children. They don't always make the best choices, but I don't think this is an issue of evil parents or anti-vaxxers. I think it's, as we heard, it's complicated. It's hard to get access, who wants to make their kids cry? A whole bunch of stuff comes into play and I think the other one factor I haven't heard that I think is really important is we haven't seen these diseases forever. In my childhood we saw these things every day. They were part of our daily lives and we feared them and you know we're almost authors of our own problems because we've been so successful with vaccination that these things nobody knows what measles looks like anymore and

I hope they never will. Well most cases in this province are in southwestern Ontario in rural and farming communities. We reached out to their health unit for comment, and I just wanted to read part of their response. They sent us an email, and part of it says, throughout our response, we have remained nimble to opportunities to vaccinate anyone who is making the decision to do so. Some examples would be end-of-day doses

for those with known exposure, in-care vaccinations at convenient locations, pop-up community clinics at churches or centralized locations where we are invited, post-exposure vaccinations for school and child care centers with confirmed exposures to keep kids in school and staff working, and in some cases, home visits. Every dose counts toward protecting the individual and our communities. Vaccination uptake is an individual decision based on factors that are sometimes complex. We connect with local organizations and cultural groups to understand how to effectively reach residents

with credible information about measles. And we thank them for sending that response. Dawn, how can we protect these communities from similar outbreaks in the future? One of the problems is when there's communities that have really low vaccination rates, of course, measles can spread. And as you can see, if you look at the Public Health Ontario list of exposures, those spreads don't stay

within those communities. But a big element here is about trust and about knowledge. One of the things that I think it's important to highlight is that family doctors, primary care practitioners, need to know a lot more about vaccination because people have really sophisticated questions. And we don't want to call that vaccine hesitancy if a parent wants to have a discussion,

if they want to understand how the vaccines are made, if they have concerns about allergies or anything like that. That's not a bad thing. That's a good thing. But it does mean we need to have really educated people, and sometimes those are best to be nurse practitioners, people in the community. We also need major faith leaders. I hear that they mentioned vaccination in churches

because that's a really important voice to this conversation about how actually all of the major faiths support vaccination. There's very very few faiths that that forbid it. So all of these things are important and getting the vaccines to the people which is exactly what that public health unit is describing has always been shown to be one of the most effective ways to get things done. Jillis, how are you doing? Yeah I mean it is normal and okay to have questions about your health and we need

to make sure that people know that it is always okay to have those conversations with their doctor, with their nurse practitioner. If they're like millions of Ontarians who don't have access to primary care right now, that they do know where they can go to, that they they can get that information and that it is reliable. And I really appreciated what you said about knowledge and trust because I think that those are the two most important tools that we have in public health, is information and trust, and making sure that people are able to know how best to protect themselves, their families, and everyone around them too.

What I found interesting about that statement that you received is that, yes, vaccination is an individual choice, but it isn't something that only affects us. It affects literally everybody that we come into contact with and then everyone that those people are going to go on to come in contact with too. So we have to make sure that we are doing everything that we can to best inform people who do have those questions so that they can make the best choices for themselves.

But also understanding that these are these are decisions that have impacts beyond their own family, beyond their own close community because it can travel so easily. And it goes beyond vaccination too. It goes to other public health measures and tools that we have in place and we have to be working on that also. I wanted to share a clip with you from Premier Doug Ford about how this province has responded to the spread of measles. This was from a press conference from last week. Let's take a look.

They have 150,000 vaccines ready to roll. We just have to get those communities to get vaccinated. And for religious reasons, they don't want to. That's a problem.

You have to protect all of Ontario. You can't just ignore one community. How do you , it's a good point mandatory? How do you... It's a good point, but how do you force someone? Do you grab their kid and start jabbing them with a needle? Andre, I think, mentioned this, or Jeffrey, I want to ask you this question.

I think most parents want to keep their children safe. They want to protect them. But how do you convince people who have decided not to get their kids vaccinated, that to keep their children healthy, that they should do so? Yeah, so that is a complicated question. And different parents will be in different head spaces.

I like to use the example of smoking. If somebody wants to smoke, it doesn't matter how many times that you tell them that they may get lung cancer. Like that will not have an effect. You know, we did see interviews that were widely posted on the internet of the parents of the child that died from measles in Texas who were still not interested in getting a vaccine. There, it's not an education kind of thing. Thankfully, that is a,, there, it's not an education kind of thing.

Thankfully, that is a, I think, a tiny minority. And what I think is most useful when you are dealing with individual families is to emphasize that we are all on the same side. Like we are trying to make the best decisions that we can for that child, for the family, and for the community. You know, I think sometimes families think that, you know, doctors have an agenda or public health has an agenda and they are trying to stand up for their own children, but really we're all here for them. And it is primarily, I think, through, at least for me, as an individual clinician working with individual families,

my job is to listen to what they say, okay, to see if I can correct any obvious, you know, factual errors. And then, you know, emphasize that we are doing this, you know, because we are trying to make the decision that is, has the most benefit for the least risk for the child and for their community. I think that we've heard that word trust a couple of times. And Jill, I'll come to you after, John. But Jill, I just wanted to get your view on this. Mr. Ford said, do you grab their kid and start jabbing them with a needle?

How do you respond to that? I don't even like the joke around it. I think that we have to make sure that we're starting out in a place where we're coming to people with respect and empathy, because there are people who are in a very challenging mindset around vaccination, around public health in general. And I think we've all been through a lot

over the last five years. It has significantly affected the way that people view the health care system, view the way that we're doing anything as communities. And we have to recognize that we are looking at public health and vaccine confidence in a different way than we were before the pandemic. Now this was a problem before the pandemic.

I was at a Toronto Board of Health meeting in 2019 advocating for a strategy to start tackling vaccine confidence, recognizing that we were already on a path that was putting us in a position where we were going to start seeing growing outbreaks. I don't think anybody imagined we'd be where we are right now, but I do think that this was predictable to some extent. And so this is something that is going to take time and a lot of care and compassion for people who are just really not sure about the right way to go. And I completely agree with everybody who is saying that people want the best for their kids. And sometimes when they aren't sure what that is,

the best looks like inaction rather than choosing something that they just aren't sure about. So I don't think that we should be seeing that sort of flippant response. And I understand what the Premier is saying, but no, we're not even gonna joke about grabbing people's kids and just jabbing them with needles. No, we're going to talk about, okay, what do you need here?

And then recognizing that there will be a small percentage of the population that will simply never vaccinate. They just won't. What else are we doing to make sure that we are reducing the spread of illness in our communities? And I would like to say that paid sick days is a very big part of that. I'm actually going to support in some ways what the Ontario government and Doug Ford has just said there because considering, I think it would be fair to say he's leaning

on the side of a populist government. We have one of the most pro-vaccine populist governments I think in North America right now. Actually, the Ontario government's actually been first in the world in some cases for introducing some really specific vaccine policies. now actually the Ontario government's actually been first in the world in some cases for introducing some really specific vaccine policies and the thing I like about that statement despite the questionable use of the word jabbing is he's not proposing anything other than vaccination to get us out of this mess because that is the only evidence-based thing that will work and so I do

I am supportive of the fact that our government acknowledges that and he's struggling with the same issues we're all struggling here with today, how we get it done is difficult, but at least acknowledges that that is the only path forward. Andrea, I want to come to you next. Premier Ford says that the province is, quote, throwing everything and the kitchen sink at this. In a recent column, you wrote this about Ontario's Dr. Kieran Moore, the chief medical officer of health. You wrote, Dr. Moore has also defended the province's law that allows any parent with a quote, religious or philosophical objection to opt out of vaccinating their school-age children. The opt-out law is indefensible. Why is the opt-out law indefensible? I think fundamentally we have a social contract and part of that social contract is keep children

safe. That's the whole basis for this law. You know children have to be vaccinated to go to school, to daycare, to protect others as well as to protect them. So I don't feel Premier Ford, I don't feel Dr. Kieran Moore are really pushing that. You know we have this religious and philosophical exemption that allows anybody to just say oh I don't want to get a vaccine. feel Dr. Kieran Moore are really pushing that. You know, we have this religious and philosophical exemption that allows anybody to just say, oh, I don't want to get a vaccine. What is a philosophical objection to vaccination? That to me is a nonsensical idea. What's your philosophy? Your philosophy is I want kids to die. What kind of philosophy is that? So I think we have this law. I think it's a very good law, and we should enforce it. If

kids are not vaccinated, they don't go to school. It doesn't matter what community it is. You know, Dr. Moore is going around saying, you know, oh, I'm worried that people are sensitive to the fear we created during COVID. Again, I think that's giving way too much voice to a very tiny minority. I don't think public health created fear during COVID except for a very very small percentage of people who were predisposed to it. So I think we have to stand up for what we believe in and stop you know being playing to this very small minority and sucking up to them. We have to enforce the laws we have. You know we've had we saw in the US two big outbreaks

of measles in the last decade and what did they do well they copied Ontario they brought in much stricter laws that's the way to go it's not backing off it's not throwing up our hands to me the frustration is this incredible passive passively how passive the government is being and how passive public health is being oh, we'll let them choose No, that's not good enough for everyone. I'm done. I see you nodding I'm gonna come to you But I feel like I should maybe get Jeffrey to kind of respond to what Andre said Because I'm sure you have a lot of people who come to your clinic and maybe have those views. How do you talk to them?

Yeah, I I think it is it is quite challenging like if Yeah, I think it is quite challenging. Like if, it would be much simpler, okay, if humans were logical creatures who worked on evidence, but they definitely are not, right? And so it's already been talked about how people perceive this like act of commission as being worse than an act of omission, which is a problem. Like people don't want to do anything. I mean if a child dies of meningitis and they weren't vaccinated it's because you know the universe willed it.

But if something happens after a vaccine, they will feel regret for the rest of their lives. People also don't understand, you know, probability. So if you tell them that there is a, you know, a almost negligible chance that something bad will happen after a vaccine and a very small chance that something bad will happen after the disease, they'll get stuck and not do anything. And so it is, it is for these reasons that they will often make choices that are not based on evidence. And I worry that, okay, if these children are not allowed to go to school or if the families are not allowed to, you know, access services,

things for those children will get worse rather than better. And this is the worry, I think, too, because you're, if you're being suspended, it's not a situation where you're maybe creating that trust, nurturing that trust. And I also think that maybe people might not know what measles does. There's a TV show called The Pit, and there's a scene that goes viral with this parent, this family shows up to the ER, their child has measles, and then there's a kind of a standoff between the mom and dad about whether or not the doctor should proceed to

take care of their child who's dying. Dawn, can you help us understand what happens to a person's body when they have measles and how does that impact their community? Measles is a terrible, terrible infection. Of all the vaccines we have, the one that has saved the most lives is measles. Unlike other respiratory infections like influenza or COVID that infect the lungs, it actually infects and kills immune cells. So leaves a person incredibly vulnerable, which is why some people will get encephalitis, which is swelling of the brain.

Others will get pneumonia. And unfortunately, when this happens in a really young baby, especially there can be lifelong issues, deafness, blindness. Measles used to be a major cause of birth defects, stillborns, and dangerous pregnancies in a pre-vaccine era. In fact, in some countries, you actually get your antibodies checked for rubella and measles before you get pregnant to make absolutely sure that's going to be a safe pregnancy. So the consequences can be incredibly deadly. And this is upsetting to communities.

And let's be really clear. One of the reasons we all have to be vaccinated is because babies under six months can't be protected by vaccination. And when those infections happen in those babies, even if they survive, they can have neurological consequences years or decades later. So to maintain a world where every baby is safe, we all of us have to do our part and get vaccinated. Jill, I wanted to talk to you about something that I know is very painful. You endured the greatest loss of all, the death of a child. What do you say to parents who feel judged or

unsure about what they should do? I want them to understand how serious these things can be. You know, we're not vaccinating against these things because they're uncomfortable or inconvenient, but because when we don't, people die. We're talking mostly about measles right now because it's very much in everyone's minds. We're seeing it exploding in our province. And I have to tell you that as a parent who has lost a child to preventable disease, it's very worrying to watch,

because I unfortunately live with the consequences of this every single day, and I will for the rest of my life. Nine years ago, we lost one of our children to a school flu outbreak. And he was vaccinated, but with the flu, it's much more challenging to establish that same immunity because the flu is so unstable. Most people who are vaccinated against the flu, if they do get sick

they'll they'll have a very mild case and a very very small percentage of people will have a severe outcome if they do get the flu after being vaccinated. And unfortunately that was our situation. We lost our two-year-old. I don't want this for other people. I don't want them to spend the rest of their lives missing somebody that they love or to lose their lives themselves because they haven't taken whatever steps are available to them.

I want them to do whatever they can to get the information they need so that they can best protect themselves and everyone around them. We did everything that we could to protect Jude, and we have some peace in that. But it's never going to be OK that he's not here. And I desperately would give anything to prevent another family from going through what

we go through every day. I want to talk about solutions, but I just want to ask you a follow-up, if I may. Thank you for sharing that. I know it's very difficult to talk about. You've tried over the years throughout COVID to tell your story and to help parents have a better understanding of vaccinations and you've also received a lot of great pushback and harm to you, but you keep doing it. How come? Nothing that anybody can say is worse than not having Jude here anymore. So it's not great.

My inbox has been the stuff of news stories. But there's nothing worse. Jude just simply isn't here anymore. He should be 11 years old. He should be going to middle school next year. And his whole life is gone because of a school flu outbreak. And that's something that you think, well, the flu is no big deal.

We have cold and flu season. You know, you go take some over at the counter meds and you're better in a few days. Except that in a typical year, 3,500 Canadians die from the flu. And so looking at what's happening right now, measles, it's so preventable. It's one of the easiest things to prevent. And so seeing these

cases rise and knowing how, knowing how devastating this can be for so many people and the long-term effects that we have no idea about just yet, it's, it's just really sad. I don't want this for anybody. I don't want people to go through something that can be prevented. And we're not going to be able to prevent every illness. It's not possible. But there's a lot more that we can be doing right now to help keep people safe. We have less than three minutes and I wanted to talk about how we move forward. Andre, you and the Global Mail were at the forefront of getting people to understand

what was going on with COVID. What needs to be done in this country to prevent the measles spreading and more families being hurt. I think part of what we're doing here is part of it is to talk about it. We have to be aware of it. I think there has to be more aggressive talk from public health about reaching out to parents, making it easier to get vaccinated. We talked about all the barriers to vaccination for people who want it. So we have to get rid of those. We have to reach out to specific communities. You know, we know that this outbreak is principally in the Mennonite community who are not anti-vaccination, but there's other issues there. So there's a whole number of steps that need to be taken and we know

what they are. We've been vaccinating children for seven years and doing it very well and we seem to have forgotten how to do it effectively and I think again we're giving too much credence to this very small loud voice that has power in places like the the US White House and we have to think of the the broader community and protecting it. And Dawn? School-based clinics. It's so simple. There are schools where there are literally hundreds of kids who aren't vaccinated. Bring the vaccines to the people so all those working parents don't have to take time off

work to try to find a family doctor, if not a family doctor, a public health unit that may or may not work with their schedule. Getting catch-up clinics in schools, I think, would be the quickest, fastest and frankly most economical way to get it done. And Jeffrey we have less than 30 seconds. My big wish is that Ontario gets a vaccine registry as we have been talking about for literally decades. That would make very many things so much easier. Thank you all for taking time out to talk to us about this. It's very important as you mentioned, Andre, for us to speak about this and solutions moving

forward because we're all in the same community together. Thank you, we appreciate your time.