The Decibel - Measles is now spreading across Canada. What’s being done?

Episode Date: May 12, 2025

Measles is spreading at an unprecedented rate in Canada. It was considered eliminated in Canada in 1998, but last week, Ontario reported 1,440 cases of the disease, Alberta reported 313 cases, and Saskatchewan reported 27. There are also cases in British Columbia, Quebec, and Nova Scotia. In April, New York State issued a travel advisory for people coming to Ontario, warning “measles is just a car ride away.”Vaccination rates are also on the decline. In Ontario, only about 70 per cent of children under the age of 7 have been fully vaccinated against measles. André Picard is a health columnist for The Globe and Mail. He’s on the show to explain how significant it is that we’re seeing these kinds of measles numbers, and how he thinks public health officials need to address this moment. Questions? Comments? Ideas? Email us at [e-mail]

We last did an episode about measles in March. At that time, there had been about 370 reported cases in Ontario since October. Last week, that number reached 1,440. In April, the state of New York issued a travel advisory for people coming to Ontario, warning that measles is just a car ride away. But the disease is spreading elsewhere in Canada, too. Alberta has 313 reported measles cases, and now Saskatchewan has 27. There's also been cases in British Columbia, Quebec, and Nova Scotia.

And this is a disease that was considered eliminated in Canada in 1998. Measles spreads rapidly. After an infected person is left an area, it can linger in the air for up to two hours. Most people who contract measles will get a cough and a runny nose, and then develop the telltale red rash. But it's the potentially dangerous complications—pneumonia, blindness, and even death—that makes this

disease a real concern. So today, we're talking to André Picard. He's a health columnist for The Globe. He's on the show to explain the significance of measles outbreaks of this size in Canada and what he thinks public health officials should be doing differently to contain them. I'm Maynika Ramen-Wilms, and this is The Decibel from The Globe and Mail.

Andre, thank you so much for being here. Hi. We're seeing a lot more measles than we're used to seeing in Canada right now. Biggest outbreak is in Ontario. So Andre, when we look at those cases, where did those measles cases in Ontario come from? Well, the outbreak started with someone coming back from a wedding in New Brunswick. There's a wedding in the fall, late October, and then it's sort of trickled up since then. So these things go in, you know, it just takes one person to travel and then measles start

spreading and then it spreads its tentacles a little bit everywhere. Okay, okay. So the New Brunswick case is spread to Ontario. We're also seeing cases across the country in Alberta, BC, Saskatchewan now. Where did those ones originate? Do we know? Usually the cases start with the traveler coming in. So the Alberta case doesn't seem to be linked to Ontario.

Saskatchewan does seem to be linked to Alberta. And Quebec was a totally separate one, another issue, another religious community. Okay. When you say another religious community, does that mean the New Brunswick one also started in that same way? Yeah. It's been linked to, and the Ontario Chief Medical Officer have talked about this, it was a Mennonite gathering, and that's the same outbreak source as in Texas.

So this seems to be spreading now in Mennonite communities. The one in Quebec was linked more to an orthodox, ultra-orthodox community. Okay. If we look at the numbers in Ontario, I mean, there's been 1,440 cases of measles reported since October. If we look at Alberta, it's now just over 300.

Can you just put this into context for us, Andre? How significant are these outbreaks in the context, I don't know, of the last few years or decades? Well, the biggest outbreak is in 30 years, easily. We usually have about 90 cases of measles a year in all of Canada, and they're almost all imported. So, there's very little domestic spread. That's what you're trying to avoid.

That's why we're in elimination status. It means that measles are not spreading domestically. Now we're going to lose that status, it looks like, because these cases are occurring within Canada, within communities. And that's what's new. And that's what's disturbing because when it starts, it's like a little fire and the fire gets bigger. The fire gets bigger. Yeah. So this is really the difference here then, the drastic increase in cases and the fact that it is spreading domestically within the country. Yeah, that's really the big issue now because little number of cases coming in every year we can handle.

That's kind of normal. How do these outbreaks compare to in other places? Like we're hearing about measles in the United States as well. How are we doing compared to them? Well yeah we hear a lot about the outbreak in Texas. Ontario's outbreak is much bigger in just basic numbers but per capita Ontario is about 21 times worse than all of the United States. That does surprise me a little bit that we are we have so many more cases than the states. Do we have a sense of why the numbers are so different or do we track them the same? Yeah, we track them in the same way

It's just that it's gotten into a community and it's spreading and there doesn't seem to be in fact very much public health Effort to stop it. That's a big frustration So let's talk a little bit more about that then, Andre. First of all, let's start with who exactly is contracting measles in Canada right now. Do we have a sense of the demographics? Well, we're being told not directly, but kind of indirectly it's spreading in Mennonite communities in southwestern Ontario and a little bit in southern Alberta. So that seems to be the source.

But we don't really have good data. We don't collect racial data. We don't collect racial data. We don't collect religious data. So a lot of this is just presumption based on when people, where people are getting infected. So measles is a reportable disease. If a doctor sees a case, they have to report it to public health and we're supposed to track where the exposures occurred and try and find people, other people who may have been exposed. So you get daily reminders,

here's where an exposure occurred, say this school or this shopping mall, and then you're supposed to go back and find people who were in that place at the same time. It's like the tracking that we probably all remember from the beginning of COVID, right? That contact tracing. Yeah, it's really standard contact tracing,

but with measles, it's more complicated because it can spread so easily and it can kind of, the virus can kind of hang in the air for a couple of hours. And do we know, is it mostly children who are getting infected or a mix? It's almost always children because they would not be vaccinated. Older people would have immunity. Older people like me, you me, if you were born before 1970, you almost certainly had the measles and you have immunity. And then after that, people loved vaccination. It really saved a lot of lives, so they embraced it.

And then in recent years, people are losing interest for a whole variety of reasons. So it's children who are mostly unvaccinated. And we're going to talk about the vaccination in a little bit, but I do want to touch on this public health response that you alluded to, Andre. Of course, we talked about Ontario was seeing the biggest outbreak. How would you characterize the province's response so far? Well, I think it's pretty limp, I would say. Very little is happening on a provincial scale.

The chief medical health officer keeps saying, well, we're doing things locally. So I know down in Southwestern Ontario around the Mennonite communities, they are doing advertising in low German. This community still uses low German, doing some outreach, but it's very, very, it seems very concentrated and very timid.

The chief, the medical officer of health, Dr. Kieran Moore said to the Globe last week, you know, that he's sensitive of the fear we've created. So he's got this worry that they're going to make people more fearful if they talk about things. And I think that's very counterintuitive. I don't think that's correct in any way. So this is interesting. You called the response timid in a way here. Is there a reason for that? Like, do you kind of get a sense of why the province would choose to do things that way?

Well, the answer they're giving us to that question is, you know, post COVID, people don't like public health as much. They don't take to the messaging. So their kind of their strategy seems to be we're going to lie low. But when you lie low, the disease is going to spread. So I see in my mail, on my social media, a lot of frustration from the general public saying, why aren't we doing more? Why aren't we doing catch-up vaccine campaigns? Ontario has a very, very bad vaccination rate

for MMR for children. Do we know what that rate is, actually? The last I saw was under 7. It's only about 70%. And just to compare, what does it actually need to be at in order to prevent the spread of measles more widely in the community? Ideally to get this so-called herd immunity, you should be above 95%. Because if you don't, there's just the chances of there are breakthrough cases, you know,

it's not 100% effective. Some people have more robust immune systems than others. And we're seeing a little bit of that. I was looking at some detail at the Ontario data and we do have some breakthrough cases. And that means people who are vaccinated getting the measles. Do we know how that happens, Andre? Yeah, there's actually, it's interesting in the Ontario numbers, about 20% of this one group about 20, age 20 to 40,

got measles even though they were vaccinated. So these breakthrough cases are really a numbers game. The more measles is spreading, the greater your risk of getting infected, even if you are vaccinated. And this is the age where people have children. So they're most exposed to the children and probably exposed a lot to measles.

So it kind of explains that anomaly in the numbers, which some people are worried about. Okay. And that really underscores then why it's so important here to contain the spread of measles. Andre, you mentioned just a minute ago that in Ontario, only 70% of children under the age of seven are fully immunized against measles. Do we know why that number is so low? People are not bringing their children to get vaccinated. That's the short answer. They're not getting their MMR. Some of it has to do with COVID. There's a whole couple of years there where kids missed out on their vaccines. We're still not catching up. A lot of people don't have doctors in these religious communities we're talking about. There's hesitation to participate in mainstream medicine. So there's a whole host of reasons

that vaccination rates are low. We talked a little bit about how this is really spreading in Mennonite communities, particularly in southern Ontario. And you mentioned how the province, you know, you said they may have a bit of a timid response to what's going on. I guess I wonder, is there a consideration here of trying to balance adequately addressing this problem

without stigmatizing certain communities? Is that a factor in how they're responding? I think so. I think there's no question they're trying to be careful. But I think it's having the opposite effect. I think we don't say one day it's spreading in the Mennonite community, and then the next day say, oh, well, we

don't want to stigmatize people. You have to be open about this stuff. You can do it, I think, in a sensible way. You can say, here's why it's spreading in these communities. Here's what we're doing special. These are not cloistered communities. They interact with the public a lot. They're just hesitant to participate in officialdom.

And again, there's good reason for this. They have a history of persecution, not only abroad that brought them to Canada, but in Canada. This Mennonite community in southwestern Ontario is quite fascinating. Actually, it's now coming from Mexico into Canada. We have fled to Mexico many years ago when there was persecution in Canada, and now they're coming back. So that's, again, that explains a little bit of how the measles has traveled as well from Mexico to Texas to Canada. Yeah. Let me ask you quickly about the strain on the public health system.

Dr. Kieran Moore, who we've said is the Ontario Public Health Officer, he said he expects to see 100 to 150 new cases every week until the summer. What kind of strain does that put on our system, Andre? It puts a lot of strain. Just the tracking aspect of measles is very, very expensive because you have to find a lot of people. There was a study published about a little outbreak in Ontario in 2015, there were only 16 cases

and that costs $1.2 million just in tracking. So data shows about $30,000 for every case of follow-up. So that's the one aspect. And the other aspect is, you know, who has a family doctor anymore? It's hard to get help. I was getting, I'm getting emails. I got a bunch this morning from doctors saying, people are coming to me to ask for the measles vaccine. I don't have it. I'm measles vaccine. I don't have it.

I'm a family doctor. I don't have it. I don't have the time to give it. So we should be having clinics. You know, that's what you do when there's an outbreak of a childhood disease. You have clinics. Publicly, you have nurses do the catch-ups.

And we're not doing that. So there's going to be more strain on the system. You know, in Saskatchewan yesterday, they announced that they had 15 new cases in the last week. And their chief medical health officer said, this is a disaster. This is a big deal, 15 cases. Ontario's averaging about 200 a week.

Wow. You mentioned Saskatchewan. I also want to talk about Alberta, because we are seeing a large number of cases in this province as well, over 300. How has that province responded to this? Well, they've been very quiet. They've had an interim chief public health officer for years now since COVID. So there's some issues there with public health and the government of Daniel Smith. But to their credit, Alberta has just announced a new campaign last week

to talk about measles and the need for vaccination. They're doing some catch-up clinics but only in specific areas but I think we're going to have to see broader availability of clinics. We'll be right back. Okay so Andre we talked a little bit about, but let's actually focus in on this because you mentioned how our vaccination rate is kind of not up to par where it needs to be to stop the spread of measles here, at least in certain provinces. What kind of vaccine legislation do we have in Canada right now? What is the standard? There's only two provinces that make it mandatory for children to get a whole series of childhood

vaccines to go to school or to daycare, so Ontario and New Brunswick. provinces that make it mandatory for children to get a whole series of childhood vaccines to go to school or to daycare, so Ontario and New Brunswick. And then Manitoba has interesting legislation that makes measles vaccine mandatory. The others, there is no legislation. That's interesting. So the only two provinces have that at the provincial level. So what do the other provinces do in order to, I guess, track this or make sure people are getting vaccinated?

Well, it's done more on a local level. Like some schools will say you have to bring in your forms. They've taken the approach that we won't legislate. And to be fair, you know, where there is legislation, you're allowed to opt out. So you can opt out for religious or philosophical reasons. And as many people have pointed out, and I've done this in columns, what exactly is a philosophical objection to vaccination? I don't even know what that means. Does it mean I don't mind when kids get sick and die? That seems an odd philosophy to me. But I guess it is there to give people the freedom of choice, I would imagine, though. You know, it's making it a law that's not really a law because you can opt out of it so easily. I think it's just hypocrisy to be honest.

We know some people are hesitant to vaccinate their children because they're worried about potential side effects, right? And in most cases here, these are people who wanna do the best thing for their kids. But can we just do a quick fact check here, Andre? Like if we're talking about potential side effects of the MMR vaccine, which you get for measles, versus actually getting measles,

how do those two things compare? Yeah, there's really no comparison. The MMR is one of the oldest, safest vaccines and measles in particular is probably the most effective vaccine ever created, quite safe. The only side effects are really kind of minor ones. You may get a little fever afterwards, not feel well. So pretty basic stuff.

Whereas measles, you know, most people, they get it. It's unpleasant. You get a rash, you get a runny nose, you get a headache, a fever, and they get better. But a small percentage, the fever is the bad part. So fever can cause all kinds of bad things. Meningitis, before vaccination, measles was the principal cause of blindness, of deafness, of cognitive delay in children. And then there were some deaths. Not a lot of kids die, but death is

not the standard we want to look to. We want to get look at the morbidity. What's the danger here? And it's pretty grave for children. And then the other part of it is we know that measles attacks the immune system. And even if you've had a mild case of measles, you're going to become susceptible to other childhood illnesses because it damages your immune system. And then finally it can come back a few years later and be very, very grave illness. It kind of has this, it lingers in your system for a while and some children actually die years later because of measles.

So what you're saying there is even if you know the initial infection then maybe is not too rough, it actually could have effects later on for your immune system down the road. Yeah, it's very bad news. It's very similar to, you know, we talk a lot about long COVID, but we know this long COVID effect exists with every infectious disease. There is some people who have long-term consequences because of a fairly minor infection. And this is well established with all viral illnesses. And we're seeing it with COVID, especially because so many people got infected.

We talked a little bit about vaccine hesitancy. Let's also address disinformation here, Andre, because we've seen this a lot in the health sphere in the last few years. Is there something that we as the media or is it maybe more public health messaging can do to kind of combat the disinformation that's out there, specifically when it comes to measles? Yeah, I think the public health in particular has to be more aggressive about countering can do to kind of combat the disinformation that's out there, specifically when it comes to measles. Yeah, I think the public health in particular has to be more aggressive about countering false information.

We all know RFK Jr. in the US. This is an anti-vaxxer in a position of great power who says things that are shockingly untrue every day. He's the Secretary of Health and Human Services in the US. Yeah. Yeah. And he said last week that the measles vaccine is made with aborted fetal tissue. There's no truth to that whatsoever.

There's a long complex story about some fetal tissue being used decades ago, but it's nowhere near the vaccine in any way now. So things like that make people hesitant. Another issue is people just haven't seen these illnesses. You know, if you are of a generation where everyone in your class had this, where some of them didn't come back,

you remember this stuff. You don't have to convince someone like me to vaccinate. But when people haven't seen it, and then they hear, oh, the vaccine's dangerous, then they are hesitant. And again, like you, I think it's really important to underscore that I believe that everybody wants the best for their children. These are not awful parents. These are

people who are not fully informed, people who are scared and not making the right decisions, and we're not helping them make the right decisions. If an individual is encountering disinformation, I guess, on a personal level, what's the best way to respond? Like, how does someone, I guess, deal with that? Yeah, I think it's important to not stigmatize people. It's important to not say, oh, you're stupid. You don't know things. I think it's just talk them through, well, here's why I got my kid vaccinated, because

I think the dangers of this illness are way worse than any risk of the vaccine. We know that the most effective disinformation counter is peers. So you really listen to your peers more than you listen to experts. We're in an era where we don't like experts anymore. That's fine. But peers have a real influence. So the problem is people are hesitant, hang around with other people are hesitant, and it confirms their biases and their fears. Is there anything, Andre, that you would like to see public health officials do specifically when it comes to dealing with measles?

Like anything that they're not doing right now that you think would actually benefit the public? I think we really need to do public clinics, you know, to make it available to children. I think we have to do what Albert is doing, sort of large-scale public information clinics. Here's why vaccines are important. Just really basic stuff, just to put that bug in people's ears, to make them think about it. I think a lot of vaccination now is just not happening out of people are just forgetting or they're

busy. We make it difficult for parents to get their kids vaccinated. How do you get to the doctor if you have a low paying job and you can't get off work and you don't have childcare and you don't have a doctor? We make it really, really difficult. We used to do vaccinations in schools. We don't tend to do that anymore. That would help.

Better data. A lot of people don't know if they're actually vaccinated or not. You know, unless you have your little ratty little yellow booklet, people of a certain generation have terrible electronic records. I've written for 30 years about the need for a vaccine registry. This is a very simple technology that most countries have, and we don't have it. So just very lastly here, Andre, on that point, like if people are concerned, maybe their vaccine is not up to date, what can they do?

What's their best way to address this? Well, I think, you know, it depends on your age and your status. So for kids, if you can get an appointment, go to your doctor, make sure they're vaccinated, check out their, if you have some form of vaccine record, make sure they have their MMR. And if they don't go get it caught up. If you're born before 1970, pretty well, don't worry about it. You probably are at little risk, but if you are, if you have an immune deficiency of some

sort, you can get a, you can get a booster. You can get another MMR. It's not going to hurt you to get an extra one, except that we don't want to take the supply away from people who really need it. The group that's really the most at risk of measles is pregnant women. It can really harm the fetus, it can cause miscarriage in a very large percentage of people. Young children under the age of one are really at risk. We don't generally vaccinate till one year. And now we're doing some at six months in Ontario

because of the danger, but those are the real categories of people who have to be really careful. And then there are some people who cannot get the vaccine. They have certain immune deficiencies, they have cancer. Those are the ones we have to protect. What I find really sad about what's happening is I think what we're seeing is kind of a breach of the social contract. The social contract is we should be protecting children.

That's what we should all be doing. And part of that is getting vaccinated. And if we're not doing that, society has a lot of much bigger problems, I think. Andre, always good to talk to you. Thank you for being here. Thanks. problems I think. Andre, always good to talk to you. Thank you for being here. Thanks.

That was Andre Picard, a health columnist for The Globe. That's it for today. I'm Maynika Ramon-Welms. This episode was edited and mixed by Ali Graham. Our intern Kelsey Howlett helped produce this episode. Our associate producer is Aja Souter. Our producers are Madeline White, Michal Stein, and Ali Graham.

David Crosby edits the show. Adrian Chung is our senior producer, and Matt Frainer is our managing editor. Thanks so much for listening, and I'll talk to you tomorrow.