The Decibel - Why measles infections are surging again

Episode Date: March 6, 2024

Measles cases have been popping up all over the world, including in Canada. This highly contagious virus can be devastating – and even deadly – to people who haven’t been vaccinated against it.The Globe and Mail’s health columnist André Picard explains why we’re seeing this sudden rise and what can be done about it.Questions? Comments? Ideas? Email us at [e-mail]

We're past the peak of cold and flu season, but there's another respiratory virus causing alarm. Measles. The WHO says that 49 countries currently have large and disruptive outbreaks. And if you're not vaccinated against it, this highly infectious disease can be deadly. Andre Picard, The Globe's health columnist, is on the show to explain why we're seeing this resurgence and what can be done to get more people vaccinated. I'm Mainika Raman-Wilms and this is The Decibel from The Globe and Mail. Andre, thank you so much for being here today. Hi. To start, I was hoping maybe you could just take us back in time a little bit and paint us a bit of a picture.

What were things like before there was a vaccine against measles? Well, back in the old days, so when I was a child, measles was a big deal. Everybody got measles and, you know, 100,000 people a year in Canada, even though the population was much lesser. Every child would get measles at some point and some of them would get really gravely ill and some would die. We would have about 50 to 100 deaths in Canada, even in the 60s when we had relatively good medical treatment. Wow. And what is it like to have a measles infection? What happens to you? Well, you know, most people who have the measles will have fairly mild illness. They'll have these telltale red spots that look a little unseemly. If you've ever seen it, you recognize them right away. But the danger is the fever that comes along with this. So the fever can cause blindness. It can cause deafness, it can cause developmental

disabilities. This used to be the number one cause of all these illnesses in children of these disabilities was measles. And then there's another thing which we've discovered fairly recently is a concept called immune amnesia. And it looks like measles damages the immune system and actually leaves you susceptible to other infections. So once you like measles damages the immune system and actually leaves you susceptible to other infections. So once you have measles, you can get all these other childhood diseases more readily. And there's even a form of neurological damage that we know comes back seven, eight years after kids are infected, and it's deadly. There was a case of this recently in the US where a child, you know child had measles, was very sick,

was perfectly fine for seven years, died almost suddenly. So this has long lasting effects on the body. And do we know, what's the death rate on this disease? The death rate is fairly low, thankfully, because we have, especially now, we have better treatments for fever, but it's the sequela, they say. So other things like the deafness, the blindness, these things are hard to prevent because they happen quickly. And how exactly does this virus spread, Andre? It spreads really, really easily. It's airborne.

It also sticks around. It's one of these unusual viruses. You can actually get infected about an hour after someone leaves the room. So it just hangs around on surfaces in the air. So it's highly, highly infectious. So when, again, when I was a kid, if there was measles in a class, everybody had measles. It happened really quickly. Nothing compares to measles. So on average, 12 to 18 people will get infected if someone in the room has measles. With COVID, it would be one to two. Okay. And obviously, if you're unvaccinated, you're at risk. But I mean, does that mean there's no risk for people who are vaccinated? Where do we stand with that? It's not no risk. It's not

zero, but it's a really highly effective vaccine, 95 to 97% effective. So it's very unlikely you get infected if you're vaccinated. And the most fascinating thing about this is that the vaccine works forever. So people who got, you know, vaccinated in the 1960s, they still have protection. This is not a virus that mutates, that changes. It's very different from COVID. So it's very stable. So anybody who's been vaccinated, who's had their two shots, or who's been infected, they're pretty well not going to get measles again. And when do people, kids usually tend to get the vaccine now? They get it after age one. So you don't get it before that because

your immune system's not developed enough. So you get it as part of the MMR vaccine, measles, mumps, rubella. And then you get a second shot a little later. And this being Canada, that depends on the province. Every province is a little different. We talk a lot about with COVID, people who are immunocompromised being at higher risk. Is that also the case with measles? Yes. Immunocompromised people, pregnant women especially, there's a lot of danger. It can cause miscarriage. It can cause your child to be born with deafness or blindness. So it is very dangerous to pregnant women, especially in immunocompromised. There's very few deaths now in the world, but the one death that happened recently in Europe was a 26-year-old who had an immune condition. So it is a real

live risk today. Well, so let's look at the rise in cases that we've been seeing over the last little while. Where are we actually seeing these little cases popping up here, Andre? Well, we're seeing that this is mostly a problem in the developing world. So the big countries, Yemen, Azerbaijan, Kazakhstan, India, Ethiopia, those are all the big ones. But then we're seeing significant outbreaks around Europe, the UK, France, for example. So lots of places that Canadians travel. The US has a record number of cases as well, mostly concentrated in Florida. And the situation in Florida is also special too, because a lot of these kids have not

traveled abroad, right? And that's usually where we see the disease these days is when we travel abroad, right? But they actually, they got it in Florida. Yeah, as far as we know, we don't really know the index case. The first child identified hadn't traveled. So that shuts off alarm bells. So that's why Florida is really, people are really paying attention. Very unusual since the 90s that there's any domestic spread of measles. Can we look at the broad numbers here, Andre? How big of an increase in the last few years are we talking about when we are looking at measles cases? Measles back before the vaccine killed about 2.6 million, mostly children,

every year. So one of the biggest childhood killers ever. And then that dropped steadily after the vaccine right till 2019, where we were down below 90,000 cases. We're talking seriously about maybe this disease can be eradicated because it doesn't have an animal host. So in theory, we could get rid of it, never see measles again. But then during the pandemic, there's been this huge resurgence. So we're up this year to I think 136,000 deaths last year and 9 million cases that we know of. So very, very high numbers. And that's a dramatic increase. So over two years, a doubling of cases. Of course, we should talk about Canada because we're also seeing cases here. So Andre, what's the situation in Canada? Well, in recent days, we've seen a jump in cases. As of Tuesday afternoon,

we have 17 cases in four provinces. So that's significant. The epicenter seems to be Montreal. There's 10 cases in the province of Quebec, most in Montreal and the surrounding area. And again, only three of those cases are linked to travel. So that is very concerning. It tells us that this is spreading, and again, probably more widely than we think. Then we have a really interesting case in Ontario, where it's a man in his 30s who's infected. He was actually vaccinated, but he's linked to a high school. So there's been very wide exposure. So people are watching that one really carefully. And so we've got Ontario, Quebec, and then there's also cases in BC and then a case in Saskatchewan, if that's right? Yeah. And both of those are travel related,

so not as concerning. But BC, first case since 2019. So that's the first case in five years. And that's in a province where people travel a lot, where there is one would think exposure. So again, it suggests bad things are happening. So this is a unique situation for Canada, Andre, right? Because this is not something we had to deal with for a long time, right? Like there was a number of years where we didn't really think about it. Yeah, we essentially eliminated measles a long time ago, which means no domestic transmission. Now, of course, there are flare-ups every couple of years, something happens. There was actually a big outbreak after the 2010 Olympics in Vancouver, again, linked to international travel, but it got into the community, it spread.

What's going on now is a bit different because it is happening in multiple places, community transmission in different provinces. That's why it's different. We already have more cases this year than we had all of last year. There were only 12 last year. We're up to 17 already. Wow. So, Andre, while the overall number of cases in Canada is currently small, you know, 17 doesn't seem like a big number.

We've talked about how contagious this virus can be. So, Andre, I guess how concerned should people be? I think everyone should make sure they're vaccinated. This is an extremely contagious illness. Once it gets into a community, it can go really fast. Now, the good thing in Canada is we still do have very high vaccination rates. So we have this very concerning case in York Region, outside Toronto, but we learned that 95% of kids in the high school where the exposure happened are vaccinated. So that's really good news. But there's still that opening, that 5%. We know in Montreal, Montreal is probably the

most concerning. We know that the data published there in some schools, they have vaccination rates as low as 30%. So if the measles gets into a place like that, into a school like that, it can really spread like wildfire. And of course, we're talking now as March break is just around the corner in much of the country, so people are going to be traveling. This, I would imagine, is also something people should be thinking about. Yeah, absolutely. You know, there's this eerie parallel for me to going back to 2020, where March break in Quebec, this is what set off COVID in Canada, right? Quebec always has an early March break. They go to Florida where there was COVID. Now they're going to Florida where there's measles.

There's a lot of eeriness that makes me real, have a lot of trepidation about what's coming. We'll be right back. OK, Andre, let's talk about the big question here, which is, you know, the reason for this increase. So why are we seeing so many measles cases right now? Well, it's a few reasons. One of them, it has to do with the pandemic. Public health was overwhelmed in much of the world. So people were locked down. They were not going to their doctors, et cetera.

So a lot of kids missed their vaccination, millions around the world. So you got to do this. Every kid has to be vaccinated at one and then again a few years later, or else they'll get measles. So we missed a lot of kids. So that has created this opportunity. So that's what's happening in the developing world. A huge spread because of unvacc of kids. So that has created this opportunity. So that's what's happening in the developing world, a huge spread because of unvaccinated kids, people who want to be vaccinated, but they weren't able to. Then we have North America, Europe, which is a totally different

situation where we have people shunning vaccination for a whole host of reasons, misinformation, belief that their immune system is magic, et cetera. And then they're getting measles because of their rejecting the vaccine. So there's kind of this double track thing going on. I want to ask you a little bit more about vaccine hesitancy. I mean, we've talked about this a lot during the pandemic, but hesitancy around the measles vaccine actually goes back before that. Can we talk about when and where the elevated fears specifically around this vaccine came from? I think there's a mixture, again, of a couple of things. There's, I think, just kind of an indifference. People now, you

know, if they're younger than me, they haven't ever seen measles. They take it for granted. This is the classic public health paradox. When public health works, people take it for granted. Vaccines are a classic example of this. People say, why should my kid get a measles vaccine? I've never seen measles in my life. You know, I'd rather not, my kid not get a needle. So that's most parents who are not getting their kids vaccinated. It's that. It's not malicious. It's just kind of like, I don't think this is a problem. And then there's a very small, loud minority that's like, oh, vaccines are bad, they're poison. And that kind of filters over to the other hesitant group who goes, yeah, maybe I should just hold off on this. So it's kind of this mixture. Most people, you know, I'm of the belief that everyone wants the best for their

child. I don't think anyone's doing this maliciously. And with this vaccine, too, I mean, there was this false link to autism that people maybe still are thinking about or have this connection in their mind as well. Yeah, we call that the so-called Wakefield effect. So Andrew Wakefield, who published this paper, which ended up being exposed as a fraud. And it's interesting history, that paper. He linked, he said, people who get MMR vaccine, it raises the risk of autism. This scared a lot of parents. And it turned out that, well, why did he publish this? Because he ironically had developed his own vaccine, which he wanted to sell. He wasn't anti-vaccine to begin with, but he's kind of gone into that camp and he's done untold damage. And the

interesting thing, if you do the math, it's the children of Wakefield who are now having babies. And they grew up in this era where they were told, oh, you can't be vaccinated, you'll get autism. And now they're having kids and they're having that same perspective. And it's kind of a second generation of vaccine hesitancy. Yeah. Okay. So not getting vaccinated for a variety of reasons, either the hesitancy or the access. This seems to be the center of the issue here. So, Andre, let's talk a little bit about the vaccine. How exactly does the measles vaccine, which is usually the MMR vaccine in Canada, how does that work? So this is an inactivated vaccine. So there's no real measles virus. It just simulates it. So you trick the body into thinking it's been exposed to

measles. It creates antibodies. And then you have this shield up for, in the case of measles, the rest of your life. So it's pretty simple technology. So it's essentially kind of, I guess, in a way, triggering your immune system, basically preparing it for when it does encounter the virus. Exactly. And unfortunately, this has led some people to believe they say, well, then it's just better to get infected, right? And yes, you will have protection from infection, but then you'll have the additional risk of, well, maybe your kid will get gravely, have a bad fever. Maybe they won't be that sick, but you'll still miss five or 10 days of work. So there are consequences to so-called natural immunity. There's this mythology that

getting infected naturally, and I use that word in quotes, is better than from a vaccine. And it's not true. They're equally effective, but only one of them has potential harms. Do we know about vaccination rates in Canada for the MMR vaccine? Do we have those numbers, Andre? We actually have terrible data. Unfortunately, we don't have a national registry of vaccination. So we have provincial data, sporadic, a few years old. So we do know that vaccination is dropping a little bit, especially post-COVID, just out of practicality, people couldn't get to their doctors. But then there's that little element. So the anti-vaccine sentiment is in

pockets. So that's where the real danger lies. So there have been outbreaks of measles in Canada over the years. They're almost always in religious communities. Some Orthodox Jewish communities that don't believe in vaccination. They've had big outbreaks in Quebec, in New York City. We've seen it among some Amish communities where they don't believe in vaccination. That's where measles usually happens. But the new thing is we're seeing in mainstream communities like in Florida that it's happening. So that's a whole other element. It's pretty easy to contain those religious communities because they're very insular. But when it gets into a broader community, it becomes a whole other challenge. And how much of a community needs to be

vaccinated to keep measles at bay? Like, is there a threshold or a tipping point here, so to speak? Yeah, they say for herd immunity, it should be up around 95%. So just about everyone should be vaccinated. Otherwise, you have sort of holes in the armor, if you will. How much of a population worldwide needs to be vaccinated before we can declare that this virus has been eradicated? Do we have a threshold there? Oh, it certainly would have to be 100%. We have to get everyone vaccinated. We've eradicated one disease in history, smallpox.

We're getting close on polio, although that one's backsliding a bit because of COVID as well. You really have to get everyone and you have to stop it from circulating in the community for a few years. And then once that's done, then it's gone forever. So, I mean, Andre, given the current rates of vaccination and like we've just talked about some people's hesitancy here. Can we eradicate measles? Is that still possible? So this is possible, but it's probably not going to happen in the short term. There are other issues, other challenges in the world.

But what we can do is we can eliminate it. So Canada officially eliminated measles back in 1998. And that means there was no in 1998. And that means there was no domestic spread. And that's been the case for a long time. Almost all our cases are imported from other countries. And then we have these small sporadic outbreaks in unvaccinated communities that are usually easy to control. So I think in the short term, that's what we have to do is try and eliminate it everywhere, stop the spread, and then it makes something like eradication much, much easier. What can health officials do to get people comfortable with vaccinating their children?

You know, I think it's just some hard work. I think public health, unfortunately, is kind of old-fashioned in its communication ways. They kind of operate like the clergy. We're going to tell you this is good and you should do it. And that's not how modern life operates. They have to engage more. They have to, I think, challenge anti-vaccine forces who are very good at communication, who are very organized. And they are very self-interested.

They're usually selling so-called alternative products to prevent illness, making a lot of money off it. You know, we have to realize why people are doing this. I would say the most unfortunate thing is the most effective way to get people to vaccinate is when there starts to be death and people see it as a reality. And I hope we don't get to that, but I think we're going to see something like that in Florida. Sometimes you pull kids from school if they're not vaccinated. Could this kind of be used in a way as, I guess, another point of encouragement? Well, there are vaccine mandates of various sorts.

Canada doesn't tend to have mandatory vaccination, but we have, you know, before you go to school, you have to show that you have vaccine. If you're not vaccinated, you could be excluded from class if there's a disease that pops up. So there's various rules, but there's a real push. And this, again, this is related to COVID. People really hated lockdowns. They really hated school closures. So there's a real movement to get rid of any rules around vaccination. You know, it's this classic individual versus the collectivity. Who do you protect? And that's actually the most disturbing thing about what's going on in Florida is the Surgeon General of the state saying, oh, no, kids who have measles, they can go to school. Kids who are unvaccinated,

they can go to school because, you know, that's about freedom. It's all up to parents to decide. And it shouldn't be up to individuals to decide. We should be protecting this group of children and not just allowing people to do whatever they want. Just to end here, Andre, I want to come back to something you mentioned earlier about the public health paradox, really, at the center of this problem, which is that, you know, measles was so effectively controlled because of the vaccine. And because the vaccine has worked so well, people have forgotten how bad the measles are. So I guess, are you worried about this happening with other diseases potentially as well? Oh, it's absolutely happening elsewhere. We're seeing a rise in all kinds of things. We're seeing outbreaks of whooping cough.

There's a big outbreak of syphilis now. These are medieval diseases that we've controlled for a long time. It's even happening with AIDS. We've been so successful at treating AIDS that a younger generation now is like, they don't worry about that. And the offshoot of that is syphilis because people aren't practicing safe sex anymore. People forget. They have very short memories, out of sight, out of mind. And this is unfortunate. And there are real consequences to it. Andre, thank you so much for taking the time to be here today. Thanks. Always a pleasure. And a little note before we go. This week, The Globe and Mail is celebrating its 180th birthday. The Globe has

always worked to provide journalism that matters, and we want to thank you for supporting The Decibel and The Globe and Mail. Okay, that's it for today. I'm Maina Karaman-Wilms. Our producers are Madeline White, Cheryl Sutherland, and Rachel Levy-McLaughlin. David Crosby edits the show. Adrian Chung is our senior producer, and Angela Pachenza is our executive editor. Thanks so much for listening, and I'll talk to you tomorrow.