How Canada can regain its measles elimination status

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TORONTO — Infectious disease experts say Canada’s loss of measles elimination status shows how badly investment is needed in public health, rebuilding vaccine confidence and solving the primary care crisis.

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On Monday, the Pan American Health Organization (PAHO) revoked the measles-free status Canada has had since 1998 because an outbreak of the virus across several provinces has lasted for more than a year.

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Dawn Bowdish, an immunologist and professor at McMaster University, said cuts to public health funding, the lack of a national vaccine registry and a shortage of family doctors — all while misinformation about vaccines is circulating widely — have contributed to the rise of measles.

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“There’s no two ways about this. This will take money — a lot of money — and a lot of investment. And it will take a lot of political will,” Bowdish said

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Public health workers don’t have the resources they need to do enough vaccination outreach to communities and bump up surveillance to quickly identify cases and stop transmission, she said.

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Not having a national vaccine registry means many people can’t easily find out if they’re up-to-date on their immunizations if they were vaccinated in another province or country, Bowdish added.

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Matthew Miller, scientific director of the Michael G. DeGroote Institute for Infectious Disease Research at McMaster University, said a national vaccine registry would be “the Holy Grail,” but setting up electronic provincial registries that can share data with each other would be the next best — and possibly more realistic — thing.

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In addition to showing where there are gaps in vaccination, the registries could help parents stay up-to-date on their children’s immunizations by sending automated reminders, Miller said.

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“Although it is the case that a lot of measles transmission is happening in under-vaccinated communities who are specifically vaccine-hesitant or anti-vaccine, there are lots of people who miss shots not because they’re anti-vaccine but just because they forget.”

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Completing a national electronic vaccine record system would be an important step for Canada in its fight against measles, said Dr. Daniel Salas, executive manager of PAHO’s Special Program for Comprehensive Immunization.

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The Public Health Agency of Canada is currently working with the provinces and territories on a system called STARVAX that would produce standardized reports on vaccination. At the moment, the system only includes five provinces and one territory.

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The primary care crisis in Canada is another challenge that needs to be addressed to improve measles vaccination, Bowdish said.

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If families don’t have a primary care doctor or nurse practitioner, their kids are at risk of missing vaccinations since pharmacies don’t do measles, mumps and rubella immunizations for very young children, she said.

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“Inevitably, if you don’t have good consistent care, these are the kind of things that get dropped.”

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Measles, one of the most contagious diseases in the world, requires 95 per cent vaccination coverage to obtain herd immunity.

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Bowdish said tougher enforcement of school vaccination policies, essentially restricting exemptions to valid medical reasons, is critical to stopping the spread.