In 1986, Roald Dahl, the famous children’s author, wrote a letter to British parents sharing his eldest daughter’s tragic story. Olivia caught measles in 1962, when she was 7. Dahl described how just when he thought she was getting better, one morning everything suddenly changed.
“‘Are you feeling all right?’ I asked her.
‘I feel all sleepy,’ she said.
In an hour, she was unconscious. In twelve hours, she was dead.”
Olivia had developed a rare measles complication called encephalitis or brain inflammation.
When it’s your child, “rare” becomes irrelevant. A year later, in 1963, the first measles vaccine was licensed – a measure that likely would have saved Olivia’s life.
When Dahl shared Olivia’s story in 1986, Britain was seeing close to 100,000 cases of measles a year, yet parents were choosing not to immunize their children.
Over the past 50 years, the World Health Organization estimates that essential vaccines have saved more than 150 million lives globally. “That’s six lives a minute, every day for five decades.”
Sixty per cent of these lives saved are from measles vaccination. The outsized effect of measles vaccination on mortality comes from both preventing measles deaths and infectious diseases-related deaths. By infecting long-lasting memory cells, the measles virus causes Immune Amnesia for two to three years. It wipes out anywhere from 10 to 70 per cent of a person’s antibodies to other diseases that were acquired through immunization and infections.
As one person wrote, “Measles destroyed my health – my parents didn’t vaccinate me.”
“I got every single illness going for the next five years or so. I was ill for almost the entirety of my first year at uni with coughs, colds, tonsillitis, chest infections, ear and kidney infections. I had no defence against anything.”
At the population level, failing to contain measles outbreaks will open the door to many more infectious diseases as the recently infected join the ranks of the vulnerable.
What Dahl was describing in 1986 was vaccine hesitancy, a delay in acceptance or refusal of vaccines despite their availability. The ongoing COVID pandemic has made vaccine hesitancy worse. The explosion of misinformation and disinformation on social media has hindered public acceptance of vaccines tremendously.
Unfortunately, vaccine hesitancy is in the news again with the global resurgence of measles, including a large outbreak in Ontario with more than 1,400 cases and another one in Texas spilling over its borders. Sadly, one adult in New Mexico and two children in Texas have died. Last year, a child in Ontario died. All were unvaccinated.
Alberta is also in the midst of a measles outbreak. As of May 12, there were 365 cases, the majority amongst children under 18 years of age. Of those, for cases where immunization status is available, 95 per cent are un- or under-immunized (single dose of MMR vaccine).
Even back in 2023, Alberta’s health surveillance dashboard was showing measles immunization rates (two doses by age 2) as low as 10 to 30 per cent in some rural portions of the province. These numbers are frightening – like dry kindling waiting for a spark, these communities are highly vulnerable to a fast-moving measles outbreak. Such an outbreak will have been a predictable – and preventable – tragedy.
In 1998, Canada eliminated measles through vaccination, surveillance and a community immunity rate above 95 per cent. For this reason, many have never seen measles, making it easy to underestimate its impact.
Measles is the most contagious disease known – one infected person can infect 12-18 others (for the Omicron COVID variant, that number was seven), seeding an explosive, exponential chain of infection. Measles, like SARS-CoV-2, spreads through tiny infectious particles called aerosols that linger in the air we breathe even after the infected source has left the room. In a classroom with poor ventilation and air filtration, one infectious student can infect up to 90 per cent of susceptible classmates. Frustratingly, parents’ pleas for clean air in schools and childcare settings have been stonewalled.
It is precisely because it is so contagious that measles elimination requires such a high vaccination rate. High community immunity (95 per cent or more) is needed to protect all those who cannot be immunized – infants less than 6 months, people who are pregnant and the immuno-compromised. A “you do you” approach to measles vaccination is incompatible with public health’s role. And yet public health has taken a laissez-faire approach at this critical juncture, essentially enabling vaccine hesitancy at a time when we can ill afford it.
An earlier outbreak in New Brunswick last fall helped seed the outbreak in Ontario, which itself contributed to measles in Alberta. Where will it go next? Ironically, Mexico has just put out a measles travel advisory for the U.S.A. and Canada. We should take that as a vote of no confidence in our public health.
For months now, both Ontario and Alberta should have been all hands on deck and pulling all stops to urgently contain outbreaks. With exponential growth and low vaccination rates, even small delays in responding to an outbreak can lead to a much larger problem, making public health’s task more difficult and more expensive.
Yet, there has been little sense of urgency among public health leaders. In Alberta, it took the abrupt resignation of the Chief Medical Officer of Health Mark Joffe and his scathing Op Ed along with three children in intensive care for Health Minister Adriana LaGrange to finally announce a province-wide immunization campaign. It is vital for public health to level with the public now about the dangers of measles, and the risks of vaccine hesitancy.
Recent modelling from Stanford University researchers showed what a return of endemic measles would look like in the U.S. Even a small decline in vaccine uptake would lead to eleven million measles cases and tens of thousands of preventable deaths over the following two-and-a-half decades. Endemic measles is a nightmare scenario, even without accounting for Immune Amnesia. With measles, there can be no complacency.
Back in 1986, Dahl closed his letter: “I know how happy she [Olivia] would be if only she could know that her death had helped to save a good deal of illness and death among other children.”
No parent should have to bury their child because of measles. Unfortunately, politicizing public health by downplaying the risks of measles and normalizing vaccine hesitancy puts us on precisely this trajectory. It is a future we should seek to avoid.
A version of this article was first published May 10 in the Surrey Now-Leader and has been updated with the most recent available statistics.
