In 1998, Canada celebrated a huge milestone. We became one of the first countries in the world to eliminate measles.

27 years later, things are dramatically different. And that's because one year ago, in New Brunswick, measles made a reappearance.

What started as one case quickly spread across the country and has continued to spread for a full year.

Now pay attention to that one year mark because it's important.

According to public health, if the chain of transmission can't be broken in a year, it means a country can no longer call itself measles-free.

Canada's status will officially be determined at a meeting next month.

Now, we have had outbreaks since 1998, but we've always been able to break the chain of transmission.

But not this time. Spread has been slowing, but it's still making headlines like possible exposures this month in Ottawa and Alberta recently reported its first measles death since the outbreak began.

So how did we get here and what would it take to make measles a disease of the past? Again, welcome to "The Rundown."

Measles is the most contagious disease in the world, so how can we stop the spread?

In the latest episode of Unravel the TVO series that unravels key issues happening in Ontario and across the country, producer Sangeeta Patel takes a look at herd immunity and how we build it.

Diseases never really disappear. They just stop spreading because we make it harder for them. That's the idea behind herd immunity.

When a community is protected from infectious diseases because they can't easily spread from person to person.

So how do we actually get herd immunity?

Herd immunity has been a big goal of public health ever since vaccines were invented.

The idea is when enough people get vaccinated, or they've already had the disease and built up some immunity from it, it stops the spread.

But here's the thing some diseases can reinfect people.

So really, the ultimate goal isn't herd immunity. It's elimination where we get rid of the disease from the community altogether.

Experts suggest the way of doing that is to vaccinate everyone who can safely get the shot.

That way, we're not just protecting ourselves, we're protecting newborns, people with weakened immune systems, and the elderly, too.

And Canada's actually done this before. We've eliminated diseases like smallpox and polio.

But like any chain, we're only as strong as our weakest link.

And when it comes to measles, we've lost our gold standard elimination status.

We earn that back in 1998, thanks to our strong public health and vaccination program.

So if we lose that collective protection, what happens then?

Well, disease can spread through the community again.

And with something like measles, it spreads fast.

It has a really high infection rate, especially because it's airborne.

That means if you come into contact with someone who has it, there's a really good chance you'll get it too.

And it's not just the infection itself that's the problem.

Measles can lead to complications. Things like respiratory failure, brain swelling, hearing loss, vision loss, or even death.

So here's the bottom line herd immunity isn't just a science term, it's a social contract.

Vaccinations can not only protect the person getting the shot, but others in the community as well by preventing the spread.

Because the moment we let our guard down, diseases remind us they've never really gone away. They've just been waiting for an opening.

Since Canada officially eliminated measles in 1998. We've had outbreaks, but never one like this.

So how did this outbreak get bad enough for us to lose our elimination status, and where did it come from?

Those questions took the Globe and Mail's Nathan Vanderklippe from Thailand to New Brunswick to Texas.

I sat down with Nathan and immunologist Dr. Dawn Bowdish to find out what we can learn from tracing the virus.

Dawn, thank you so much for joining us in our temporary studios, and Nathan, for joining us on the line from Spain.

Dawn, it's been one year since the measles broke out in Canada, causing the country to lose its measles elimination status.

It sounds like a pat on the back for a lot of us that that was something that that we held.

But break it down. What does that actually mean?

Well, it means we're on a list of countries that are torn apart by war or that don't have good public health, and none of our G7 contemporaries are on that list.

It shows that there were multiple systems that broke down to have this happen, and it also shows that we have a lot of work to do, because if we haven't been able to shut down these outbreaks in a year, it shows that we're going to have to invest a lot in our public health system so that this stops and ends and doesn't happen again.

I think I know the answer to this, but avoidable.

Completely avoidable.

I mean, we had that that status for almost 20 some odd years.

And and the only way to get out of a measles outbreak is to have everyone vaccinated.

It's just that contagious.

And every time a new baby is born, we've got new vulnerable people in our population.

So our focus is going to have to be on getting those vaccination rates back up to get off that really problematic list.

When we talk about vaccination, let's be clear. What is the the rate if someone gets the vaccine, can they is it 100%?

No, it's not 100%.

But as with most vaccines, if you are vaccinated, it's thought that it will modify the disease, make it less severe.

So, yes, there are cases of adults who got vaccinated a long time ago, but most of the cases, over 90% of the cases are in either people who never were vaccinated or people who were only had one dose hadn't got that second dose yet.

Nathan, you travelled 40,000 kilometres around the world to track how measles got to North America.

Before we get into where you actually went, my question is why?

Because as Dawn just described, we're at a really interesting and important moment in public health for Canada.

And I think if you look at some of the things that led us to this moment in public health, I think they are part and parcel of some of the other major developments that we have in our society right now.

I don't know that what is happening in public health is is out of step with what's happening in our politics.

And I think there's a there's a lot of questions about why that is and what is happening.

And it just felt like maybe in this one particular instance, we could find out how it happened.

And maybe in finding out how it happened, maybe it helps us to understand things just that much better.

Dawn, before we get into sort of Nathan's travel journey to tell the story, is this outbreak something that we can come back from as a country and as a province?

Most recently, Ontario just earlier this month was clear of of measles sort of cases.

But we got to recent new ones last week.

Can we come back from this?

Well, remember we were living in a measles free country for a long time.

But it takes resources and that includes resourcing public health.

One of the challenges with this outbreak is that pockets of people are being unvaccinated.

And those pockets of people, for various complicated reasons, are choosing not to get vaccinated.

And they need people they can trust to speak to them and help them make those decisions.

We have to invest a lot of money in making public health accessible to those people as well.

There are major, major structural issues that are going to require major governmental resources.

So, for example, in Ontario, our chief medical officer just made a case for having a vaccine registry.

I cannot tell you how many people I've spoken to who think they might have got measles vaccinated, maybe weren't sure.

The conversation earlier with some colleagues about it. Yeah.

How do you look it up?

You know, and if you've switched family doctors, if you've moved provinces, I mean, really what would be helpful would make us sort of comparable to the other G7 countries, would be having a national vaccine registry.

That's complicated because our provinces administer our health care.

But I'd settle for a provincial, you know, every province having one of these.

So at least we would know where people weren't vaccinated.

And at least people could be proactive in getting vaccinated.

Of course, the other feature that will require time and effort is the family doctor crisis.

Childhood vaccines are not given in pharmacies.

They're given in the family doctor's clinic.

And if you don't have one, it becomes the parent's job to somehow find a public health clinic or find a way for their kids to get vaccinated.

That's a lot of work for working parents who have a lot of other challenges in this economy.

All right. Now that we've established sort of where we are right now, I want to go back in time.

Nathan 2020 4th October. Where did this outbreak begin here in Canada?

Well, we first heard about this outbreak when we had public health authorities in New Brunswick. Describe a couple of initial cases that took place there.

They put out a warning. Warning. You know, if you are at a local hospital between this and this time, perhaps you were exposed.

They said there was a large family gathering, and then they moved quite quickly to set up a couple of pop up vaccination clinics in rural New Brunswick.

From there, it took some time for more information to come out, but we learned eventually from public health authorities in Canada that there was a measles case that had come on a flight from Manilla, which is what they said, Manilla and into Canada and then across Canada and to New Brunswick.

And then, of course, you know, shortly after we had those first case and cases in New Brunswick, we started to see a large number of cases in Ontario as well.

And from there, if you track it, it sort of there's you can we put it on a map for, for our website. And it's just little pinpricks like fireworks coming up across the continent. As, as these cases spread.

I want to get a better understanding of the the family that you spoke with. The first case in New Brunswick and also the the hospital and the doctors that were working with them.

How did they react when they realised that they were dealing with measles?

As we mentioned, it's been 20 plus years.

You know, perhaps some doctors are not familiar with seeing it. Perhaps it's something in a textbook.

But how did they react?

Well, at first with confusion, and I think that was true for everyone who was involved.

Certainly in the first few days, you had this Canadian woman who who flew to Canada from Asia, from Thailand, as it turns out, not from not from the Philippines.

She began to grow, feel unwell on the flight, but she had an absolute gruelling set of flights, numerous legs of her flight journey to Canada and thought, well, listen, you know, it's jet lag, it's I'm tired and, you know, like anybody would be with, with that many flights.

She takes an Advil.

She's coming home for her sister's wedding. She's excited.

She makes it the night before.

And so she gets up the morning of the wedding.

She's not feeling well.

Her throat is sore, and.

But she pops an Advil and says, you know, I'm gonna get through this because she's crossed the globe to attend her sister's wedding.

And and then after the wedding, she starts to feel unwell again.

And she goes to the hospital.

And the doctor who sees her looks and she's. She has a rash. She has a fever, she has a sore throat.

And and if you're a doctor, you see a lot of people with rashes, fevers and sore throats, and you see them with those for very understandable reasons.

And so the first the first diagnoses, the first guesses at diagnoses were not the measles.

In fact, measles didn't come up for several days, as best we can understand.

There was a thought maybe since you're coming from Southeast Asia, maybe you have scarlet fever. Maybe it's strep throat.

The woman's son had recently had strep throat, and so they sent her home with some antibiotics.

And so she actually went back from the hospital on the day, the day of the wedding, and went back home for a couple of days.

Dawn, I know we are coming off the heels of Covid, but it is still remarkable when when Nathan's talking about, you know, this map lighting up with all the cases of how this all started with really one person, can you help us understand how one person contact the virus can turn a whole nation upside down in terms of an outbreak.

Can you help us understand how one person contact the virus can turn a whole nation upside down in terms of an outbreak.

Measles is the most infectious, most contagious virus we know of, the most infectious.

And so that means that any pocket of vulnerability, it's easy for it to spread through.

And again, the fact that a lot of people, there are pockets of people who weren't vaccinated, so many people who attended that wedding weren't vaccinated.

And then they all travelled back to their various home cities and countries.

And of course, many of their friends and neighbours weren't vaccinated.

And then those people travelled.

And so it speaks to two things.

The one is there is no way out of this other than vaccination.

It is so contagious that no amount of healthy living or even the contact tracing and all those things that we have to do can get us out of this because it will just spread faster than we have the resources to stop it.

But it also shows how important making sure that we have consistent vaccination all over the country.

Because when there are those pockets of people, it's really, really easy for it to spread.

And of course, humans don't stay still.

After we saw some of these small communities in southwestern Ontario, I remember my heart and stomach dropping when I saw that one of the exposure sites was Ripley's Aquarium, a major tourist centre in Toronto.

Right, because you know, anyone who would have been there, it would be impossible to trace.

All the people who were there would now be vulnerable.

So this just really speaks to the fact that there is no way out other than vaccination.

Nathan from rural New Brunswick. You end up in a small Texan city population, what, 7 or 8000 people?

Tell me how that journey began.

Well, I think anybody paying attention in Canada and certainly anybody involved in public health in Canada would, would obviously have noticed all of these cases that that emerged in Ontario.

But but I think where we started to get a much larger international spotlight on this outbreak was when we started to get hundreds of cases in Texas, and those cases in Texas began to appear at a really fractious political moment as well.

I mean, some of the first cases were reported there within days of Donald Trump returning to the White House.

We had a whole new set of people in positions of authority in the United States.

We had we had a health secretary who had a history of of casting doubt on vaccines and all the rest.

And right at that very moment, you had a, you know, a major outbreak of measles taking place in Texas, which of course, is itself a conservative state.

And so, you know, that that was when you had CNN live trucks operating in sort of this small town.

And that's when I think you got a lot of attention on it.

And there were a number of indicators that what had happened in Texas had a link to what had happened in Canada.

There were there were some reporting on genotyping that suggested we were looking at a similar virus.

But what I found really interesting was that nobody seemed to understand how it got there.

And and that was true of people in public health. That was true of doctors.

I spoke with the doctor who treated the first case there.

She had no idea how it got there.

The local public health officials had no clue how it got there.

They were like, well, we think it came from Canada, but we don't know for sure.

And so I was interested in seeing whether it was possible to to at least shed some light on how it may have come all the way to, you know, far northwestern Texas, from from Ontario.

And we're talking about places that are thousands of kilometres apart from each other.

Can you shed some light into that? Why is it that federal authorities and local authorities had no idea?

Well, it wasn't for lack of trying.

I mean, they asked the question, but we were we're looking at and I think there's this this is a really important thing to bear in mind when you think about what we're at with measles right now.

We are in this very long and sometimes very dark shadow of Covid and and the experiences that people had with Covid, particularly around vaccines, around mandates for vaccines, around the impact that mandates for vaccines had on the lives of some who refused to have those vaccines around.

The contact with the mechanisms of public health, which I think can be uncomfortable.

Contact tracing is uncomfortable.

You know, somebody from the government calls and says, you know, where have you been?

Who have you talked to that that's uncomfortable.

And I think, you know, that was fresh in people's minds.

And I think, you know, that was fresh in people's minds.

And there was a sense that that what had taken place around Covid was destructive.

And so then the measles comes and suddenly all of these familiar and unwanted mechanisms start to gear back up again.

Hi. I'm calling to contact trace and people like, no, sorry, I want nothing to do with this.

And that was the answer for a lot of the public health authorities in Texas.

Where did this come from? No, I don't know don't want to talk.

And so there were not a lot of answers that came out.

Don, that poses some challenges for health officials.

How do you guys work to figure out those gaps?

But also I'm also going to put in there, you know, you talked a little bit about sort of vulnerable communities, but communities that may have reservations, whether it's cultural beliefs, religious beliefs, simply misinformation.

There's this mantra of public health, which is, you know, you have to go to where the people are, and it's helpful to have trusted leaders in those spaces.

So one of the things we really need are people who have extra training about vaccines in general.

So there's lots of people who have a blanket. No, but once they have a trusted leader, have that discussion with them and sort of talk about risks and benefits and ways that they can understand. Most people actually are movable.

There's very few people who are hard. No, once they get the answers to their questions.

But I think it's also really important to understand that it's fine for parents to have conversations with their doctors about this.

There are very few things we would expect people to just blindly accept from their doctor, and one of the challenges in the vaccine space is doctors don't often have a lot of training in some of the really nuanced questions.

You know, I'll just give you an example.

A colleague of mine runs a vaccine hesitancy clinic and got referred to a family who wasn't getting their measles vaccine.

Turns out that kid had a deadly egg allergy and no one could tell them. Was the measles vaccine like the flu shot where it's made in eggs? Right?

That is not an unreasonable conversation to want to have.

So what would be incredibly helpful if we had nurse practitioners, doctors, pharmacists, people who are embedded in the community have these training to have these really advanced conversations with people.

And again, that takes time and money and political effort.

But that would be a big help in getting over some of this misinformation.

Nathan, knowing what you know about how easily measles can spread, do you think this changes the broader attitudes towards vaccinations?

So one of the interesting things, because I asked people, you know, were you vaccinated?

It wasn't the focus of my reporting, but I was just kind of curious because I was curious about why not.

And and the answer I got more than anything was not rooted in conspiracy or some of the other things that we tend to associate with vaccine hesitancy.

For most people, the answer was, well, isn't the measles gone?

Like, why do we need to get vaccinated?

It just it felt like an unnecessary medical intervention for a disease that was no longer with us.

And I think the corollary to that was there are numbers of people who thought, well, listen, even if the measles isn't gone, you know, like my mom went through this, my grandparents went through this.

They survived. They were fine.

And so there there was a I think a and this is very human, but but a forgetting of what the seriousness of measles could be.

And I saw this in one way, which was in Texas.

People spoke about some of the symptoms of the measles, and they were like, yeah.

And this was where actually things got into conspiracy because people were like, oh, you know, this was an unusual strain of measles.

Something was wrong here.

People had hallucinations.

And other thing like that never happened.

You know, in my, my parents and my grandparents had it.

Well, as it turns out, it did.

If you look in the literature around measles, this is one of the symptoms that can be associated with measles.

But it's been forgotten because the measles had been relegated to the dust of time.

We are going to leave it there, Nathan.

Dawn, really appreciate it.

Really insightful stuff.

Thank you so much.

Thank you.

Thank you.

Thank you.

Remember the early days of Covid when people would wait impatiently for the latest news conference from Ontario's Chief Medical Officer of health?

Maybe that was just me, but the pandemic pushed public health agencies into the spotlight

and now, over five years later, we might not be waiting breathlessly for public health updates anymore.

But that spotlight has never really gone away, especially with the return of things like measles.

I wanted to know more about the pressures public health agencies are facing.

So I sat down with Dr. Trevor Arnason, medical officer of health at Ottawa Public Health.

Dr. Arnison, thank you so much for joining us on the program.

You are officially three months into your new position as Ottawa's medical officer of health.

Congratulations on that.

Let's talk 2025.

I'm sure there are standard practices that you have to employ just across the board.

But I am curious are there any new approaches?

Having looked at the last couple of years coming off the heels of Covid into a measles outbreak, but is there any new approaches just in general, when we talk about public health on the local level that you want to sort of play to?

So we are we are going through a renewal of the Ontario public Health standards in Ontario.

So this is the provincial standards that guide our work and what we do.

I think for me, what's top of mind in the past few months starting this new rule is how information and the information space is really affecting how people are approaching health issues.

My background working as an associate medical officer of health has largely been in vaccinations and being involved in the Covid 19 vaccination rollout.

We're seeing a lot of misinformation around vaccines, but also other all other health related issues and and treatments.

There's a lot of information being shared on the internet right now and in social media.

Well, let's pick up on the misinformation and disinformation.

Help me understand when you are around the table with your colleagues trying to figure out the proper messaging, how are you cutting through the noise?

Yeah, so a lot of it is related to basic communications approaches.

A lot of it is trying to understand where people are getting their information and how best we can speak to people so that they that we're listening and seen as a a trusted partner.

We've seen a lot of mistrust and and lack of trust for from traditional government institutions on on issues like vaccination.

And similarly, we see that people less and less have access to a trusted healthcare provider in Ontario who they can speak to about issues at the individual level.

So what we've been trying to do is engage the community and understand what some of the barriers are to getting the appropriate information.

Now, you had mentioned your background.

You were also part of Ottawa's Covid 19 task force.

Also very important to note that around that time in 2022, Ottawa was being occupied.

There was a convoy that was downtown quite busy.

And I imagine part of the messaging is also understanding who you are sort of fighting against or trying to, you know, where those other messages are coming from.

And I'm curious, who do you point the finger at for some of the misinformation and disinformation around vaccine hesitancy for example?

You know, I've been working in the vaccine space for for a very long time, and I, I would I would be hesitant to actually say that a lot of the. Myths around vaccination have have changed substantially over the past few decades.

Even if we go back to the, you know, 1800s. And when vaccines started, a lot of the same concerns about vaccines that are raised today are similar.

So the the. The real difference in our society, I think, is where people are getting their information and how the information is flowing and who's being seen as trusted voices of information and what the motivations behind misinformation and disinformation is.

Dr. Arneson, very quickly, I do want to pivot a little bit about measles for last year.

That was the focus.

And, you know, there was hope that Ontario had it under control.

But there were two cases that were discovered in Ottawa, and I am curious about the conversation around exemptions, whether it's religious, philosophical, is that worsening the vaccine hesitancy?

Is that adding fuel to the fire?

So certainly vaccine hesitancy is the is is a cause of what we're seeing, the issue around people choosing not to vaccinate for measles, mumps, rubella is certainly a cause of why we're seeing people with measles and spread of measles within the province.

Now, what we're seeing is that people are not familiar with the disease and in many cases are not getting vaccinated.

And that's a number of a number of factors.

It's not always related to specific religious beliefs.

Again, it could be related to misinformation that people are hearing through social media or other other forms of communication.

And it could also be, in some cases, access issues when it comes to exemptions.

What we're talking about is in Ontario, the Immunisation of School Pupils Act, which is an act for reporting vaccines to attend school, which is an important tool in in trying to make sure that people are up to date.

But it's it's not necessarily a perfect tool.

People can choose those exemptions.

We haven't seen massive increases in exemptions.

However, you know, we do see challenges with people being able to report their records year over year and especially during the pandemic when school was disrupted for periods of time and getting that information and also people's access to healthcare services were disrupted.

We did see a decrease in in vaccination of some of these important immunisations that we're still seeing catch up with.

So really the the fundamental issue is getting people to understand the importance of routine vaccination and getting the vaccinations.

And there's a variety of, of, of barriers or reasons that that might not be happening as much as it once was.

We are going to leave it there.

Dr. Arneson, really appreciate your time and your input.

Thanks very much.

And that's it for us here at "The Rundown."

Like our studio, this show is a work in progress and we want your input.

Send an email to therundown@tvo.org or DM me on Instagram @jeyanjeganathan and let us know what you think is working or not working so far.

See you tomorrow!