The Development and Treatment of Measles in Canada
The earliest known case of measles dated back to the AD’s and vaccinations for the contagious airborne virus had been present since the 1963 according to the World Health Organization. Fifty-six years had passed since vaccination for measles was discovered and there are still multiple outbreaks around the world to this day. As industrialization occurs, diseases tend to shift from communicable to chronic diseases. In developed countries such as North America, where the health system is more advance, accessible and available than developing countries, still face outbreaks of infectious diseases. Primarily focusing on the recent incidents in Canada, in 2015 there was a measles outbreak in Lanaudière region of Quebec, 2017 in Nova Scotia and in 2019 the outbreak in Vancouver. Possible drivers of why measles has yet to be contained and eradicated in North America could be related to vaccination rates. Canada has been known for a reputable healthcare system with free vaccination for measles since 1980 however the lowest measles case was recorded in 2012 with 9 reported and confirmed cases. Fluctuation in vaccination rates could be caused by surveillance, report of measles cases as well as under vaccination. Though those are not the only causes but had shown to be contending factors in the current measles cases. Recognizing that vaccination rates could be a driver of measles outbreaks, preventative measures had to be taken. Methods such as enforcing laws, clarifying misconceptions and educating the importance of vaccination were implemented to encourage and raise vaccination rates to avoid such outbreaks from occurring.
A highly contagious airborne disease with a lengthy incubation period of approximately 14 days had made measles challenging to contain and track. From the time of exposure to when the first symptoms, all happen under a long period of time, making the exposure period difficult to identify and dangerous. Long exposure periods and long airborne and surface survival allow the disease more time transmit to a larger population. By the time symptoms do show and it had been identifying, measles would have had 14 days to spread to other beings. This causes a chain reaction; an outbreak where containing the disease is priority. The lengthy incubation causes difficulty in tracking the point of exposure. Especially when time is the most vital part in controlling an outbreak, every minute spent on finding the exposure point is every minute given to the outbreak to manifest.
A reason associated with causing challenges in tracking measles is the lack of reported cases. In Canadian Communicable Disease Report (CCDR) from six years ago in figure 1 that there is a missing 10-year data between 1959 to 1969. The lack of data for measles cases causes difficulty in how to develop counter actions to this infectious disease. In the Canadian Communicable Disease Report of 2013, one of many possible reasons for the missing data between 1959 and 1969 could be poor surveillance and low or incorrectly report cases. Poor surveillance such a record keeping on the health care administration side could partially be the reason why there is missing data. Additionally, it is also on the ownership of the patients and their family to seek medical help when needed. When patients do not report to health care professional, they become the anonymous factor that catalyzes the outbreak. Missing data not only occurs in Canada but across the entire globe as well, shown in the World Health Organization’s (WHO) Distribution of measles cases by country and by month, 2011-2019. Developing countries such as Haiti has either no data available or zero reports of measles cases which support that the lack of historical surveillance does not accurately represent the actual cases. Haiti had a measles outbreak in 2000, which involved one thousand cases during the epidemi. Then in 2010 when a 7.0 earthquake had struck, creating catastrophic damage and conditions for major infectious disease outbreaks such as measles. Earthquake shelters with overcrowding and injured people makes for a very susceptible pool yet there we no data reported in the World Health organization’s Distribution of measles by country and by month, 2011-2019. With the lack of report, there is it is increasingly more difficult to analyze outbreaks and exposure. Lack of report and incorrectly report cases does not only affect developing countries, it affects develop countries as well. Several developed countries fail to report cases even when they have the means to. It is possible to attribute the missing data to human mistakes, accidentally left out a data or mistakenly reported a case. Having consecutive years of unconcluded data is a setback to eliminating measles by 2012 in which the World Health Organization and Wester Pacific Region had planned for in 2005. However, the most undesirable factor in preventing the elimination of measles would be under vaccination.
Under vaccination is the low rate of vaccination within a portion of a population that should be vaccinated. Under vaccination is dilemma that exists for reasons such as unavailability and inaccessibility. Much like healthcare, vaccination needs be both available and accessible. If the vaccination is available but not accessible it is like having no vaccination at all because no one could have to option to be vaccinated. Availability of vaccination is just the presence of the vaccination in a community. Lack of vaccination is usually attributed to lack of resources such as funding, equipment and professionals. In developing countries, funding is usually insufficient for healthcare due to multiple expenses elsewhere. Countries recovering from natural disasters or war will lack the funding, equipment, and professionals to up hold the rates of vaccinations. A primary example would be the country of Sudan which suffered civil conflict in 2013 which displaced millions of its citizens which make the country susceptible to poverty, malnutrition and health problems. With the chaos and corruption, the people who were displaced into rural areas had no access to health care since the only health services were a “government-run Public Health System”. Health servicess were partially available and to many people inaccessible either due to distance or cost. Sudan had attempted to improve their health care system and immunization rates however those improvements were impeded by the civil conflict with “fully immunized rate of children at 7.3%”. Developing countries and countries suffering from disasters whether it be natural or human caused, face many barriers in their health care system. Yet developed countries such as Canada who is free of conflict and has a reputable health care system still faces communicable disease outbreaks such as measles.
In Canada, there had been multiple measles outbreaks since the 2012. Even with available and relatively accessible vaccination, Canada still faces under vaccination. The suspected primary reason for low vaccination rate is vaccine hesitancy. Vaccine hesitancy is that even though vaccines are available and accessible, people are reluctant to getting them. Vaccine hesitancy has undone the advancements vaccine has made in reducing preventable disease. Many countries that were close to eliminating certain diseases are now facing reemergence like measles where cases had increased a total of 30% globally. At the start of 2019, Vancouver experienced a small outbreak in measles. Possible drivers of vaccine hesitancy are disinformation, selective immunization and dependency on herd immunity. According to Dr. Jane Finlay, there is a number of the British Columbia population that choose not to be vaccinated due to “disinformation that fuels their anxiety of vaccines”. The distortion of vaccine originated from a false Lancet report by Wakefield that related autism to the measles, mumps and rubella (MMR) vaccine which flared up public concerns. Even with multiple studies conducted resulting in the disapproval of the claims in the Lancet report, people still refer and believe those dishonest allegations against vaccines. Social media pages and groups of anti-vaccinations such as Anti Vaccination Saskatoon are still active and promoting with over 19,000 followers. These persisting groups continue to spread unsupported claim which creates a pocket of unvaccinated people whom sustain detrimental blows when disease flare up. Declining vaccination rates can also be attributed to selective immunization. A common reason for people to no vaccinate themselves or family is for religious purposes. Certain religious communities believe that vaccination is acting against the divine beings that created mankind. For instance, majority of the Amish community willfully refused vaccination creating an under vaccinated population. On top of under vaccination due to selective vaccination and disinformation, these subpopulations rely on herd immunity. Herd immunity is the protection an individual receives when their surrounding community has immunity hence diseases cannot be transmitted to them. However, herd immunity for measles requires a minimum of “90-95% of the population to be vaccinated”. Some people tend to overestimate and rely on herd immunity too much until an outbreak occurs in their community. When diseases bloom, the vaccination rates tends to surge as people rush to get the vaccine causing a public panic. Only vaccinating when diseases are on an outbreak can be a fatal plan as vaccines could take sometimes to take effect. These pockets of lower vaccination subpopulation sustain the most damage when a disease hit. In Vancouver, there are a number of areas where herd immunity cannot exist due to the low immunity rates of 50-70%. Certain schools in B.C. have alarmingly low rates of vaccination, which is dangerous because school setting provides an ideal outbreak point with all the proximity of children and lack cleanliness. To combat some of these problems, Canada and the World Health Organization has brought upon a few possible solutions.
Outbreaks and fatalities of preventable infectious diseases are inacceptable especially in developed countries. Developed countries with advance health care system, the funding and man power to provide care should not be facing similar outbreaks as developing countries. Developing countries have limitations, which developed nations do not have; there should be no excuses for poor service. In Canada, there is a possibility in altering regulating immunization at schools. Schools across Canada provide vaccination to elementary and high school students, but vaccination is not mandatory in British Columbia. There is a form in which families can fill out to exempt their children from vaccinations. However, under Ontario’s Immunization of School Pupils Act states that any unvaccinated students could be fined up to one thousand dollars and may be suspended to the maximum of twenty days. Making vaccination mandatory across the country may be difficult, as resistance would arise. A less forceful approach being discussed is a systematic regulation of vaccination by having all parents submit vaccination record to the school. With the school having a record of immunization, the staff can dismiss students who are under vaccinated. Susceptible students will be permitted to return to school if it is confirmed safe for them. The World Health Organization deemed vaccination hesitancy one of the many threats mankind must combat globally in 2019. A few suggestions made in terms of solutions to the vaccine hesitancy dilemma are community engagement and mobile health. Having an interconnect communication between the health care system and the community will improve the quality of service. By building relationship with the community, it enforces trust, which benefits the promotion of immunization. Another tactic the World Health Organization proposed was mobile health (mHealth). Since society has already and continuously integrated so much technology into day-to-day life, it is understandable to use it as a tool to “achieve global health objectives”. The concept of mobile health (mHealth) is to encourage self-help. By implementing mobile technology into appointment reminders, health promotions, and health advices, it could “transform the face of healthcare”. For instance, health promotions through cellular alerts for vaccinations could greatly increase vaccination rates. It is important to promote and inform but accessibility is also vital. These mobile applications could reduce inaccessibility to healthcare across the globe. However, this application market is still underdeveloped with “18% focused on health issues”. With all the proposed solution, time and persistence will be needed to enforce it and possibly see results in improving measles vaccination.
Much like other communicable disease, measles is one that is difficult to contain due to the long incubation period. Measles had been a re-emerging disease even to the developed societies even though they are free of the limitations and setback of developing societies. By identifying all the problems of lack of reported cases or misreported cases and under vaccination attributing to the measles outbreak plans towards mending this problem. However these solutions such as implementing health regulations, enforcing relationships between health care professionals and community and piloting a mobile health program will require continuous efforts and time for these solutions to take effect.
