Deep Dive
Shownotes Transcript
World Ocean Day is upon us, but can we really talk about two-thirds of the Earth's surface in just one day? Absolutely not. I'm Ian Urbina, back with an all-new season of The Outlaw Ocean. My podcast delves into the impossibly vast and shockingly lawless world of the open seas. Find and follow an all-new season of The Outlaw Ocean wherever you get your podcasts.
This is a CBC Podcast. I'm Dr. Brian Goldman. This is White Coat Blackheart. In 1998, the World Health Organization declared that Canada had eliminated measles. Well, that's no longer true. Since October 2024, Ontario has had just over 2,000 cases of measles and, sadly, now one death. A premature infant that was reported on June the 5th.
In Alberta, as of this week, there were 749 known cases of measles. A number not seen there since the 1980s. One public health official in the province has called the current caseload the tip of the iceberg. It makes us wonder what public health and the Alberta government have been doing to try and stem the tide. Dr. Mark Joffe served as the province's chief medical officer of health until mid-April when he chose not to renew his contract.
Joffe was appointed by Alberta Premier Danielle Smith in November 2022. Dr. Mark Joffe, welcome to White Coat Blackheart. Thanks so much for the opportunity. Before we begin, I want people who are listening to this interview to know the scope of the conversation and so that we have it on tape. What are the things that we can talk about and the things that we can't talk about? Certainly. So I'm more than willing to talk about measles, the situation in Alberta, how things have evolved.
What measles is, why we're concerned about it. What I will not talk about is the specific inner workings of the government of Alberta. Okay, let's begin with the subject at hand, which is measles. What's your take on why measles cases in Alberta are at their highest level right now in decades? We are seeing...
a serious issue with measles in Alberta as a result of immunization rates that are not sufficient to prevent the disease from spreading in the province. This is something that has gradually developed over a number of years, but our immunization rates at this point are so low that we are seeing a significant rise and outbreak of measles.
We're going to talk about the low immunization rates and the reasons for it and what the province is trying to do about it in a moment. But first of all, how did measles get into the province at this time? So it's been very complex, actually. We have had at least six different introductions of measles in
into the province that we are aware of and likely more than that. We had at least two that derived from international travelers. We've had at least a couple that entered through contact with the province of Ontario where there's an ongoing measles outbreak and we've had at least another couple of separate introductions that came up from the U.S. and possibly with a connection to Mexico.
I gather that the latest data in the province of Alberta is that 68 percent of two year olds in the province have had two doses of the MMR vaccine. How effective would you expect that 68 percent figure to be at preventing measles from spreading in Alberta?
Well, in a word, it won't be effective. That leaves a very significant percentage of two-year-olds and beyond that will not be protected. And that's exactly what will allow a measles outbreak to occur, just as we're seeing now. How prepared is the province to deal with measles? Well, we knew this was coming, quite honestly. We knew that our immunization rates were not sufficient to prevent an outbreak. We
We knew that measles would be introduced into the province because, in fact, there's a global rise of measles with many countries experiencing outbreaks. So all it takes is an individual returning by car or by plane from another destination. If they are not immunized, if they bring measles into the province, we know that we will see spread.
And so we had been preparing for this. And in fact, over the last year, there's been considerable preparation by the medical officers of health throughout the province of Alberta, anticipating that this would start to happen. What were the things that were supposed to be done to try to stem this person-to-person spread of measles in the province? So the preparation that was undertaken was...
preparing our healthcare facilities for the possibility that individuals with measles would come seeking care. And more than that, it was planning for mass immunization clinics or at least making sure that individuals requiring immunization could access it. At the same time, planning for the possibility that we would need assessment centers so that individuals who were sick with measles could actually seek care
access to care, to an assessment, to see whether they had measles or not. I think the part where we did not do as well as we could have was in mass communication to the population. Can you be more specific about that? I think we did not communicate adequately to the population of Alberta, advising them that immunization rates were inadequate to prevent an outbreak and
that children and some adults might be at risk of developing measles and that they should access vaccine, that vaccine is safe. There's a very long history of use of vaccine. We know the MMR vaccine works extremely well, but two doses are required and the vaccine itself is safe. And we really needed to communicate, I think, more effectively than we did. Are you saying that Albertans have not
either received the message or heeded the message to get vaccinated? I think it's complex. And I think over a number of years, our immunization rates have gradually been declining.
We've come through a very complex COVID-19 pandemic that did a couple of things. First of all, in some situations, it impacted access to vaccine. So some children perhaps fell behind in their immunization. And then at the same time, we've got, I think, a crisis of disinformation and misinformation everywhere.
where individuals are now perhaps concerned about measles vaccine. And even more than that, I think they don't understand what measles is. It's a disease that for the most part we've eliminated from Canada. So people have forgotten about it. You called it a crisis of disinformation. What do you mean by that?
Well, we live in interesting times. We live in an information era where information is easier to access than it ever has been in the past. But at the same time, there's a tremendous amount of misinformation and disinformation that is out there. And I think, quite frankly, the population is confused. They're unsure where to get information. They're unsure what to trust. And the end result of that is declining immunization rates.
There are communities in the province where just 14% of the population are immunized against measles. That's an incredibly low number.
Yeah, frankly, it's scary and it's really unacceptable. Those are the numbers for two-year-olds in Alberta who have received two doses. And in areas of the province where we're seeing measles circulate now, we have rates as low as 14%, as you said, or 25% or 17%.
And of course, two-year-olds who are unimmunized run a greater risk of complications, don't they? So children under the age of five are most at risk for developing complications of measles. So some years ago now, the province of Alberta moved to a routine immunization schedule, which the first dose of MMR is provided at age 12 months, and the second dose is provided at 18 months later.
So this is why we're looking at the rate of two-year-olds who have received two doses, because that is the recommended schedule in Alberta. Paint us a picture of what could happen should someone with measles enter a community where just 14% or 25% of two-year-olds have received both doses of MMR vaccine.
So measles is the most infectious of all diseases that we know of. It is spread on small aerosol particles that can travel long distances and that can linger in the air for even up to a couple of hours after an individual with measles has left that location.
So we know that an individual with measles who is infectious can spread to up to 12 to 18 more susceptible individuals. Those would be individuals who have not had at least one dose and preferably two doses of vaccine. So you're saying that measles could spread through a community like that quite quickly?
Absolutely. So we'll see one individual with measles will spread to several others. Those several other individuals will spread to several more. And that is why we've seen a very rapid spread of measles through the province of Alberta. And what impact could it have on the health care system in the province?
So historically, approximately 20 to 25% of individuals with measles would be admitted to a healthcare facility. The experience more recently, at least in Alberta and in Ontario, is that approximately 7 to 10% of individuals with measles require admission to hospital. Of course, many others are accessing emergency departments, urgent care, their family physicians or other healthcare settings.
Did you ever think that we would be having a discussion about the measles situation such as it is in Alberta and Ontario in 2025? I never would have believed it. I am a practicing infectious disease specialist. Now, I treat adults. And in my career, I've only seen one adult with measles that required admission to hospital.
This is a disease that for the most part we've kind of forgotten about. And unfortunately, it's that complacency that is allowing resurgence of this very serious disease. Is this getting under control or not? What are your worst fears?
Well, my worst fears is that we will continue to have large numbers of infected children and some adults who are not immune, and that we will see the complications of measles that we're very familiar with, and that this is going to go on for a number of months yet before ultimately it will settle down. So how do we turn this around? What do we know about what works and what doesn't work for getting the message across that children need the MMR vaccine?
So there are a number of things that are needed. We need leadership. We need political leadership. We need medical leadership. We need to be very clear that the expectation is that individuals will access vaccine that we know works, that is safe, and that will protect them, their families and their communities. So that's the first message. And we need to get that message out in ways that people can understand. Health literacy in Canada is actually not very good.
So we need to be able to explain what measles is and why we need to prevent it. We need to do that in a variety of languages and we need to do it in a culturally sensitive and appropriate way so that individuals who are perhaps in religions or cultures that are a little more vaccine hesitant, that they can understand the need. And in fact, we need to work with influencers in those communities, whether religious leaders, cultural leaders, organizations,
or whatever, in order to get the message across in a cultural and language appropriate way. And we really need to be very clear that the norm is for individuals to be immunized.
Let me emphasize the majority of Albertans and the majority of Canadians are in fact immunized. The problem is that we now have sufficient numbers that are not immunized that we are seeing a resurgence and outbreaks of measles. Do you think enough is being done to encourage communities to vaccinate their children at the present time?
I think the messaging is getting out. The problem is we are way behind and this messaging actually needed to come out a year ago, five years ago, 10 years ago. As our immunization rates began to decline, we are really now playing catch up. Assuming members of any particular community do not wish to be vaccinated, is it possible to contain measles within that community?
We know from past experience that we need about 95% of the community to be protected against measles in order to prevent this most infectious disease from spreading in the community. As rates drop below 95%,
That's when you have enough susceptible individuals in the community that you can see outbreaks occur. There are enough individuals that measles will infect and spread from one to the other, and that's when outbreaks occur. So we really need to get to 95% to prevent this from happening.
Boy, it seems like the province of Alberta is a long, long way from that. Yes, we are. So what's your most optimistic prognosis for measles in Alberta? I think measles will continue to circulate for a number of months in Alberta. I think there will be many more infections. And ultimately, I hope between
The number of individuals that accept immunization, and in fact, there are many coming out now to accept immunization, between that number and unfortunately the number who will be infected over the next few months, we will reach that 95% total immunity that we need to reach. So is the province of Alberta going to reach that 95% level through vaccination or by getting measles, which would involve many, many more people getting infected, if I've got it right?
I think it'll be a combination. We really need people to get out and get immunized if they have not been. And again, if they choose not to be immunized, then we will continue to see measles circulate. Eventually, it will burn itself out. So we need to get to 95% immunity, whether that's through immunization, hopefully, preferably, or through infection. And then we need to maintain it at those levels in order to prevent future infections.
It didn't have to be this way, did it? Absolutely. It did not have to be this way. It's gradually been coming at us over a number of years. And again, it's unfortunately, it's a reflection that people have forgotten what measles is, what vaccine preventable diseases can be like.
They're taking it for granted. It's really vaccines are a victim of their own success. They were so effective at preventing these diseases that people have forgotten about them. They've forgotten what they are, why they're serious, why we should prevent them. And now we're...
in a situation where our immunization rates are too low to prevent these outbreaks from happening. Dr. Mark Jaffe, thank you so much for speaking with us. It's been an absolute pleasure. Thank you so much. Dr. Mark Jaffe's contract as Alberta's Chief Medical Officer of Health expired on April the 14th.
In a statement at that time, the province cited Joffe's dedication and professionalism while providing public health expertise during a time of significant challenges and transitions. We'll be right back. Hey, I'm Gavin Crawford, host of Because News, where comedians answer questions about the headlines for meaningless points. And one of our regular panelists is here. It's Alice Moran. What's up, Alice? Hi, Gavin.
We always like having you on the show, partly because you're always up on the news, but mostly because of your vast knowledge of Pokemon and baseball. I feel like up on the news is a bit of a stretch, but I like being on the show because every time you cover a sports story, you somehow make it about musical theater. Jellicle songs for NHL Cats. Because news. It's like the news, but with laughs. Listen now wherever you get your podcasts. Jellicle songs for NHL Cats.
You're listening to White Coat Blackheart. This week, a status update on the measles situation in Alberta. One expert who believes that the Alberta government has been too slow to respond to measles outbreaks throughout the province is Dr. James Talbot. He's a former chief medical officer of Health of Alberta and an adjunct professor at the School of Public Health at the University of Alberta.
Dr. James Talbot, welcome to White Coat Blackheart. Thanks for having me. What do you make of Alberta's response to the measles outbreaks thus far? Well, as I've said in public, I'm very concerned that they're behind the curve and that the situation is going to get worse and that the government is not taking this either urgently enough or seriously enough. What, in your opinion, has been missing thus far?
I think the biggest thing has been a sense of urgency and understanding that this is a serious disease, that it is highly communicable and that we need to get ahead of the curve. So they've already declared in the southern zone that they're not going to do individual notifications of outbreaks because the situation is so widespread. And that's a signal that you should be moving to protect the most vulnerable, whether you know they've been exposed or not.
And they are not doing that in any effective way. Dr. Talbot, is it possible that the government, that public health is doing the right things, but just not publicizing it? Well, you know, the thing about public health is that it happens in public. And so when you see the kind of numbers that we're seeing, particularly in the South and as a province as a whole, it's an indication that whatever you're doing, it's not working yet in the South.
There are parts of it that are significantly worse than the less than 50%. So until the government starts publicizing on a regular basis, how many kids are immunized and how many are left to be immunized, I don't think they're taking it seriously.
It's interesting. I want to follow up on what you said about public health needs to be public. We've heard from the former acting chief medical officer of health, Dr. Mark Joffe, who recently left the position. What's your assessment of the job he did?
I think Mark was put in a difficult situation. I've known him for 30 years. First of all, Mark's an excellent infectious disease physician and a first rate human being. And I think he took the job even though he knew that he didn't have the experience in public health and he didn't have the training in public health that was needed because the option was going with no one. My hat's off to him for what he attempted to do. But past that point, he was effectively muzzled. Anyone who knows Mark
knows that he would have wanted to use his expertise
in measles and measles control to be able to make sure that all the children in Alberta were safe. And the fact that he was kept silent for so long is pretty much proof that he was muzzled. And a week after his contract was up, he presented grand rounds on the measles situation in Alberta, in which he indicated that it was a failure of leadership, particularly at the top levels. And I have no reason to disagree with that conclusion.
Muzzled from speaking or muzzled from acting and speaking? He certainly wasn't able to speak. And a big part of the job in public health is making the public aware that there's a threat and what they can do about it and whether things are working or not.
in particular for vaccine misinformation. Members of the medical profession in Alberta begged for the government to allow Dr. Jaffe to speak out so that he could counteract that misinformation that was going out about vaccines. I know that you are particularly concerned with whether or not the chief medical officer of health is a physician. How important is that?
I think there are two reasons. Certainly, there are lots of people who are really important to what we do in public health who are not physicians. So this isn't a knock on them.
But when it comes to leadership, there are two things that make a medical practitioner really important. The first is that your loyalty is to the people of Alberta because you swear a Hippocratic oath. And that oath says, you know, first do no harm. And so you're not just reporting to the Minister of Health or the Premier of Alberta. You're reporting to the people of Alberta.
And that's a very important role and responsibility and level of accountability. And the second reason why I think it's important for it to be a medical doctor is that the decisions that you make, not all of them, but a significant number of them can literally be the difference between life and death for people. And there just aren't very many professions who have that kind of background. And one of the things that that teaches you is to be humble.
You know, it's not to let your ego be part of this. As a physician, you have been in places where you've made recommendations or failed to make recommendations that have had an impact on people's health. You become more cautious, you become more humble and more respectful of the science.
And those two things, I think, are really important when you have people making those life and death decisions. One, that they understand their loyalty isn't to the premier or the minister. It's to the people who could be affected by that decision. And secondly, that because the decisions are life or death, you have to be very careful and you have to be guided by the science.
Where is this heading as far as measles is concerned? I mean, I've heard some people say that this thing is going to burn itself out by the fall. What do you think? Right now, on a per capita basis, Alberta is getting new cases at a rate higher, about twice as high as Ontario is. And Ontario has been battling this a lot longer, and it's kept the numbers relatively small compared to the population.
In the South, they've recently indicated that they're not publishing individual outbreaks anymore because there's so much activity. You should just assume that you could be exposed. And the North and Central Zones are in the same situation with how poorly immunized the populations are. So I don't see any reason for this to burn itself out. There's just too much kindling out there.
There are too many unimmunized people. And I'm not seeing anything from the province in terms of increasing the first line of defense, which is contact tracing and isolation and quarantine, which is what would be required to bring the situation in the South back under control. The second way, the plan B, is that when it's out of control, you go as rapidly as possible to immunize the most highly vulnerable, which is kids under the age of five.
And they don't seem to be taking that seriously either. So if I look at how highly contagious the disease is, my expectation is that until they do something different and more effective, it's going to continue to spread. It will be circulating in significant parts of the province by the time fall happens. There's going to be transmission in the schools. I think in October, Canada's eradication status is revisited.
So if we don't have better control, I think Alberta will have contributed to Canada losing its status as a country in which measles has been eliminated. You're speaking with me now, Dr. Talbot, because you still believe there's time to turn this around.
I do. I don't know anyone in public health who's a defeatist or a pessimist about our ability to get our act together and work in an organized way to protect our children and to protect our communities. And we know this isn't a new disease. This isn't one that we have to put a full scale push on to get a vaccine and get it approved and approved.
All the things we did during COVID. It's not really that large a number of people affected compared to the number of doses of vaccine that we were delivering in Alberta and in Canada every day for COVID when we decided that this was serious enough to make a difference. You know, a government that doesn't believe that protecting its children is the most important job they have has lost the plot. Dr. James Talbot, thank you so much for speaking with us. My pleasure. Thank you.
After our conversations with Dr. Talbot and Dr. Jaffe, we requested an interview with the health minister to address criticism of the province's measles response and concerns that Jaffe was muzzled.
We received a statement from an official with Alberta's Public and Preventative Health Services that did not respond to concerns about Jaffe. It did include the following: "Alberta's government is taking the current measles outbreak seriously and continues to monitor the situation closely, particularly in areas with low immunization rates such as the South Zone, and is working closely with Alberta Health Services to coordinate a timely and effective response.
They say between March 16th and May 11th, more than 47,000 measles vaccines were administered across Alberta. The statement lists some of the actions they've taken, including expanded access to vaccine clinics and the introduction of an early dose of measles vaccine for infants ages 6 to 11 months.
A dedicated measles hotline, a social media campaign in 14 languages to further encourage immunization, and a targeted call-out campaign aimed at parents of infants who are eligible for measles vaccination. It won't take more than a few weeks to know how well those measures are working. That's our show this week.
For more on measles, we put our recent coverage on White Coat and on The Dose at the top of our feed. White Coat Black Art was produced this week by Stephanie Dubois and senior producer Colleen Ross, with help from Jennifer Warren and Samir Chhabra. Our digital producer is Ruby Buiza. I'm Brian Goldman, and I'm proud to bring you stories from the Canadian side of the gurney. See you next week. For more CBC Podcasts, go to cbc.ca slash podcasts.