Canada expected to lose long-standing measles-elimination status – The Globe and Mail

Report on Canada’s Measles Elimination Status and Implications for Sustainable Development Goals

1.0 Executive Summary

Canada’s measles elimination status, achieved in 1998, is in serious jeopardy following a significant resurgence of the disease. A total of 5,139 cases were reported across nine provinces and one territory as of October, resulting in two infant fatalities. This public health crisis represents a substantial setback for Canada’s progress toward key United Nations Sustainable Development Goals (SDGs), most notably SDG 3 (Good Health and Well-being). This report analyzes the current situation, its contributing factors, and the direct implications for Canada’s commitment to the 2030 Agenda for Sustainable Development.

2.0 Current Epidemiological Situation

The Pan American Health Organization (PAHO) is currently reviewing national data to determine if Canada has maintained its measles elimination status, which requires the interruption of domestic transmission for 12 consecutive months. The recent outbreak presents a significant challenge to this status.

• Case Numbers: 5,139 cases reported nationwide as of the end of October.
• Fatalities: Two infant deaths were recorded, one in Ontario and one in Alberta, from measles contracted in utero.
• Official Warnings: The Public Health Agency of Canada issued a risk assessment in July highlighting the high likelihood of prolonged transmission, and former Chief Public Health Officer Dr. Theresa Tam warned that the virus could be considered endemic if cases continued past October.

3.0 Conflict with Sustainable Development Goal 3: Good Health and Well-being

The resurgence of a vaccine-preventable disease directly undermines Canada’s efforts to achieve SDG 3, which aims to ensure healthy lives and promote well-being for all. The outbreak signifies a regression on several specific targets within this goal.

1. Target 3.2 – End Preventable Deaths of Newborns and Children: The deaths of two infants from measles are a direct failure to meet this critical target. The return of endemic measles would pose an ongoing threat to child mortality rates.
2. Target 3.3 – End the Epidemics of Communicable Diseases: Losing elimination status would mean Canada is no longer successfully combating the epidemic of measles, moving the country away from this target rather than toward it.
3. Target 3.8 – Achieve Universal Health Coverage: The decline in vaccination coverage points to significant gaps in universal access to essential health services, specifically routine immunizations, which are a cornerstone of primary healthcare and universal coverage.

4.0 Analysis of Contributing Factors and Broader SDG Implications

The outbreak is not an isolated health event but is linked to systemic issues that impact multiple SDGs. A study published in the Canadian Journal of Public Health confirmed a decline in measles vaccination coverage in 2023 compared to 2019, driven by several factors.

• Weakening of Public Health Institutions (SDG 16): Experts note the outbreaks are a warning that public health programs are suffering. Paused school immunization programs during the COVID-19 pandemic and a failure to prevent domestic chains of transmission indicate a weakening of the strong institutions necessary to protect public health.
• Reduced Access and Increased Inequalities (SDG 10): Barriers preventing Canadians from accessing primary care providers, who traditionally administer MMR vaccines, contribute to lower immunization rates. These barriers often disproportionately affect vulnerable populations, exacerbating health inequalities and contravening the goal of reducing them.
• Misinformation and Education Gaps (SDG 4): The rise of health misinformation and disinformation, confirmed by a Canadian Medical Association survey, directly challenges the principles of quality education and access to reliable information. When a third of Canadians avoid effective treatments due to false information, it signals a failure in public education and undermines trust in scientific and medical institutions.

5.0 Conclusion and Recommendations

The potential loss of Canada’s measles elimination status is a critical public health failure with serious consequences for the nation’s health and international reputation. It also serves as a clear indicator of challenges in meeting foundational commitments to the Sustainable Development Goals. To realign with the 2030 Agenda, a multi-faceted approach is required.

• Reinforce Public Health Infrastructure (SDG 3, SDG 16): Immediately increase investment and efforts to lower barriers to vaccination, ensuring programs are robust, accessible, and resilient.
• Ensure Equitable Access to Primary Care (SDG 10): Address systemic issues that limit access to family doctors and primary care providers to ensure all citizens can receive routine immunizations and credible health advice.
• Promote Health Literacy and Combat Misinformation (SDG 4): Develop and support initiatives that provide the public with access to credible, evidence-based health information to counteract the damaging effects of disinformation and rebuild trust in the healthcare system.

Analysis of Sustainable Development Goals (SDGs) in the Article

1. Which SDGs are addressed or connected to the issues highlighted in the article?

• SDG 3: Good Health and Well-being: The entire article focuses on a public health crisis—the resurgence of measles in Canada. It discusses the disease’s spread, vaccination rates, the strain on the public health system, and the resulting health consequences, including infant mortality. These are all central themes of SDG 3, which aims to ensure healthy lives and promote well-being for all at all ages.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. Target 3.2: End preventable deaths of newborns and children under 5 years of age.
   • The article explicitly states, “Deaths have also occurred… In both instances, infants died after contracting measles in utero and being born prematurely.” This directly connects the measles outbreak to preventable infant deaths, a key focus of this target.
2. Target 3.3: End the epidemics of… communicable diseases.
   • The article’s main subject is the potential loss of Canada’s “measles elimination status” due to a dramatic rise in cases. Measles is a highly communicable disease, and the discussion of its spread, outbreaks (“Ontario’s measles outbreak was declared over on Oct. 6”), and the risk of it becoming “endemic” aligns perfectly with the goal of ending epidemics of such diseases.
3. Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services and access to safe, effective, quality and affordable essential… vaccines for all.
   • The article highlights challenges in vaccination, which is a cornerstone of universal health coverage. It mentions a “decline in measles vaccination coverage,” barriers for patients to “access primary health care providers,” and the need to “lower barriers for vaccination.” This points to systemic issues in providing essential health services like routine immunizations.
4. Target 3.b: Support the research and development of vaccines and medicines… provide access to affordable essential medicines and vaccines for all.
   • This target is relevant as the article centers on the measles, mumps, and rubella (MMR) vaccine, described as a “safe and effective tool.” The call from Canada’s chief public-health officer to “bolster vaccinations to stop the disease’s preventable spread” and the discussion around declining vaccination coverage directly relate to the challenge of ensuring access to and uptake of essential vaccines.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. Indicator for Target 3.2 (Implied): Neonatal or Infant Mortality Rate.
   • The article mentions that “infants died after contracting measles.” While it doesn’t provide a specific rate, the reporting of these deaths serves as a qualitative indicator of failure to prevent deaths in newborns, which is measured by indicators like 3.2.2 (Neonatal mortality rate).
2. Indicator for Target 3.3 (Mentioned): Incidence of a specific communicable disease.
   • The article provides precise data points that measure the incidence of measles: “There had been a total of 5,139 cases across the country as of the end of October.” This number is a direct measure used to track progress against ending epidemics.
3. Indicator for Target 3.8 / 3.b (Mentioned): Proportion of the population covered by essential vaccines.
   • The article directly refers to this type of indicator when it cites a study that “found a decline in measles vaccination coverage in children in 2023 compared with 2019.” This is a clear reference to Indicator 3.b.1 (Proportion of the population covered by all vaccines included in their national programme), specifically for the MMR vaccine.

Summary Table of SDGs, Targets, and Indicators

Source: theglobeandmail.com