There’s a concerning trend emerging in Canada and the United States when it comes to vaccine hesitancy.
In the United States, a key legal adviser to Robert F. Kennedy Jr., the man tapped to be the next U.S. health secretary, is working to get rid of polio and hepatitis B vaccines in America, according to the New York Times. Kennedy himself has vocally opposed vaccines for years.
And here in Canada the overall childhood vaccination rate is declining, said Dr. Jason Wong, chief medical officer at the BC Centre for Disease Control. Wong is the deputy provincial health officer and a clinical associate professor in the University of British Columbia school of population and public health.
It’s concerning “that we may be seeing some downward trends of people’s uptake of vaccines,” Wong said, adding that ideally vaccination rates would be as high as possible to prevent outbreaks and onward transmission.
In places where childhood vaccinations aren’t available, preventable diseases are having devastating consequences, like in the Democratic Republic of Congo, where measles kills thousands of children annually.
On Canada’s East Coast, where vaccinations are readily available, three out of every 10 kids are not vaccinated against measles.
It’s not too different on the West Coast.
Wong said that last year only around 69 per cent of two-year-olds in B.C. were up to date on all recommended vaccines, down from 74 per cent in 2017.
By seven years old, that percentage falls to 66 per cent, which is down from 73 per cent in 2021, Wong added.
These stats are missing data from around nine per cent of the population, which could mean that some of them are vaccinated but their health-care provider never registered them in the provincial registry, Wong said.
The province also records when someone refuses or is unable to be vaccinated, which is “generally” one per cent of the overall population, he added.
B.C.’s routine immunization program protects kids from a wide range of diseases.
By two years old, kids are protected against diphtheria, tetanus, pertussis (whooping cough), hepatitis B, Haemophilus influenzae Type B, polio, 13 types of pneumococcal bacteria, meningococcal C, rotavirus, hepatitis A (if Indigenous), influenza, COVID-19, measles, mumps, rubella and chickenpox.
Canada has eliminated diseases like measles and polio within its borders, but these diseases rage elsewhere in the world and therefore people still need to be protected by vaccination, Wong said. Smallpox, on the other hand, has been eradicated globally and therefore Canada no longer vaccinates against it because there is no risk of being exposed.
Vaccines are a big deal. A landmark study published in The Lancet this spring calculated global vaccination efforts targeting 14 pathogens since 1974 had averted 154 million deaths due to disease and decreased global infant mortality by 40 per cent.
“This really speaks to the power of vaccines; we just really don’t see these types of diseases commonly anymore,” Wong said.
The Tyee has compiled a list of seven diseases that used to be commonplace but, thanks to vaccines, are mostly out of sight, out of mind in Canada.
Pertussis, or whooping cough
Whooping cough is an infection of the airway that spreads when people cough, sneeze or have close contact with others.
About one infant out of every 170 who gets whooping cough will die from it, one in 100 will get brain damage and one in 30 will have convulsions or seizures, according to the BCCDC. One in five will get pneumonia. Whooping cough kills about three children in Canada each year.
Whooping cough starts like a cold but gets worse over a two-week period until someone is coughing so hard they make a whooping sound as they try to breathe. Babies younger than six months, teenagers and adults may not whoop.
Anyone who’s had a cough for more than two weeks should see a doctor. Antibiotics may be prescribed to reduce how long someone is sick or contagious. Without treatment a person can be contagious for three weeks.
Cases are on the rise, which HealthLink BC says could be linked to how protection from the vaccine used in the 1980s and 1990s lessens over time. Boosters are recommended for teenagers and adults.
About 80 per cent of two-year-olds are vaccinated against whooping cough, according to the BCCDC.
Measles (rubeola)
Measles is one of the most infectious diseases on the planet — so infectious that you can catch it if you walk through a room where an infected person was hours ago, Wong said.
The disease can cause brain swelling, leading to seizures, deafness or brain damage, and kills around one in every 3,000 people, according to HealthLink BC. In the United States, 40 per cent of children who get measles have to be hospitalized.
Adults and infants less than 12 months old are most likely to suffer complications or death.
Symptoms include high fever, runny nose, sneezing, sore throat, a cough and sore, red eyes that are light sensitive. After these symptoms fade, a rash appears all over the body. A person is infectious four days before the rash starts and for four days after it first appears.
Measles vaccines can prevent infection and, if an unvaccinated person is exposed, they may be able to immediately get vaccinated to prevent disease.
A population needs to have 95 per cent immunity to prevent substantial transmission if there’s an outbreak, however, and in B.C. only 72 per cent of seven-year-olds have been vaccinated against measles, according to the BCCDC immunization dashboard.
Because measles isn’t common in B.C., the immunization rate is reflective of the overall population’s immunity because the only way to get immunity is to be vaccinated. People aren’t getting sick and building immunity that way, Wong said.
In 2014 there were 344 cases of measles in B.C., which fell sharply to 195 in 2015 and 13 in 2016, according to the BCCDC communicable disease dashboard. In 2020 there was one case. There have been no cases in the last three years.
Mumps
Mumps is a respiratory infection that causes inflammation of the brain or the lining of the brain, temporary deafness, or permanent deafness in one in every 20,000 cases, according to the BCCDC.
Symptoms include fever, headache and swollen and painful salivary glands and testicles/ovaries. One in five people will be asymptomatic but still contagious.
The illness is transmitted when an infected person coughs, sneezes or otherwise swaps saliva with another person, for example by sharing a drink or kissing.
Rates of mumps have fallen by over 99 per cent in B.C. since 1996, when kids started getting two doses of the vaccine, but spiked in 2017, when there were 2,266 cases across Canada and 162 cases in B.C., according to the BCCDC. There have been no cases in B.C. for the last three years.
Rubella
Rubella is a virus that causes mild illness in adults, with symptoms such as low fever, tiredness, a rash and joint pain. However, when pregnant people catch rubella during their first trimester, the virus can cause congenital rubella syndrome, which nine times out of 10 will result in miscarriage or stillbirth, deafness, eye problems, heart defects or liver, spleen and brain damage, according to the BCCDC.
About one in 5,000 people who contract rubella experiences brain swelling and one in 3,000 gets thrombocytopenia, a decrease in platelets. Platelets are tiny blood cells that help blood clot to stop bleeding.
From 2014 to 2023 there were two cases in B.C. and five in total across Canada, according to the BCCDC.
Diphtheria
Diphtheria is a disease caused by toxin-producing bacteria that can infect the nose and throat and damage the heart and nerves. In unvaccinated individuals, without proper treatment it kills three out of every 10 people it infects, according to the World Health Organization. Children younger than five are at higher risk of dying.
The BCCDC gives slightly better but still terrifying odds, saying one in 10 will die.
Symptoms begin two to five days after exposure and include a sore throat, fever, swollen neck glands and weakness. Dead tissue from the respiratory tract forms a thick, grey coating in the nose and throat, making it hard to breathe and swallow, the WHO says. Death usually happens from inflammation of the heart.
There were five cases of diphtheria in B.C. from 2014 to 2023, according to the BCCDC. If someone is infected, they can be given diphtheria antitoxins and antibiotics.
The WHO says there are typically “resurgences” of diphtheria any time immunization coverage becomes low.
Tetanus
Tetanus is a bacterial infection that can cause seizures and muscle spasms in the neck, arms, legs and belly strong enough to “break bones, including the spine,” according to the BCCDC.
The bacteria are commonly found in soil or dirt and enter the body through a cut or wound. Symptoms usually start within two weeks of exposure and get worse over time.
Treatment for tetanus requires hospitalization so that doctors can work to control muscle spasms and pain and help the patient breathe. They may use antibiotics; tetanus immune globulin, which helps the immune system destroy toxins; medications to decrease muscle spasms; and a vaccination to prevent tetanus in the future.
Children get a series of vaccines starting at two years old, and adults should get a tetanus shot every 10 years. Anyone who gets a dirty cut or wound, or is bitten by livestock or a wild animal, should get a tetanus shot if their tetanus shot was five or more years ago.
There have been six cases of tetanus in B.C. in the last nine years, according to the BCCDC.
Polio
One out of every 200 people infected with polio will have permanent paralysis, usually in the legs, and of those paralyzed, between five and 10 per cent will die when their breathing muscles stop working, according to the BCCDC.
The disease lives in the gut and transfers from person to person through feces, usually when someone’s hands, food or water are contaminated.
The virus attacks the nervous system. Symptoms can include fever, tiredness, headache, nausea and vomiting, severe muscle pain and spasms, stiffness in the neck and back, weakness in the arms or legs and paralysis of the face, neck or breathing muscles.
The good news is that Canada was certified “polio-free” in 1994, and in the last 30 years the only cases of polio in B.C. were in unvaccinated residents who were exposed to polio-infected visitors from another country.
The bad news is that only 74 per cent of two-year-olds and 72 per cent of seven-year-olds are vaccinated against polio, according to the BCCDC immunization dashboard.
U.S. influence
Whether or not the United States will change what vaccines it offers its population remains to be seen.
Wong said he’s not sure what impact that could have on public health in Canada but added that “getting vaccinated is one of the best things you can do to protect yourself and your family from diseases.”
The more people who are not vaccinated against a specific disease, the more likely an unvaccinated individual is to be infected with the disease, he said. This is why it’s important for as many people as possible to be vaccinated, because it improves the health and safety of those around us as well as ourselves. It also helps protect people who are unable to be vaccinated, such as immunocompromised people who are unable to get the measles, mumps and rubella vaccine, he said.
Wong said he saw misinformation and disinformation about vaccines spread during the pandemic.
“There was a sense that vaccines are not safe. That is probably the biggest vaccine disinformation and the most harmful,” he said.
Vaccines are very safe, he said, and go through a “robust development and review process.”
Even after a vaccine is authorized, “we continue to monitor for safety signals to ensure people are getting more benefit from the vaccine than they are from any side-effects,” Wong said.
Vaccines provide a “substantial benefit with very rare adverse effects,” he added.
The odds of having adverse effects caused by a vaccine are between one in 100,000 and one in one million, he said.
“That’s not quite at the level of the chance of being struck by lightning, but it’s in the ballpark of the chance of being struck by lightning,” Wong said.
