In 1986, Roald Dahl, the famous children鈥檚 author, wrote a  to British parents, sharing his eldest daughter鈥檚 tragic story. Olivia caught measles in 1962; at the time she was seven. Dahl described how just when he thought she was getting better, suddenly one morning, everything changed. 

鈥溾�楢re you feeling all right?鈥� I asked her.

鈥業 feel all sleepy,鈥� she said.

In an hour, she was unconscious. In 12 hours she was dead.鈥�

Olivia had developed a rare measles complication called encephalitis or brain inflammation. 

When it鈥檚 your child, 鈥渞are鈥� becomes irrelevant. A year later in 1963, the first measles vaccine was licensed 鈥� a measure that would likely have saved Olivia鈥檚 life.  

When Roald Dahl shared Olivia鈥檚 story in 1986, Britain was seeing close to 100,000 cases of measles a year, yet parents were choosing not to immunize their children. 

Over the last 50 years, the World Health Organization estimates that essential vaccines have saved over 150 million lives globally: 鈥溾��&苍产蝉辫;

 of these lives saved are from measles vaccination. The outsized effect of measles vaccination on mortality comes from both preventing measles deaths and the infectious diseases-related deaths that follow. By infecting long-lasting memory cells, the measles virus causes ifor two to three years. It wipes out anywhere from 10 to 70 percent of a person鈥檚 antibodies to other diseases, acquired through immunization and infections. 

As one person wrote, 鈥� 鈥� my parents didn鈥檛 vaccinate me.鈥� 鈥�I got every single illness going for the next five years or so. I was ill for almost the entirety of my first year at uni with coughs, colds, tonsillitis, chest infections, ear and kidney infections. 

I had no defence against anything.鈥�

At the population level, failing to contain measles outbreaks will open the door to many more infectious diseases, as the recently infected will now join the ranks of the vulnerable.

What Roald Dahl was describing in 1986 was , a delay in acceptance or refusal of vaccines despite their availability. The ongoing COVID pandemic has made vaccine hesitancy worse. The explosion of misinformation (false information) and disinformation (intentionally false information) on social media has tremendously hindered public acceptance of COVID vaccines. 

Unfortunately, vaccine hesitancy is in the news again with the global resurgence of measles, including a large outbreak in Ontario with now over  and another one in Texas spilling over its borders. Sadly, one adult in New Mexico and . Last year, a child died in Ontario. All were unvaccinated.

Alberta is also in the midst of a measles outbreak. As of May 8, there were 313 cases, 82 per cent amongst children under 18 years of age. Ninety-five per cent of cases were un- or underimmunized (single dose of MMR vaccine).

Even back in 2023, Alberta鈥檚 health surveillance dashboard was showing measles immunization rates (two doses by age two) as low as 10 to 30 percent in some rural portions of Alberta. These numbers are frightening 鈥� like dry kindling waiting for a spark, these communities are highly vulnerable to a fast-moving measles outbreak. Such an outbreak will have been a predictable 鈥� and preventable 鈥� tragedy. 

In 1998,  through both vaccination, surveillance and a community immunity rate above 95 per cent. For this reason, many have never seen measles 鈥� it鈥檚 easy to underestimate its impact.

Measles is the most contagious disease known 鈥�  (for the Omicron COVID variant, that ). Each of these infected individuals can then go on to infect another 12-18 others and so on, seeding an explosive, exponential chain of infection.

Measles, like SARS-CoV-2, spreads through tiny infectious particles called aerosols that linger in the air that we breathe, even after the infected source has left the room. In a classroom with poor ventilation and air filtration, one infectious student can infect up to 90 per cent of their susceptible classmates. Frustratingly, parents鈥� pleas for  and child-care settings have been stonewalled.

It is precisely because it is so contagious that measles elimination requires such a high vaccination rate. High community immunity (95 per cent or more) is needed to protect all those who cannot be immunized 鈥�  infants less than six months, people who are pregnant and the immuno-compromised. A 鈥測ou do you鈥� approach to measles vaccination is incompatible with public health鈥檚 role. And yet public health has taken a laissez-faire approach at this critical juncture, essentially enabling vax hesitancy at a time when we can ill afford it.

The earlier outbreak in New Brunswick last fall helped seed the outbreak in Ontario, which itself contributed to measles in Alberta. Where will it go next? Ironically, Mexico has just put out a measles travel advisory for the U.S.A. and Canada. We should take that as a vote of no confidence in our public health.

For months now, both Ontario and Alberta should have been all hands on deck and pulling all stops to urgently contain outbreaks. With exponential growth and low vaccination rates, even small delays in responding to an outbreak can lead to a much larger problem, making public health鈥檚 task more difficult and more expensive.

Yet, there has been  amongst public health leaders. In Alberta, it took the abrupt resignation of the Chief Medical Health Officer and his scathing , along with three children in the ICU, for the health minister to finally announce a provincewide immunization campaign. It is vital for public health to level with the public now about the dangers of measles, and the risks of vaccine hesitancy.

from Stanford researchers showed what a return of endemic measles would look like in the U.S.A. Even a small decline in vaccine uptake would lead to 11 million measles cases and tens of thousands of preventable deaths directly attributable to measles over the following two and a half decades. Endemic measles is a nightmare scenario, even without accounting for immune amnesia. With measles, there can be no complacency.  

Back in 1986, Roald Dahl closed his letter to British parents thus:  鈥淚 know how happy she [Olivia] would be if only she could know that her death had helped to save a good deal of illness and death among other children.鈥�

No parent should have to bury their child because of measles.

Unfortunately, politicizing public health by downplaying the risks of measles and normalizing vaccine hesitancy puts us on precisely this trajectory.

It is a future we should seek to avoid.

Arijit Chakravarty is the CEO of Fractal Therapeutics, which focuses on applying mathematical modelling to drug discovery and development. Over the past four years, he has led an interdisciplinary team of volunteers in publishing 20 peer-reviewed papers on COVID-19. Their work has focused on examining the public health response from a risk mitigation standpoint and proposing (therapeutic and non-pharmaceutical) strategies for combating the disease. 

Dr. Lyne Filiatrault is a retired emergency physician who spent most of her 25-year career at Vancouver General Hospital. For 15+ years, she served as VGH Emergency Department Quality Improvement director. On March 7, 2003 she was on duty when Vancouver鈥檚 index case of SARS presented to the emergency department. Her team followed the precautionary principle, and . In 2021, she joined  where she was an active, and outspoken member for close to three years. She is now a member of the  and continues to advocate for preventing the acute and longer-term harms of SARS-CoV-2 infections.