Measles, bird flu pose emerging challenges for Peel amid increasing vaccine hesitancy and shortfalls in public health funding

Over the last year, Ontario has recorded 65 cases of measles—nearly three times the annual average over the last decade. The dramatic spike has left public health experts concerned about the potential causes, and the ease of spread among a population that is displaying a disturbing increase in vaccine hesitancy since the COVID-19 pandemic. For context, Ontario averaged between seven and 22 cases of measles annually prior to the pandemic.

The spread is potentially exacerbated by disruptions in routine vaccination programs through schools caused by the dramatic shift in public health resources to address COVID-19. 

An “enhanced epidemiological summary” of measles cases in Ontario, reported by Public Health Ontario on January 16, shows that eight measles cases entailed hospitalization last year, including seven unimmunized children. It also included one fatality of a child under the age of five.

Travel-related infections are a significant factor in the spread of the contagious virus. Public health reports indicate that 17 cases are linked to exposure outside Canada, with two of these cases resulting in six epidemiologically linked infections reported in April and May.

Data from the Canadian government show a total of 139 measles cases across the country last year. Of these cases, the majority, 55 percent (77 cases), were males, while 45 percent (62 cases) were females.

Ontario is the third-highest province affected by the current resurgence of measles, accounting for 26 percent of cases. Quebec leads with 38 percent, followed by New Brunswick at 34 percent. Among these cases, 43 patients were children and teenagers aged five to 17 years, while 61 infections were reported among individuals aged 18 to 55

Measles, also known as rubeola, is a viral respiratory illness that results in symptoms such as fever, rash, watery eyes, and cough. It is highly contagious and spreads through the air when an infected person talks, coughs, or sneezes. The best way to protect against this disease is through the vaccine, which was first introduced in 1963.

Data from Public Health Ontario show a disturbing spike in measles cases in 2024.

(Public Health Ontario)

A staggering 75.4 percent of the 65 cases involved completely unimmunized individuals, which highlights a critical gap in vaccination coverage. Among the remaining infected individuals, only five had received the recommended two doses of the measles-containing vaccine. A similar trend is seen across Canada with 66 percent of infected individuals not being vaccinated against measles. Additionally, 10 percent of individuals had received one dose of the vaccine, while another 8 percent had received two or more doses. The vaccination status of 16 percent of the individuals was unknown.

In Canada, measles vaccines are only available in combination with mumps and rubella (MMR) or with mumps, rubella, and varicella (MMRV). Unlike some countries, where standalone measles vaccines are administered, the combined formulations provide broader protection. 

Public Health Ontario reported in July 2023 that, among 7-year-olds, there was a significant decline in immunization coverage for measles, mumps, and varicella during the period of 2020-21 and 2021-22. The report also suggested that the proportion of children who had only received one dose of the measles vaccine was seen to have increased during that time, which suggests many did not complete the two-dose schedule required to ensure full protection against the disease.

This trend could be a reflection of the disruptions to routine immunization programs during the COVID-19 pandemic, compounded by vaccine hesitancy and accessibility challenges. Vaccination-related challenges are having a significant impact both nationally and in the Peel Region. Public Health Ontario has recognized vaccination hesitancy as an increasing concern, especially following the COVID-19 pandemic. Misinformation about vaccines has contributed to a decrease in public trust.

It is evident from the results of 2021 public polling that while 74 percent of Ontarians intended to get vaccinated against COVID-19, hesitancy was explicitly visible, with only 48 percent willing to take the first available vaccine. This was particularly concerning in the Region of Peel, which quickly became a hotspot for COVID-19 spread during the pandemic. 

Public Health Ontario has emphasized that the success of vaccination programs largely depends on the effectiveness of the health sector in addressing barriers related to vaccine intake. This includes combating vaccine misinformation, particularly in marginalized communities, and prioritizing culturally sensitive approaches to communication and implementation.

"With regards to the measles, mumps, and rubella vaccine, we are working closely with our school board partners to collect up-to-date immunization records," Dr. Monica Hau, lead physician and associate medical health officer at Peel Public Health, told The Pointer. Peel recorded three cases of measles last year and one case in 2023. According to Peel Public Health’s 2025 business plan, 50 percent, or 115,000 students in Peel, were missing the record of at least one dose of vaccine required to attend school, a gap that will take several years to close. Immunizations for Hepatitis B, Meningococcal, and Human Papillomavirus (HPV) are 10 to 36 percent below pre-pandemic benchmarks. 

"All students in Ontario are required to have vaccinations against nine specific diseases unless they have a valid exemption. And so currently, we are working to notify parents, starting with those in the youngest age group, individuals who may not have been screened during the pandemic, to collect their immunization records and to send reminder notices to parents to let them know that their child may be overdue for a vaccine,” Dr. Hau said. 

In terms of resistance to vaccination, she stated that the rate of non-medical exemptions for vaccinations in Peel has remained stable at around 3 percent, with 2.8 percent of parents choosing not to vaccinate their children.

She highlighted the main factors contributing to vaccine hesitancy are the persistent myth of a link to autism—as a result of a frequently debunked study published in the 1990s— as well as the proliferation of online misinformation, especially after the pandemic.

"There's no associated link, after numerous scientific studies. However, the myth may still persist for some people, and that may cause them to become hesitant,” Dr. Hau said, adding that the proliferation of online misinformation about COVID-19 has now spilled over into vaccines in general.  

While Peel Public Health remains one of the lowest funded health units in Ontario, Dr. Hau says they are working to increase staffing and resources to collect immunization records and provide vaccinations, particularly for residents without a family physician, including newcomers.

Unfortunately, there are persistent shortcomings in the Peel healthcare sector, which has been underfunded for years. The regional public health unit is operational with one of the lowest per capita funding levels compared to other health units in Ontario. A nearly $10 million funding shortfall has been reported since 2018, which has strained the public health workforce and limited its capacity to meet the growing population's health needs.

This is a significant concern as Peel Public Health grapples with a surge in many different infections across the region.

“There is an increasing burden of communicable diseases including a high number of institutional outbreaks and increasing rates of some communicable diseases,” Peel’s 2025 budget states. This includes a 154 percent increase in HIV rates in 2023, and a 61 percent jump in syphilis cases compared to the five-year average from 2018 to 2022. This is made increasingly difficult by the rise in asylum seekers arriving in Peel, the document states. 

Dr. Monica Hau emphasizes the importance of strengthening vaccination efforts and addressing misinformation to combat measles and prepare for emerging public health threats.

(Muhammad Hamza/ The Pointer)

Along with the concerning increase in measles cases, Canada reported its first human case of avian influenza, commonly known as bird flu. The New England Journal of Medicine, a respected non-profit organization dedicated to advancing medical science and public health through the publication of vital research and clinical findings, released a report on December 31, detailing the case of a 13-year-old girl from British Columbia who tested positive for the H5N1 virus.

The teen first went to the emergency department on November 4, 2024, experiencing fever and conjunctivitis in both eyes. Initially, she was discharged without treatment. She returned to the emergency department on November 7 after developing a cough, vomiting, and diarrhea. Her condition worsened, leading to her transfer to the Pediatric Intensive Care Unit (ICU) at BC Children’s Hospital on November 8 with temporary oxygen support. At that point, she was suffering from respiratory failure, pneumonia, kidney injury, thrombocytopenia, and leukopenia.

While the source of the disease is still unknown, the Journal reported the teenager is off enhanced oxygen delivery as of December 18; the virus is no longer infectious, and she was transferred to the pediatric ward.

As the affected teenager was from the Fraser Valley, the general assumption was drawn through genome sequencing that there might be a linkage between this case and two infected wild geese who were found dead in the Fraser Valley in October last year, or it might have originated from a poultry farm in B.C. where outbreaks of H5N1 had been previously reported. However, the exact mode of transmission is still unverified.

The virus's cross-border reach was identified through genome sequencing, linking it to a serious human infection recently discovered in Louisiana. In the U.S., 67 confirmed human cases of H5N1 have been reported, including 11 in Washington State, while outbreaks among poultry have been reported in all 50 states.

A “worrisome” genetic mutation identified in the virus, which may increase its ability to spread among humans, has raised alarms among experts despite the U.S. Centre for Disease Control maintaining that overall public health risk is minimal. The researchers of the study published in the New England Journal of Medicine last year found that these ominous mutations could potentially target human cells more easily, and the severity of the disease could enhance, particularly in high-risk populations such as agricultural workers and those in close contact with infected birds. The researchers cautioned that an urgent need for robust monitoring and containment strategies is needed on both sides of the border.

The zoonotic virus can cause a range of symptoms, including common flu-like symptoms such as cough, vomiting, and conjunctivitis (pink eye). 

While there is no specific vaccine for H5N1, a subtype of the avian influenza virus, antiviral medications can help reduce morbidity and mortality, especially when treatment is initiated in the early stages of the infection. There is no protection against H5N1 from seasonal influenza vaccinations.

Dr. Hau told The Pointer that Peel Public Health has established routine measures to address emerging diseases, including surveillance systems, rapid pathogen identification, and awareness-raising among healthcare providers.

"We do routine measures for any new emerging disease, and so that includes, first of all, having surveillance systems in place to be able to detect anything that is new," she said. “The first step is surveillance. The second one is around information, and awareness raising amongst our healthcare practitioners."

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