😷 The Hidden Epidemic: What Toronto's Measles Crisis Reveals About Our Broken Health System

See the related Substack Episode, and there is a comic ".  )  

When a "defeated" disease comes roaring back, it exposes every crack in our public health foundation

There's something almost quaint about measles making headlines in 2025. Like hearing that someone still uses a rotary phone, or that a city's traffic lights run on punch cards. Measles was supposed to be done, finished, relegated to the history books alongside polio and smallpox. Canada declared it eliminated in 1998. We moved on.

Except diseases don't read our press releases.

Toronto Board of Health: June 3, 2025 Meeting

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Transcript

0:25

Welcome to the Deep Dive. Today we're digging into the sources from a recent Toronto Board of Health meeting. This was June 3rd, 2025. Yeah, we've got the reports, the public comments, the minutes, the whole package. And our goal here is to really unpack what went down. especially around the big public health challenges facing Toronto right now. We want to pull apart the discussions, you know, the different viewpoints, especially on things like measles, but also other topics that came up. It's about understanding the pressures and the perspectives. Exactly. We'll focus heavily on the measles response because that was a major part of the meeting. But we'll also hit on other key things, AI and public health. funding stuff, basically giving you the crucial takeaways from these documents. It's not just what they talked about, but what it tells us about public health operations and importantly, what the public expects from them. OK, so let's paint the picture. Hybrid meeting, some online, some in person. Kicked off with the usual acknowledgments, land acknowledgment. Right. Pride Month 2, National Indigenous History Month. And a shout out to the new Anishinaabe Health Toronto facility opening, setting the context. Then they got into the admin, approving minutes, adding an item, something about TPH maybe getting its own website, which is interesting. Yeah, exploring the feasibility of that. And they shuffled the agenda a bit for a confidential item later on, standard stuff. Before the main topics, there were also these quick updates from staff. Community Champion Awards, National Nursing Week. Newcomers Day activities, highlighting health resources there. A reminder about school vaccinations, you know, end of the school year approaching. Safer partying resources, too, for grads. And the ongoing harm reduction work, like naloxone training. Important updates. And also, they mentioned the search for the new medical officer of health. Looks like they expect a recommendation in July. That's a really key role. Definitely. Oh, and a couple of declarations of interest. Directors Roy and Krish on the Urban Health Fund item. Just procedural. Okay, stage set. Let's dive into the main event, really. Measles. This took up a lot of time and really exposed some core tensions. Right. Let's start with the official TPH presentation. What picture did they paint? They went over the basics. Measles, viral, airborne, extremely contagious, like one person can infect nine out of ten unvaccinated close contacts. Wow. Yeah. Symptoms, rash, fever, cough, the usual suspects, but also potentially life-flatting complications. That was stressed. And the history is key here, isn't it? Eliminated in Canada since 98. Exactly. But here's the warning they flagged. If this sustained transmission goes on past October 2025, Canada could actually lose that elimination status. That's according to the Pan American Health Organization. So the stakes are high. What about the current Ontario outbreak? It started October 18th, 2024, traced to travel, a case in New Brunswick initially. And since then, Ontario's seen way more cases than the old pre-pandemic average, which was only about like... 11 a year for the whole province. And mostly in unvaccinated people. Overwhelmingly, yes. That's what the data showed. Okay, what about Toronto specifically? Toronto's pre-pandemic average was lower, around five cases a year. In 2024, they had 10. And as of June 2nd, just before this meeting, seven confirmed cases for 2025. So not huge numbers in Toronto yet compared to some areas. Right. Staff actually pointed out that Toronto hadn't really seen outbreak-linked cases before the pandemic based on their sources. But the risk from nearby regions is definitely there. It's spilling over potentially. And the TPH response isn't just about those seven confirmed cases around. It's much bigger. Oh, way bigger. They talked about mobilizing staff, investigating suspect cases, 152 of those in 2025 so far. Each one takes time, resources. And the contact tracing. Huge. Following up on people visiting Toronto who might have been infectious, tracing hundreds of contacts just from that. Overall, they've followed up with almost 1,000 people this year. That sounds expensive. It is. They put a number on it.$750,000 for the response team so far. And it's climbing.$750,000. And crucially, they're pulling staff and resources from other public health programs to cover this. Yeah, and it impacts the whole system where tests and doctors' offices, exposures in hospitals, ERs, all needing follow-up, too. They mentioned the impact on schools, too, with exclusions. Right. Under the Immunization of School Pupils Act, or ISPA, if an unvaccinated person is exposed, they can be excluded from schools. school or daycare for up to 21 days. 21 days. That's a long time. It is. And they gave that example from southwestern Ontario where schools actually had to close because staff didn't have their vaccination records sorted. Shows the ripple effects. So what's TPH doing on the prevention side? Communications campaigns, obviously. But a big focus is that ISPA assessment program. They check vaccine records for specific grades, currently kids born in 2008 and 2016. And those letters. Yes. A massive mail out. individualized letters going out in June to about 140,000 students with incomplete vaccine records. 140,000. Yeah. The goal is to get those records updated or get kids caught up on shots. They're also adding appointments at TPH clinics, but primary care is still the main route. They reviewed the vaccine recommendations too, I assume. Yep. standard stuff first dose around one year second dose at four to six years adults born before nineteen seventy generally considered immune born nineteen seventy or later two doses recommended and you can get them if you're unsure was there anything near on recommendations yes related to the provincial situation Ontario recently advised an earlier MMR dose between 6 and 11 months for infants living in southwestern Ontario because of the outbreak there. Okay. So TPH updated their existing advice, which already recommended that early dose for travel to risky areas to explicitly include... southwestern Ontario now, reflects the local concern. And now the vaccination rates themselves, that seems like a key piece of context. Absolutely critical. STAC reported rates have dropped because of the pandemic disruption, and it's worse for younger kids. Now much worse. Well, for seven-year-olds, only 69% were up to date in the last school year. Compare that to 17-year-olds who are over 85%. That's a big gap. And why the drop? They cited issues accessing primary care, but also, pointedly, vaccine hesitancy and confidence issues. That came up repeatedly. But that ISPA program seems to make a difference when it's enforced. Definitely. They showed data for the GREED 11s born in 2008, started the year at only 23% up-to-date records, after the ISPA assessment, jumped to 87%. That's a huge increase. 64% increase. shows that requirement really drives compliance. And communications beyond the letters. Yeah, the usual channels, infographics, social media, news releases, website updates, including listing exposure locations, plus outreach to doctors, community groups. But they also talk about challenges, right? It wasn't all smooth sailing. No, quite frank, big challenge. Increasing vaccine confidence when there's so much misinformation out there. Also, a lack of good data on why parents are hesitant, specifically in Toronto or Ontario. And the tech issue. That was a major one. Outdated technology. Specifically, the lack of a provincial electronic vaccine registry. rely on manual reporting, paper records. It makes tracking cases and contacts incredibly difficult and slow. Okay, so that's the TPH perspective. Data, actions, challenges. But then the public deputation started and things got interesting. Yeah, this is where you really see the impact of the last few years. A lot of deputants came forward saying, look, vaccination is important but it's not enough on its own for an airborne virus like measles especially with rates being what they are exactly especially when rates aren't near that ninety five percent needed for measles very critical they felt information on airborne protection was like hidden buried deep on the website in toolkits, not pushed out on social media where people would see it. Not reaching schools effectively either, they said. Yeah, examples given of info arriving late, like right before March break, or parents having to push schools to share TPH guidance. The feeling was the public just isn't grasping the seriousness, or how low vaccine coverage is in some places. One parent mentioned a grade two class with only 45% MMR coverage. Wow. Any specific stories that stood out? There were a few. A parent whose masked child caught COVID at school anyway, missing a trip. Huge frustration about sick kids attending school and the lack of layers. Another parent speculating why parents might sense sick kids may be lack of info on the risks. And the HVAC tech. Right. An HVAC technician saying even in health care, the understanding of airborne spread is poor. There's a disconnect between having tools like N95s or HEPA filters and actually using them properly or understanding why they matter. There were calls for TPH leadership to model masking, too. Yes, to normalize it, build trust. And a strong argument that poor indoor air quality is a public health hazard. TPH has the power to address, under provincial law, the HPPA. They connected IAQ to other issues as well. Definitely. Wildfire smoke, asthma, chronic illness, even things like behavior in schools... food insecurity links, accessibility for people with disabilities, trying to show it's interconnected. So what were the concrete asks for TPH? Clear guidance, even requirements for better air quality in high-risk places.

Healthcare settings: 9:48

doctors, dentists, hospitals, labs, long-term care, child care, and a huge focus on schools. Concerns about schools seemed specific. Yeah, citing reports of underpowered HEPA units in Toronto schools, lack of proper Mary 13 filters, ventilation issues and portables. They wanted TPH to advocate for a citywide IAQ policy, maybe mandatory masking at least. at least in health care. We also heard from universities. Yes, reps from York and TMU, making the point that measles isn't just a childhood illness. It spreads among adults in crowded university settings, too. They felt there was a lack of clear TPH guidance for post-secondary and that university admin looks to TPH for that lead. Important for campus safety committees, too. OK, so that's one major theme from the public. Add more layers, improve air quality, communicate better about airborne risk. But there was another very different perspective presented too, right? Absolutely. A completely different viewpoint from other deputants who question the safety and necessity of vaccines, particularly the MMR vaccine. What were their main arguments? They made claims that childhood vaccines, including MMR, weren't properly tested against placebos in the long term before licensing by the FDA. They cited specific details they found about the MMR2 and priorics trials, alleging no real placebo group or insufficient follow-up for long-term side effects and high adverse event rates. They questioned the risk-benefit calculation. Directly. Arguing that the number of people with long-term chronic illness post-MMR is unknown, and claiming the risk of death from the vaccine is higher than from the disease itself, especially for kids. There's a historical argument, too. Yeah, that major disease declines historically were due to sanitation, clean water, sewers, not vaccines or antibiotics. And that focus should be on nutrition, vitamins like A and C for measles, which they feel is ignored now. What else? Concerns about immune system effects. Arguments that vaccines permanently alter immunity with unknown irreversible effects. That kids shouldn't need exemptions for products known to cause harm. The assertion that healthy kids don't die from measles, only malnourished ones do. That natural infection gives lifelong immunity while vaccines might be linked to rising chronic conditions. There were some pretty strong claims about accountability, too. Yes, alleging that manufacturers and governments know vaccines cause harm or death in some children but aren't held liable, referencing a children's health defense book. So what was their call to action? For parents to question everything, do their own research. Vaccine choice should be private. They called for halting childhood vaccine programs until safety is proven by experts from both sides and for promoting alternative medicine and natural immunity. Yeah. And a specific mention of the COVID vaccine. Right. Pointing to the CDC changing its recommendation for healthy kids and pregnant women and asking the Board of Health to do the same regarding COVID shots. So you've got TPH, the push for vaccine plus team and the vaccine safety critics. A real range. Yeah. How did the board and staff respond to all this? Staff acknowledged the feedback, especially on the air quality communication. They said, you know, making IAQ info more visible is something they can look at. But they framed IAQ improvements as a longer term policy thing involving other city departments. Whereas their immediate focus in an outbreak is vaccination, case and contact management, their core tools. They also clarified it's the standard measles virus they're dealing with, not German measles or something. else and reiterated the target groups, unvaccinated kids, adults born 1970, 1995, newcomers. What about that tech problem, the lack of a provincial registry? That got a lot of agreement from both staff and board members, acknowledged it's a huge barrier. The board has been asking the province for this for years. They actually passed a motion building on Councillor Moita's earlier work to formally ask the province again urgently. Did they address the comparisons to COVID? Staff did. They said measles is serious. Absolutely. But it's different from COVID because there is significant underlying population immunity from decades of vaccination. The current job is finding those unprotected pockets. And they stress that so far their efforts seem to be working seven cases, thousands of contacts managed, but no documented transmission within Toronto yet. And 140,000 letters. Any clarification there? Yeah. Staff explained for many it's just about reporting existing shots because the system doesn't link automatically. Yeah. Others will need the shots, either via primary care or TPH clinics, and they're adding thousands of clinic spots. The cost came up again, $750,000 plus. Acknowledged again. And they reiterated they're redirecting internal funds because, currently, provincial outbreak funding only goes to officially declared outbreak regions, which Toronto isn't technically at this point. And communication with schools. Trustee Lady asked about that. TPH said they meet regularly with school boards, provide resources. They took the feedback about making info easier to find on board websites. But they also repeated decisions on filters, ventilation in schools. That's the Ministry of Education's call. Not TPH, not the boards. Do they address the vaccine safety concerns directly? In response to a question, staff said generally an extra measles vaccine dose isn't harmful if you've had it before. Exceptions for certain conditions like being immunocompromised or pregnant. Those folks need to talk to their doctor. OK, so measles was huge, but not the only thing on the agenda. What else was significant? Right. Shows the breadth of their work. The Toronto Urban Health Fund allocations were approved. But notably, a motion passed asking the CMOH to consider adding some new potential priorities for the fund's review later this year. Which were? Intimate partner violence reflecting that IPV was declared an epidemic. Also, youth vaping. And interestingly, youth energy drink consumption. Concerns about health impacts there. There was also the Heart Hub discussion. The downtown homelessness and addiction hub. Yes, some in closed session. But afterwards, in public, motions passed. One directs city staff to set up a coordination table for outreach and case management trying to smooth the pathways into services for people. And another asks the medical officer of health for an update later this year on how the heart hub is doing. including finalizing performance measures. And looking ahead, artificial intelligence. Yeah, an item on the Mayor's AI Innovation Awards prompted a really important discussion about how TPH itself might use AI. Leading to emotion. Yes. Directing the Medical Officer of Health to report back, Q3, this year on developing an AI policy framework for TPH. How staff can use it, data handling, bias mitigation, aligning with other guidance. Yeah. The city CISO mentioned a citywide AI policy is coming, but TPH has unique needs as a health info custodian. Sensitive data. Okay, let's try and pull this all together. After digging through all this, what does this meeting really tell us? What's the takeaway for listeners in Toronto? I think it starkly shows public health wrestling with a disease, measles, that many thought was basically gone. And the complexity of that fight now. You really see the tension, don't you? Between the traditional public health playbook vaccines, contact tracing, which DPH is focused on, and this strong public push shaped by the pandemic for more layers, like better air quality, masking and sheared spaces. Exactly. And it highlights the real world constraints TPH operates under. Limited resources, that huge technological gap with vaccine records, navigating complex governance where they don't always hold the final decision making power like with schools. And this isn't abstract stuff. These discussions touch the places you go every day. Schools, doctor's offices, public buildings. It shows the different forces shaping public health policy right here in the city. So this deep dive really reveals a public health unit managing resurgent threats. while also trying to look forward like with ai we heard staff detailing their response to measles the work the cost the frustrations but alongside that those passionate public voices demanding more drawing on pandemic lessons about airborne spread ventilation masks Arguing vaccination alone, especially at current rates, isn't sufficient protection in shared indoor environments. And those systemic problems really came through the desperate need for better data systems, the funding challenges. Right. It leaves you thinking, doesn't it? As these old diseases find new footholds, how do public health authorities strike the right balance? between the tried and true methods and this growing demand for more comprehensive layered strategies in our everyday spaces and crucially how do they overcome those systemic hurdles the tech the funding the tangled jurisdiction that clearly stand in the way