J.P. Antonacci, Local Journalism Initiative Reporter, The Hamilton Spectator

Grand Erie Public Health was born on the first day of 2025, the result of months of merger talks between the health units that had overseen Haldimand-Norfolk and Brantford-Brant.

A week later, as staff were still setting up their new email accounts, the measles virus appeared in the largely rural community southwest of Hamilton.

That  first case of the highly contagious respiratory disease once considered  eradicated in Canada led to many more, with Dr. Malcolm Lock formally  declaring a measles outbreak in Grand Erie before the end of January.

Lock, who died the following  month, had only recently replaced Dr. Rebecca Comley after  Brantford-Brant’s former medical officer of health went on leave. The  health unit would introduce four different top doctors before the  measles outbreak began to wane in July.

It  was during this time that health officials grappled with an outbreak  that eventually infected 300 residents, mostly in Norfolk County, and  sent 18 people to hospital. 

Among  the hospitalized were an unspecified number of unvaccinated children,  the demographic most affected by the potentially life-threatening  disease that is almost completely preventable thanks to a safe and  freely available vaccine with a decades-long track record.

Low  vaccination rates saw Grand Erie account for 12.5 per cent of the 2,376  total measles cases reported in Ontario during the outbreak, which was  declared over in October.

Grand Erie was second only to neighbouring Southwestern Public Health as the region with Ontario’s largest measles caseload.

“I think the teams did a great job of coming together quicker than  anticipated and working together, and prioritizing the response at a  time that was already very busy for everyone,” Dr. Jason Malenfant,  Grand Erie’s current medical officer of health, told The Spectator.

Managing one of Canada’s  largest measles outbreaks in decades took technological innovation,  hours of community outreach and creative approaches to overcome vaccine  hesitancy in at-risk populations. Health officials spoke with The  Spectator about how the health unit’s infectious disease experts used  new methods to battle an old enemy. 

The need for speed

The  health unit’s emergency preparedness group responded to the measles  outbreak by deploying “online systems and tools” put in place during the  COVID-19 pandemic, said Filip Pajtondziev, Grand Erie’s manager of  infectious disease.

“We were able to contact cases  right away (and) effectively and efficiently call contacts,” said  Pajtondziev, describing how robocalls helped to alert “well over 1,000  residents” of potential measles exposures.

Staff  followed up with each of the 150-plus residents who filled out the  health unit’s online self-screening portal. Any resident unable to  travel to get tested had a test kit delivered to their home, while the  health unit also arranged for mobile immunization or post-exposure  prophylactic treatment.

“We met people where they’re at and we really tried to remove those barriers,” Pajtondziev said.

To  spread the word about measles, the health unit paid for ads on social  media, issued news releases, convened press briefings and launched an  online dashboard with updates on case counts and exposure notifications.

Those notifications named  businesses, hockey arenas, places of worship, youth clubs, schools,  doctor’s offices and more, giving the date and time range when people  with measles had visited. 

“I  think it was really important to be transparent with those settings and  just let them know the importance of the health risks that we’re trying  to communicate to the community,” Pajtondziev said of the delicate task  of publicly naming private businesses in connection with the outbreak.

“We  had positive feedback from the community to be able to utilize those  (notifications) and call in to complete an exposure form.”

Removing barriers to vaccination

The  health unit focused on convincing parents and guardians to get their  children immunized, stressing that receiving two shots of the measles,  mumps and rubella (MMR) vaccine gives the recipient near-total  protection for life.

Grand  Erie staff delivered more than 750 doses of MMR vaccine at community  clinics amid the outbreak, a figure that does not take into account  shots given at doctor’s offices and walk-in clinics.

“Certainly  we used that as a metric (of success) — our ability to reach  communities, speak with them one-on-one, increase vaccination, address  head-on any hesitancy or disinformation or misinformation that we’ve  been faced with,” Malenfant said.

The health unit does not  usually offer routine immunizations to the general public outside of  school settings, but officials did so amid the outbreak to reach rural  residents who do not have a family doctor or lack access to  transportation.

“And that’s not unique to our region. That’s provincewide and countrywide,” Malenfant said.

“Trying to remove those barriers is certainly one of the goals in trying to prevent future outbreaks.”

Where religion and public health meet

Dr. Kieran Moore, Ontario’s chief medical officer of health, said in March 2025 that the measles outbreak was traced to “an exposure at a large gathering with guests from Mennonite communities in New Brunswick.”

Guests  at that October 2024 gathering unwittingly brought the virus to  southwestern Ontario, namely the region bordering Norfolk, Oxford and  Elgin counties, which has a sizeable conservative Mennonite population.

Grand Erie and Southwestern public health officials faced a challenge  shared by their counterparts in rural Texas — the epicentre of a  simultaneous measles outbreak in the United States — as well as in  Mexico and five South American countries where the same measles strain  infected members of local Mennonite communities.

Experts who study the intersection of religion and public health say some conservative religious communities  with a historic mistrust of governments are reluctant to get  vaccinated, leaving members more susceptible to vaccine-preventable  diseases like measles.

In response, the health unit met with faith and community leaders in Norfolk to open a dialogue.

“Just  meeting people where they’re at and having open conversations and  listening to those concerns,” Pajtondziev said. “We look at ways we can  support people, whatever the need may be.”

The  health unit also got creative to educate Mennonite communities about  the risks posed by measles, translating signage and handouts into Low  German — or Plautdietsch — and co-producing a Plautdietsch-language video to educate residents on treatment options and ways to limit transmission

Reading, writing and rolling up sleeves

Knowing  children are most at risk of serious complications from measles,  Pajtondziev said the health unit prioritized getting educational  material disseminated through schools and child-care centres, arranging  for on-site vaccination clinics when needed.

Churches  and private religious schools in Norfolk run by Old Colony or Old Order  Mennonites, as well as other Anabaptist sects, made repeat appearances  on the measles exposure list.

By law, students in all Ontario  schools — including private religious schools — must be immunized  against childhood diseases such as measles unless granted a medical or  philosophical exemption.

The  health unit uses an online records system to get timely lists of which  students are immunized to help determine who needs to be kept home after  a measles exposure in a classroom or on a bus.

The information is available for public schools and “at least some private schools,” Malenfant said.

But  Lock, the former medical officer of health, told reporters some private  school administrators are “reluctant” to release students’ names and  vaccination status due to privacy concerns.

The  health unit can suspend students whose parents do not submit proof of  vaccination as required by provincial law. This past March, 461 Grand  Erie students were ordered out of class due to incomplete immunization records. Most returned to school within a few weeks.

But health officials depend on family doctors to offer eligible vaccines  to their young patients “and make sure that those children are on  schedule for their routine immunizations,” Malenfant said.

Long-term fallout unknown

Along  with sending 18 people to hospital and causing hundreds more to seek  medical treatment, the Grand Erie outbreak had broader implications.

Dr.  Ninh Tran, Southwestern’s medical officer of health, told reporters the  outbreaks in the neighbouring health units were “directly connected” to  measles cases in other regions, including Hamilton, Windsor-Essex and  Niagara.

“The transmission is quite complex and doesn’t follow geographical borders,” Pajtondziev added.

Grand  Erie, which has 0.6 per cent of the country’s population, accounted  for 5.8 per cent of Canada’s 5,138 total measles cases.

Lock  told reporters the health unit’s case count was likely an  underestimate, since contact tracing was limited and some residents were  reluctant to report symptoms and get tested.

Beyond the numbers, the long-term fallout of the outbreak remains to be  seen. While most people who catch the measles will recover at home, the  virus can destroy the patient’s immune system, leaving them susceptible  to all manner of infections for up to five years.

‘Really unfortunate milestone’

Canada declared the end of the measles outbreak on Oct. 6. Just over a month later, on Nov. 10, Canada lost its measles elimination status due to the same measles strain having circulated for more than a year.

“This  is a really unfortunate milestone for Canada,” Malenfant said, calling  the loss “a huge wake-up call and a reminder to all of us in public  health and health care that we need to remain vigilant.”

Canada  had officially eliminated measles in 1998 following sustained efforts  to reach herd immunity, meaning at least 95 per cent vaccine coverage.

The latest survey  from the Public Health Agency of Canada, conducted in 2023, estimated  87.4 per cent of Canadian adults had received at least one dose of the  MMR vaccine, with two doses needed for full protection.

The  survey found the percentage of two-year-olds to have received at least  one dose dropped from around 90 per cent in 2019 to about 82 per cent in  2023. 

Regaining measles elimination status will involve addressing  COVID-inspired vaccine hesitancy and mistrust in public health,  Malenfant said.

“Certainly, I’m using (the loss of status) as motivation to regain the public’s trust,” he said.

Malenfant  called for “a really collaborative response” and “sustained investment”  in public health from all levels of government to remove barriers to  vaccination and “combat misinformation and disinformation.”

“We  need to provide credible, scientifically driven information to the  general public in a manner that is digestible and trustworthy,” he said.

‘Thankful for the team’

The  measles outbreak was an immediate test for the new health unit, and  Malenfant and Pajtondziev said Grand Erie Public Health was not caught  off guard.

“We’re  equipped for unexpected scenarios and emergency response,” said  Malenfant, explaining the cost of responding to the outbreak — including  overtime pay for staff running evening and weekend vaccine clinics —  was absorbed by the health unit’s budget.

The outbreak could have been worse if not for the health unit’s speedy and “proactive response,” he added.

“It could have reached a  greater severity, as many other outbreaks have,” Malenfant said. “And so  our co-ordinated response is hopefully contributory to that.”

During  the COVID-19 pandemic, many regular health unit programs were forced to  the back burner while staff focused on the emerging threat. This time,  business continued as usual.

“We were able to plan ahead and make sure none of our other programming was impacted,” Pajtondziev said.

“Everyone is quite passionate about what we do. They’re the experts that really help control our outbreak. So I’m very thankful for the team.”

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