There has, in recent years, been a resurgence of vaccine-preventable diseases, especially measles, a tragic situation often blamed on yuppie parents who fall prey to New Age pseudoscientific nonsense and refuse to get their children vaccinated.
Those Jenny McCarthy-inspired vaccine deniers are irksome but there is another group that is a much bigger culprit and which is rarely blamed publicly – religious fundamentalists. Witness the current, worrisome outbreak in southern Alberta. A Grade 9 student who travelled to the Netherlands came home with measles. At least 18 others around the Lethbridge area have now been infected.
The boy attends a Christian school. He contracted the disease while visiting the Dutch Bible Belt, where an ongoing outbreak has sickened more than 2,000 people and which claimed the life of a 17-year-old earlier this week.
In many fundamentalist Protestant communities the vaccination rate is abysmally low. Religious leaders range from ambivalent to openly hostile about vaccination. (While we don't know the vaccine rate in specific religious communities, we do know that the vaccination rate in southern Alberta is about 50 per cent, which is one of the worst in the developed world.)
Everyone – especially public-health officials – pussyfoots around this issue. No one dares make the connection between disease outbreaks and religious practices for fear of being labelled intolerant or bigoted or anti-religion.
Some of this concern is justified. The last thing you want is scapegoating and persecution of "the Dutch" or any other minority, for that matter.
But political correctness, a misplaced fear of offending, can be sickening (quite literally) and even deadly.
We need to be intolerant and publicly condemn practices that endanger the lives of children and undermine public health and safety. Public health has to expose the genesis of outbreaks, no matter how discomforting.
The Lethbridge outbreak is not unique; it fits a well-established and sadly predictable pattern. Measles – a once-common illness that causes an itchy rash and fever and can, in some instances, be fatal – was eradicated from North America at the end of the 20th century – meaning there is no domestic reservoir. Outbreaks occur only when the virus is imported. Public-health officials tend to blame "foreign travel" rather than fundamentalist religious practices. Consider these recent cases:
Earlier this year there was a large outbreak of measles in Brooklyn, N.Y., specifically in the ultra-Orthodox Jewish community where vaccination is shunned. It started with a seven-year-old boy who had travelled to Britain, and came back with the illness;
This past summer a measles outbreak was linked to Eagle Mountain International Church, a fundamentalist mega-church in Newark, Tex. A churchgoer who visited Indonesia came back with the infection, which quickly spread. The pastor of that church was an outspoken critic of vaccination and promoted so-called "faith healing";
This fall, B.C.'s Fraser Valley had a measles outbreak. The exact source is unclear but this is Canada's Bible Belt, an area with very low vaccination rates. Previously, there have been large outbreaks of measles and mumps in this area;
In 2011, Quebec faced more than 700 measles cases – the biggest outbreak in a generation. It was blamed on "European visitors" but the starting point was an ultra-Orthodox religious sect in the Eastern Townships.
The irony is that mandatory vaccination actually has its roots in the clergy. The first mass vaccination was undertaken in Massachusetts in 1798 by a preacher who insisted all his followers be inoculated against smallpox.
In Europe, there was also a long tradition of making clergy responsible for vaccination because everyone went to church so it was the best place to capture the masses.
It wasn't until the late 1870s that there was a backlash, especially in Britain, where there were mass anti-vaccination riots. This was, after all, the golden age of quackery and snake oil.
But most objections slowly fell away as the benefits of vaccination became evident.
So why do fundamentalists still oppose vaccination?
Predestination is a cornerstone of orthodox beliefs: Refusal of vaccination is based on the idea that people should not interfere with divine providence. Religious ultra-conservatives believe in absolute parental authority. They also tend to reject the secular state and its rules, such as mandatory vaccination for school enrolment.
You are not going to change those beliefs – at least not overnight.
What public health has to do is engage and educate – if and when that is possible. History tells us that when children start dying, mass vaccinations tend to happen, even in cloistered communities.
In fact, if there is one mitigating factor that has kept outbreaks in religious communities from spreading to the general population it's that they tend to be isolationist, to shun contact with non-believers.
But orthodox ultra-conservatives also, generally speaking, have a lot of children (contraception is not any more welcome than vaccination) and it is the very young who are at greatest risk from infectious disease and the greatest beneficiaries of vaccination.
We have to balance the right to religious practice with the rights of the collectivity to be safe and healthy; we cannot let traditional folkways take precedence over 21st-century cultural and medical norms.
We do not, for example, tolerate corporal punishment even among the "spare the rod and spoil the child" set. Nor do we allow the invocation of religious belief to deny children lifesaving medical treatments such as blood transfusion and chemotherapy.
So why should we allow parents to refuse child vaccinations based on religious beliefs? Is that not a form of child abuse?
Ethicists are divided on these questions, and so is the public.
Traditionally, the United States has had mandatory vaccination rules, coupled with exemptions for religious beliefs.
The anti-vaccination folk who are motivated by a belief in quackery rather than scriptural interpretations exploit these religious exemptions – though there is often a fine line between the two camps.
Canada has very little mandatory vaccination and it has much less resistance to vaccination; public-health officials in this country take the approach that they should educate, not compel.
Because, ultimately, what are we going to do, jail the vaccine refuseniks? How would that help their children lead healthier lives?
What we have to do is to ensure that as many people as possible – especially children – are vaccinated. With the outliers, the best we can do is expose the fallacy of their beliefs and the harm it causes. A little carrot and a little stick.
These complicated, tense and no doubt unpleasant discussions have to take place in the public realm, no matter how uncomfortable they make us. Population health depends on it.
We can't continue to hide behind euphemisms such as "imported from Europe" and half-truths such as "spreading in an isolated community" and, above all, we can't simply pray that the problem will go away.