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‘I’d say 80 per cent of the congregation is vaccinated; the others don’t believe in it,’ says Reverend Pieter Van Ruitenburg, head of the Bethel Netherlands Reform Church in Chilliwack, B.C.DARRYL DYCK/The Globe and Mail

When the time came to vaccinate his son, Pastor Abel Pol didn't hesitate. The boy was given his immunization shots, had no complications and is doing well.

This simple act of prevention is notable considering Mr. Pol's Canadian Reformed Church is based in Chilliwack, B.C. It is here, in the province's Bible belt, that many are opposed to vaccination, believing that to immunize is to evade the providence of God. As of late Monday, 228 people in the Fraser Valley region had measles, while a confirmed case had made its way west to Burnaby, just outside Vancouver.

Cases of measles have also popped up in Prince Edward Island, London, Ont., and Ottawa, and throughout southern Alberta – sometimes through travel to religious communities in the Netherlands, where vaccination rates are low, and also through travel to the Philippines, another measles hot spot.

The outbreak has raised questions: How has a disease thought to have been eliminated via vaccinations made such a rousing comeback? Have family physicians and schools done enough to inform parents on the safety of the measles vaccine? Have religious leaders turned measles into a matter of faith versus science?

"It has been a push-button issue for a long time," said Ian Mitchell, professor of pediatrics and bioethicist at the University of Calgary.

Dr. Mitchell pointed to the cultural dynamics that allow an anti-vaccination belief to take hold in smaller centres like Chilliwack and Coaldale, Alta., where immunization rates are already significantly below the national average of 95 per cent (the threshold required for herd immunity).

"I don't believe any leaders of the major religious groups [are opposed to vaccination]. It's always smaller groups, which is interesting. I think it's about group cohesiveness," Dr. Mitchell said. "I think in small groups it is not so easy to be different, everyone knows what others are doing, and there is pressure to conform. My sadness is we may have to go through a period of sickness and death before we change the culture."

Rev. Pieter Van Ruitenburg is head of the Bethel Netherlands Reform Church in Chilliwack. One of his parishioners, a teenager, has a confirmed case of measles. Days ago, Mr. Van Ruitenburg advised his church members to pick up a measles information pamphlet (sent by Health Canada) in the church lobby.

"I'd say 80 per cent of the congregation is vaccinated; the others don't believe in it," he said. While some parishioners are concerned about the origin of the vaccine, others "use the Bible and take it out of context," he said.

Those opposed to vaccinations have helped drive the Fraser Valley immunization rate to a low of between 70 and 84 per cent. Many refused comment when contacted by The Globe and Mail, including Rev. Adriaan Geuze, who previously stated vaccines interfere with God's will.

But Mr. Pol, who believes most of his congregation favours immunization, doesn't view measles as a faceoff between religious groups and the general public. He argues that vaccination falls within the providence of God; and he thinks Health Canada could play a bigger role.

"At this point, it is no longer a question of religious convictions but of understanding what vaccines are and what they do. The [federal] government carried out a successful campaign against smoking, and today you see far less people smoking than you did 20 years ago," he said.

There isn't a province in Canada where the vaccine is mandatory. Although Ontario, Manitoba and New Brunswick have vaccination legislation and require students to provide proof of immunization to attend school, parents can get exemptions for their children on medical grounds (if a child is allergic, has a weakened immune system due to certain cancers, HIV, steroid or other medicines that suppress the immune system) or if parents fill out a form stating they object to immunization. In a 2011-2012 report on vaccination rates, Public Health Ontario found that exemption rates for seven-year-olds on religious or "conscientious objection" grounds, which varied by disease, were all less than 2 per cent.

The role of health-care providers in ensuring children are immunized is critical, says Noni MacDonald, a spokesperson for the Canadian Paediatric Society. She noted that pediatricians are far more successful in getting children vaccinated when using presumptive language with parents ("We have to do some shots," as opposed to "What do you want to do about shots?"). But she added that pediatricians should address concerns point by point, and emphasize that the vast majority of vaccinated patients have lifelong immunity from life-threatening diseases, with no side effects.

With a report from Kelly Grant

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