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What has caused the measles outbreak in Vancouver? A virus and The Dunning-Kruger effect

A childhood disease that was virtually eradicated in much of the world has made a comeback in B.C. The disease is measles, and complications include pneumonia, deafness, seizures, brain damage and death.

In Vancouver, the mother of a premature baby (too young for a vaccination) is terrified that her child was exposed to measles during a recent visit to B.C. Children's Hospital. The family is in isolation, waiting for the incubation period to end. So far, nine children who attend two Vancouver french language schools have contracted measles and 33 students and staff have been ordered to stay home because they cannot provided proof of vaccination to health authorities.

In light of this outbreak, a woman in Oliver is going public about the month she spent in hospital when she contracted measles as a four-year-old child. The disease burst her eardrum leading to permanent deafness in her left ear. Another classmate of hers suffered permanent damage to her eyes. Still another became deaf in both ears. It was 1950. There was no vaccine for measles at the time.

Likewise, an article by Roald Dahl – author of Charlie and the Chocolate Factory and James and the Giant Peach – is getting wide circulation. Dahl describes how his daughter caught measles in 1962 at the age of seven before the discovery of a reliable vaccine. Her case rapidly developed into measles encephalitis, and she died.

Despite all this, some people refuse to vaccinate their children in B.C., and indeed in many U.S. states that have also experienced severe outbreaks of measles

B.C. has no law that forces a parent to have their child vaccinated in order to attend school. The current policy in B.C. is that if there is an outbreak of a vaccine-preventable disease, like measles, those who have not been vaccinated are required to stay home. This is complicated by a 10-to-12-day incubation period, where a child could be contagious in his or her classroom without demonstrable symptoms, putting other children at risk; particularly those with compromised immune systems (cancer patients, for example).  

Some provinces, like Ontario, have mandatory school-entry laws requiring immunization. However, Ontario's law has a loophole that makes its law nonsensical. It allows non-medical exemptions on so called “religious or conscientious grounds. In other words, if a parent has read junk science or conspiracy theories on the Internet about vaccines written by an anti-vaxxer, they could avoid school entry vaccination laws and send their unvaccinated children to school to infect others based on "conscientious" grounds.

As lawyers, we might think an action in tort against parents who don't vaccinate their children is the answer. However, in a paper entitled Could Parents Be Held Liable for Not Immunizing Their Children? published in the Canadian Medical Journal in 2010, the authors concluded that it was unlikely that a parent of an infected child could prevail in court, partly because it would be impossible to identify which unvaccinated individual transmitted the virus.

Some have suggested a more robust legislative solution is the answer in B.C. A petition on (available here) has, at the date of writing, obtained 35,000 signatures and calls for the Provincial Government to require mandatory vaccination of all schoolchildren B.C. except with a medical exemption, (not a religious or conscientious one).

Despite the petition and an Angus Reid poll released days ago that revealed that 70 per cent of Canadians believed in mandatory vaccination for schoolchildren, the B.C. government is reluctant to go down that road. Certainly, there are complications such as the standard of proof, enforcement (and whether parents would have to pay significant financial penalties for noncompliance), and whether such legislation would withstand a Charter challenge. But to misquote Mr. Spock about the Charter and health policy: "the needs of the many outweigh the needs of the few."

The more awkward question is this: Why is it that some parents refuse to vaccinate their children despite ample evidence that vaccines prevent disease and save lives?

Some of this reluctance to vaccinate may have evolved from a study in 1998 by Andrew Wakefield, suggesting that the measles/mumps/rubella vaccine was linked to autism. But that study, (funded in part by lawyers suing a pharmaceutical company) was found to have been a fraud and was totally discredited.

Notwithstanding how lethal measles can be, and how preventable it is with the MMR vaccine, anti-vaxers and their cadre of useful idiots on the Internet have been unable to accept that the Wakefield study was faked. Many continue to propagate misinformation, fake news and conspiracy theories to persuade others on the Internet that the MMR vaccine causes autism, isn’t medically necessary and could lead to the death of a child.

Perhaps the anti-vaxxer movement is a perfect example of the Dunning-Kruger effect, where those opposed to vaccines believe that they are smarter and more capable than they really are, and are unable to adequately assess their level of incompetence. The Dunning-Kruger effect is a cognitive bias where relatively unskilled individuals suffer from an illusion of superiority and mistakenly assess their own abilities to be far greater than they really are, which prevents them from being able to critically analyze their own incompetence.

John Cleese puts it far less diplomatically here. "If you're very very stupid" he says " how can you possibly realize that you're very very stupid? You'd have to be relatively intelligent to realize how stupid you are".

This week, the World Health Organization confirmed that since September 2018, a measles outbreak in Madagascar has caused more than 900 deaths. I wonder how the anti-vaxxers are going to explain that one? 

  • Brilliant

    pj nadler
    Brilliant! I thought the very same thing. Stupid people do not know how stupid they are but unfortunately today the internet gives them a voice of authority.