Dr. Vivien Suttorp didn't need a crystal ball back in 2013 to predict the impending measles outbreak that affected 42 people in southern Alberta — and she doesn't need one now to know that communities across southern Alberta will likely be hotbeds for further outbreaks.
One southern Alberta city, Medicine Hat, is currently seeing the second wave of a mumps outbreak in the city that seems to have originated from the local Western Hockey League team, the Medicine Hat Tigers.
It's not the only place where mumps are making a comeback in Canada, leading public health officials in several provinces to remind young adults to check if they need vaccination boosters.
Suttorp is the lead medical officer of health for Alberta Health Service's south zone.'s job. So when she's not busy dealing with an active outbreak like the mumps, she's primarily working proactively to get more people immunized.
"I was worried for specific communities, and it's the communities where we have almost annual vaccine-preventable disease outbreaks," she said.
In looking at the area's immunization data — which includes some of the lowest and highest rates in the province — overlaid with historical outbreak information, she is concerned about what they're currently dealing with, as well as what might come next.
Whooping cough is here to stay
Rates of whooping cough, or pertussis, are highest in southern Alberta with more than 50 cases in 2016, and 53 cases in 2015.
Whooping cough is no longer brought in from outside communities, Suttorp says: it's become endemic.
Pregnant women in the area are now regularly immunized for it in their third trimester, in the hopes that they will pass on enough immunity to their child to keep them safe until they start their own immunizations at two months of age.
Another big concern is rubella, a viral disease that causes painful, swollen joints and in some cases, inflammation of the brain, or a bleeding disorder.
"This is why we check during prenatal blood testing, we actually check to see if a woman is immune to rubella," Suttorp said.
She's begun mapping out the areas where she sees the lowest rates of immunity.
"This is a significant concern."
Three main issues
Suttorp says when she's working with people or communities that are wary of vaccines, there are three main motivators:
There are many people that don't see the point in vaccinating themselves or their children because diseases like measles and rubella are rare these days. Others just don't know they aren't up to date.
The problem is, travel brings these diseases that are largely eliminated in Canada back to our doorstep, she says.
Often when people travel, they are sure to take more complex vaccines, such as Japanese encephalitis, but often neglect the more basic immunization they should have received as a child.
Access to public health clinics or doctors is sometimes a factor; especially for those who live in the rural areas of the province.
The public health response to this issue involves working hand-in-hand with these communities to make access more available, through evening or mobile clinics, or other similar responses.
3. Trust of the vaccine, and its providers
Individual leaders in a community are often responsible for perpetuating mistrust, Suttorp says, and it's one of the hardest obstacles to overcome in public health.
"We've heard about key leaders in maybe a religious organization, it may be in a school, it may be a physician in a local community, or others who are encouraging individuals not to immunize, or that there's an issue with the safety of a vaccine."
Another culprit, Suttorp says, is the advent of the Internet, where any point of view can be supported, and it might be hard for a layperson to know the real science. Also a consideration is that over time she sees social norms develop, where there is a pressure in a community not to immunize.
Understanding religious dynamic
There are three major religious groups found in the region that often have the finger pointed at them for the low immunization rates: the Hutterites, the Mennonites, and the Dutch Reformers.
"It ranges so much. There are some people [in those communities] who support it and some do not," said Judith Kulig, professor emerita at the University of Lethbridge's health sciences department.
Kulig spent decades working with these religious communities on different health research topics, including immunization.
"There are situations where a particular pastor or preacher, or person of influence in the community doesn't support [vaccination] and people decide to follow that perspective."Kulig said she ran into individuals that would vaccinate but they wouldn't tell others in the community because of the social pressure they faced.
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By the public and media blocking out or discounting the perspective of some people in these groups, Kulig said, it prevents those people from coming to the discussion table and learning more about herd immunity and the reasons to be immunized.
"For us to put our backs up and not try to address it and work with people, it's just going to make it worse."
Great responsibility for community leaders
Leadership and influence on immunization can take many forms. It could be the leader of a household, of a congregation, of a health practice, or even a recognized person from elsewhere in the world.
For example, Jenny McCarthy is often cited as one of the famous people that has perpetuated misinformation about vaccines.
"Sometimes it's an actor. Sometimes we have other influences. We've had people come to speak at the university here, and it sounds like it's a credible speaker because it's at a university, which anyone can book a room at. And there's a lot of misinformation that's being provided."
Kulig said she's run into a number of chiropractors over the years who had used their position to perpetuate misinformation and suggest alternative treatments to parents for their children, even though it's against the position of the college that governs them.
Of course that influence can be seen at both ends of the spectrum in southern Alberta. Suttorp applauds the efforts of health care officers in nearby Indigenous communities for having some of the best immunization rates.
"It's just a stellar job of immunizing the children there."