The Rise of Unreason
The put out a press release a couple weeks ago about the sharp increase in people infected with measles here. There were 816 cases from October 2024 to April, then 155 new cases from April 3–11. Our immunization rates are lower than most of Europe — only 70% of kids have typical childhood vaccinations. Vaccination rates reduce dramatically in 2020. “This is a Public Health failure that must be addressed with the utmost urgency.”
recently wrote about it:
Balancing Individual Rights and Community Health Requires Knowledge of History
Ontario is in the midst of a measles outbreak, and our Chief Medical Officer of Health (CMOH) is taking a “you do you” approach. No mandates. No strong guidance. Just a gentle suggestion that people make informed decisions…if they choose to. It’s a startling response given public health’s long history of collective action, and at times, authoritarianism.
That authoritarianism wasn’t a bug of early public health. It was a feature. Modern public health emphasizes individual rights, but those rights can come into tension with the community’s right to health, especially during outbreaks of communicable diseases. Institutional public health grew out of fear.
In the 19th and early 20th centuries, plagues swept through cities, killing adults and (more often) children. In that context, society granted health officials extraordinary power. In the U.S., early health officers literally carried swords, a symbol of authority and a tool for enforcing quarantine. These powers weren’t applied equitably: racism and colonialism shaped responses. In 1900, Honolulu’s Chinatown was deliberately set on fire to contain plague — an act born of racialized fear. The fire raged out of control and destroyed much of the city. “Typhoid” Mary Mallon, an Irish immigrant cook, was imprisoned for life after sickening the children of the President’s banker. Her treatment was harsh, likely reflecting the identity of her victims. Typhoid was a leading cause of child death at the time, and while her case shocks modern sensibilities, it made sense to a society living in constant fear of infection.
As vaccines, pasteurization, ventilation, clean water and sewage treatment changed that reality, public health evolved. Individual rights gained prominence, effectively a dividend of the invisible public good that institutional public health created. The success of public health was to make itself seem unnecessary. That success is now its greatest political liability.
The main deliverable of public health is the non-occurrence of events. To paraphrase Camus, we assume plagues happen in other people’s times…until they don’t. When nothing happens, we assume that’s normal, not the product of deliberate action. To the uninformed, and to some politicians, it becomes easy to ask why we fund public health at all. That’s not hypothetical. Public health institutions in Ontario and across Canada are being defunded. The Public Health Agency of Canada is laying off pandemic-era workers. Local health units are stretched thin. But stable institutions need stable peacetime funding. Their output, normal, undisrupted life, is what makes everything else possible. The current measles outbreak shows what happens when that foundation cracks.
Measles is one of the most contagious viruses known, and can cause pneumonia, brain inflammation, and death in roughly 1 in 1,000 children. It’s completely preventable, and had been considered eliminated from Canada since 1998. We’re drifting backward. To be clear, mandates aren’t a panacea. They can backfire, especially in communities with deep, often justified mistrust of institutions. Enforcement, particularly when racialized or imposed on marginalized groups, has a dark legacy. Mandates also have uneven effects: isolating in a house with a backyard is not the same as isolating in a crowded apartment. Equity requires support, not just rules.
But public health needs to rediscover assertiveness paired with trust-building and education. “You do you” only works if you also say: here’s why you should do X, not Y, and here’s what happens if you don’t. Condom use wasn’t mandated during the HIV crisis, but it was promoted through massive campaigns. Smoking wasn’t banned in homes, but people were bombarded with reasons to quit. Today’s permissiveness is compounded by silence. And we should be honest: “you do you” has unintended victims. Choosing not to vaccinate isn’t just a personal choice: it puts others at risk, including children and immunocompromised individuals.
There’s another layer to Ontario’s public health passivity: politics. The CMOH is not independent. They serve at the pleasure of the government. In 2022, the Ontario NDP introduced the , which would have made the CMOH an arm’s-length officer. It didn’t pass. Past generations watched childhood death become rare and saw the trade-offs between liberty and safety as reasonable. We shouldn’t forget their clarity. If we’ve moved past public health authoritarianism, it’s because public health succeeded. But success breeds amnesia. And we may soon learn whether a “you do you” approach can hold when the stakes rise again.
And last week wrote what he learned from 40 years as a science editor:
“Just as I have watched breathtaking advances in science unfold, I have witnessed large parts of society turn their heads and deliberately reject the truths that have been presented to them. The rise of unreason has been the unwelcome partner to our growing scientific sophistication. My first serious encounter with anti-science denial came with the arriva of AIDS in the 80s. Scientists trace the cause: a virus now known as HIV which, as they pointed out, is sexually transmitted. This point was disputed by many individuals who claimed it was caused by ‘flawed’ lifestyles and denied that AIDS was caused by a virus. …
An even more startling example is provided by Covid. Our understanding of the disease gradually changed after its appearance in late 2019, and advice was altered as scientists learned more about its causes. Washing hands was dropped as a mantra and staying outdoors became acceptable. This uncertainty was fed upon by social media. Then came the vaccines, and the internet went into overdrive. Immunisation against Covid was linked to exaggerated numbers of deaths, and the subject was politicised, particularly in the US, where many Trump-supporting Republicans decided to shun the vaccine. The result was a grim distortion of responses to Covid infections. … The US now has an outspoken vaccine sceptic as its health secretary while cases of measles, a disease once vanquished by vaccines, are returning in increasing numbers, along with reports of early deaths, as the influence of anti-vaxxers takes a grip of the country. …
Anti-science movements have always been with us, of course — from the rise of the flat Earthers to the early establishment of groups opposed to evolution. However, the present trajectory is now becoming extremely worrying, with the US providing the most worrying examples.”
I’m still disturbed that some doctors and nurses in NICU wards stopped masking when masks mandates were lifted for Covid after a century of protecting premature babies from any kind of infection with masks. That just doesn’t make sense to suddenly stop it. So much of this doesn’t make sense. But here we are.
