On November 10, 2025, the Public Health Agency of Canada released a statement reminding Canadians that Canada is currently experiencing a large, multi-jurisdictional outbreak of measles that began in October 2024 with cases in Alberta, British Columbia, Manitoba, New Brunswick, Nova Scotia, Ontario, Prince Edward Island, Quebec, Saskatchewan, and the Northwest Territories. While transmission has slowed recently, the outbreak has persisted for over 12 months, primarily within under-vaccinated communities. Ontario continues to see measles cases and hospitalizations for measles infection across the province.
The Pan American Health Organization (PAHO) has notified the Public Health Agency of Canada (PHAC) that Canada no longer holds measles elimination status. PAHO’s Measles and Rubella Elimination Regional Monitoring and Re-Verification Commission reviewed recent epidemiological and laboratory data, confirming sustained transmission of the same measles virus strain in Canada for a period of more than one year.
Measles is a highly contagious and severe respiratory infection, which spreads rapidly by coughing or sneezing into the air. It can also be transmitted by skin-to-mucous membrane contact, by touching a contaminated surface followed by the eye, nose, or mouth. The virus which causes measles can be transmitted to a fetus via the placenta, known as congenital measles. The timing of infection during pregnancy can affect the severity of the impact on the fetus. At least one known death of a newborn has occurred in Ontario from congenital exposure to measles this year. Symptoms of measles include fever, a red blotchy rash, red watery eyes, and cough. More serious complications can occur for infants under one year of age. Pregnant people infected with measles can develop lung infections like pneumonia at almost double the rate of those who are not pregnant, adding to the risks of contracting measles in pregnancy.
Measles is a vaccine-preventable disease. In Ontario, occurrences of measles have been rare historically, owing to the successful elimination of measles in Canada and high immunization coverage over the past decades. However, the landscape has changed dramatically over the past year.
The Measles, Mumps, Rubella (MMR) vaccine is the most effective way to prevent the spread of measles. Midwives are able to prescribe and administer the MMR vaccine as per the Designated Drugs and Substances Regulation, and can ask their clients if they are up to date on their vaccine.
Midwives: Supporting Informed Choice and Delivering Evidence-Based Care
It is your responsibility to be familiar with and comply with the Professional Standards for Midwives. You must use your judgment in applying the principles to the various situations you will face as a midwife. While no standard can foresee or address every issue or ethical dilemma which may arise throughout your professional career, your decisions and actions must be justifiable.
Several factors have contributed to decreasing rates of immunization in the province. Midwives must always ensure that that they provide care which reflects community standards, commonly accepted evidence, and recommendations from professional bodies whose expertise is reliable and aligned with best practices. Midwives have a duty to provide care that does not reflect their own biases and must always offer treatments which are in the client’s best interest.
Midwives can support clients in making decisions about measles immunization by engaging in informed choice discussions that include:
- Providing clients with sufficient information to understand measles, the benefits and risks of immunization, and the risks associated with not immunizing,
- Offering additional information to clients that comes from reputable agencies such as Ontario Health and Public Health Ontario, as well as the Society of Obstetricians and Gynaecologists of Canada (SOGC) and Association of Ontario Midwives (AOM), and
- Engaging in discussions which lead to mutual understanding of a client’s motivations surrounding immunizations and providing supportive but corrective advice when clients a rely on outdated or inaccurate data.
Promoting potentially misleading statements about measles or discouraging immunization against vaccine-preventable diseases may constitute an act of professional misconduct. This includes making statements to your clients that discredit government and public health information about the safety and efficacy of vaccines, or promoting or amplifying unsubstantiated theories, pseudoscientific reasoning, or practices which are not rooted in empirical evidence. These actions undermine the health and safety of Ontarians and your clients’ ability to make an evidence-informed decision about their care.
Related Professional Standards
6. Offer treatments based on the current and accepted evidence, and the resources available.
14. Listen to clients and provide information in ways they can understand.
15. Support clients to be active participants in managing their own health and the health of their newborns.
16. Recognize clients as the primary decision-makers and provide informed choice in all aspects of care by:
- 16.1. providing information so that clients are informed when making decisions about their care
- 16.2. advising clients about the nature of any proposed treatment, including the expected benefits, material risks and side effects, alternative courses of action, and likely consequences of not having the treatment
- 16.3. making efforts to understand and appreciate what is motivating clients’ choices
- 16.4. allowing clients adequate time for decision-making
- 16.5. ensuring treatment is only provided with the client’s informed and voluntary consent unless otherwise permitted by law
- 16.6. supporting clients’ rights to accept or refuse treatment
21. Ensure that your personal biases do not affect client care.
32. Conduct yourself in a way that promotes clients’ trust in you and the public’s trust in the midwifery profession.
Call to Action
Midwives play an important role in protecting Ontarians from vaccine-preventable disease. It is within a midwife’s scope to provide vaccinations to their clients, since the Designated Drugs and Substances Regulation grants midwives the authority to prescribe and administer certain immunizations that prevent disease and protect everyone from illness. Part of routine midwifery care is providing evidence-based information about immunization and supporting clients in making health care choices for themselves and their newborns.
What midwives say matters: opinions about immunization from midwives are impactful because regulated health care professionals hold considerable influence and possess a level of inherent trust in the public domain. Midwives can provide care to their clients until eight weeks postpartum and eight weeks of age; take the opportunity to discuss and provide access to immunizations.