As of the third week of June, Canada had endured 21 straight months of uncontrolled measles transmission. Thousands of Canadians have been infected, many of them hospitalized. The country has lost the measles elimination status it achieved in 1998.

The human toll of the outbreak is well-recognized – with discussions focusing on the suffering experienced by patients and their families– as is the strain the outbreak has put on an already burdened health-care system.

However, another serious consequence is receiving far less attention: the cost ultimately borne by taxpayers and society. Recognizing the economic impact of measles does not minimize its human toll. Rather, it may help policymakers understand vaccination as an investment that prevents much greater human, social and economic harm.

Calculating the cost per case

A study by researchers at Stanford University estimated that each measles case in the United States in 2025 imposed an estimated cost of US$104,629. Their estimate included direct medical costs associated with hospitalizations and treatment, as well as public health expenditures such as testing, contact tracing and outbreak management.

The analysis also accounted for productivity losses experienced by caregivers and future earnings losses resulting from school absenteeism. Most cases in the current outbreak have occurred among children and adolescents, making this last factoConverted to Canadian dollars, this estimate is approximately $146,000 per case. Applying this figure to the more than 6,400 measles cases experienced in Canada by mid-June, the current outbreak may already have imposed an economic burden approaching $935 million – a staggering figure for a disease that was once eliminated here. particularly relevant.

Complicating factors

Of course, these estimates should be interpreted with caution. As outbreaks grow larger, the average cost per case tends to decline because certain expenditures, such as surveillance systems, laboratory infrastructure and workforce mobilization, are fixed costs that can be spread across a greater number of cases. Large outbreaks therefore often have lower costs per case, even as they generate substantially higher total costs.

The Stanford analysis was also conducted in the United States and important differences exist between the Canadian and American health-care systems. Canada’s lower physician reimbursement rates, lower administrative costs and lower health-care expenditures suggest that directly applying the American estimate may overstate the true cost of a measles case in Canada.

Unfortunately, no contemporary Canadian study has attempted a similar estimation of the economic burden of measles. The most recent Canadian economic evaluation examined Ontario’s 2015 measles outbreak and found that the province spent $1,213,491 to manage just 16 cases. Adjusted for inflation, this is equivalent to approximately $1,615,423 today or roughly $100,963 per case.

While the Ontario study did not account for productivity losses experienced by caregivers or future earnings losses associated with school absenteeism, its estimate remains surprisingly close to Stanford’s finding of nearly US$105,000. In other words, directly applying the American estimate may not substantially overstate the economic burden of measles in Canada.

Long-term costs

Even these estimates likely understate the true economic burden of measles, which extends beyond the costs typically captured by outbreak investigations and health-care expenditures.

While most patients recover, some experience severe complications that can generate long-term costs. Approximately one in every 1,000 measles cases develops encephalitis, a potentially life-threatening inflammation of the brain.

Survivors may be left with permanent neurological injuries, including blindness, deafness or cognitive impairment. These individuals may require life-long medical care and disability support. Beyond the direct costs of care, such complications can result in decades of lost productivity.

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The economic consequences are not limited to those who become infected. A small but significant number of Canadians cannot be vaccinated because of medical issues, including children undergoing cancer treatment and individuals with compromised immune systems. These individuals depend on community immunity for protection.

As outbreaks spread, these individuals and their caregivers may be forced to reduce participation in school, work and community activities to avoid exposure. School absences can affect educational outcomes and future earning potential, while missed work and caregiving responsibilities can reduce household income and productivity. Individuals may also postpone other activities that contribute to the local economy.

Measles outbreaks also place additional pressure on a health-care system that is already operating at capacity. Every hospital bed occupied and every health-care worker assigned to measles-related care represents resources that are unavailable for other patients.

As resources become increasingly stretched, emergency department wait times may lengthen, health-care workers may face greater burnout and access to timely care may deteriorate. Some patients may delay seeking care, while others may experience delays in diagnosis and treatment. Conditions that could have been detected and managed early may instead progress to more advanced stages where treatment becomes more expensive and outcomes are often worse.

Outlook and options

Since the current outbreak has already imposed substantial costs on patients, taxpayers and the health-care system, it is worth considering what may lie ahead as vaccine coverage remains below optimal levels.

A recent study published in the Journal of the American Medical Association estimated that if vaccination rates in the United States remain at their current level, the country could experience approximately 851,300 measles cases over the next 25 years. A modest 10-per-cent decline in vaccine coverage increased the projected number of measles cases to 11.1 million, the study found.

Although these projections were developed for the United States, they illustrate an important principle: small declines in vaccination coverage can produce disproportionately large increases in disease. The relationship between vaccination and disease transmission is not linear.

Canada has roughly one-eighth the population of the United States. A simple population-based approximation suggests that Canada could experience more than 100,000 measles cases over the next quarter century under similar assumptions.

However, even this figure may be conservative. The American model was built using a population with generally higher MMR vaccination coverage than is currently observed in many parts of Canada. As a result, the number of future measles cases could exceed previous estimates.

Federal and provincial governments must take meaningful steps to close Canada’s immunization gap. Doing so is not only the humane course of action but also the economically prudent one. Vaccination programs are often viewed as expenditures, yet they are better understood as investments.

Focusing on the economic costs of measles is not meant to diminish the suffering experienced by patients and their families. Rather, it highlights an often-overlooked consequence of declining vaccination rates.

If vaccine uptake continues to erode, Canadians should expect not only more illness and suffering, but also longer wait times in emergency departments, greater strain on health-care workers and higher costs for taxpayers.

Recognizing vaccination as an investment rather than merely an expense may help prevent both the human and economic costs of future outbreaks.