Brady Collins
The 2019 measles outbreak in Samoa was a devastating health crisis that resulted in the deaths of numerous children. The outbreak was attributed to a sharp drop in measles vaccination rates, caused partly by the deaths of two children who received incorrectly prepared MMR vaccinations in 2018. This incident, along with the spread of anti-vaccination sentiment, contributed to vaccine hesitancy and further decreased vaccination rates. As a result, when measles was introduced to Samoa, likely by a traveller from New Zealand, it spread rapidly, infecting thousands and causing a high number of fatalities, mostly among children. The Samoan government's aggressive response, including a state of emergency and mandatory vaccination campaigns, helped increase immunisation rates, but the outbreak highlighted the urgent need to address vaccine hesitancy and improve access to vaccinations to prevent similar tragedies in the future.
| Characteristics | Values |
|---|---|
| Date of the measles outbreak | September 2019 |
| Date the state of emergency was declared | 17 November 2019 |
| Number of cases as of 6 January 2020 | 5,700 |
| Number of deaths as of 6 January 2020 | 83 |
| Infection rate | 3% |
| Newborn vaccination rate in 2017 | 74% |
| Newborn vaccination rate in 2018 | 31-34% |
| Number of children under 5 who died | 48 |
| Total number of deaths as of 18 December 2019 | 76 |
| Number of children under 4 who died | 60 |
| Total number of deaths as of 22 January 2020 | 83 |
| Number of measles cases as of 22 January 2020 | 5707 |
| Number of babies who died in July 2018 due to wrongly mixed vaccines | 2 |
| Vaccination rate in 2019 | 94% |
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What You'll Learn
Low vaccination rates
The 2019 Samoa measles outbreak was exacerbated by low vaccination rates. The newborn measles vaccination rate fell from 74% in 2017 to between 31% and 34% in 2018, with rates dropping as low as 31% in Samoa, compared to 99% in nearby Nauru, Niue, Cook Islands, and American Samoa. The World Health Organization (WHO) and UNICEF had warned in March 2019 that the Pacific region needed to take proactive measures to improve immunisation rates.
The low vaccination rates in Samoa have been attributed to several factors. Firstly, there was a scandal in July 2018 when two nurses incorrectly prepared and administered MMR vaccines to babies, resulting in their deaths. This incident caused significant distrust in the healthcare system and vaccinations, with anti-vaccine groups spreading misinformation on social media. As a result, the government suspended its measles vaccination program for ten months, despite advice from the WHO.
Additionally, anti-vaccination activists like Edwin Tamasese, who was arrested and charged with "incitement against a government order," contributed to the spread of misinformation and further decreased vaccination uptake. By the end of 2019, an estimated 94% of the eligible population had been vaccinated, a significant increase from the previous year.
The low vaccination rates left Samoa vulnerable to measles outbreaks. In September 2019, the country experienced a measles outbreak, with over 5,700 cases and 83 deaths reported by January 2020. The outbreak primarily affected children, with an estimated 87% of deaths occurring in children younger than five years old. The low vaccination rates in Samoa highlight the importance of maintaining high immunisation coverage to protect the population from vaccine-preventable diseases.
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MMR vaccine safety
The MMR vaccine is generally considered safe by health authorities and medical professionals worldwide. The vaccine has been in use since 1963 and has an excellent safety record, with hundreds of millions of children receiving it safely.
The MMR vaccine protects against measles, mumps, and rubella, all of which are highly contagious illnesses. Measles, for example, causes coughing, rashes, and fever, and in severe cases, can lead to pneumonia and brain swelling. Ensuring that children are vaccinated is critical to controlling the spread of these diseases and preventing serious complications.
While some people have raised concerns about a possible link between the MMR vaccine and autism or bowel disease, these claims have been thoroughly investigated and debunked by numerous organizations and studies. The CDC, the American Academy of Pediatrics (AAP), the UK Department of Health, the World Health Organization, and other reputable medical establishments agree that there is no link between the MMR vaccine and autism.
In very rare cases, individuals may experience a serious allergic reaction to the MMR vaccine. Anyone who has had a life-threatening allergic reaction to any component of the MMR vaccine, such as the antibiotic neomycin, should not receive the vaccine. Additionally, as with any medical procedure, there is a small risk of side effects, most of which are benign and acknowledged by medical professionals. However, the benefits of the MMR vaccine far outweigh the risks of these recognized side effects.
Regarding the situation in Samoa, the 2019 measles outbreak was attributed to a sharp drop in vaccination rates, with only 31-34% of newborns receiving the MMR vaccine in 2018. Unfortunately, the low vaccination rates were partly due to the deaths of two children in 2018 who were given a wrongly mixed vaccine by nurses, causing local fears and distrust of vaccinations. However, this incident was due to human error and not indicative of the safety profile of the MMR vaccine itself. As a result of the outbreak and increased vaccine hesitancy, Samoa introduced a new law in December 2019, making it mandatory for all children to be fully immunized before starting primary school.
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Anti-vaccination activism
The 2019 Samoa measles outbreak was caused by a sharp drop in measles vaccination rates, which fell from 74% in 2017 to 31-34% in 2018. This decline in vaccination rates was, in part, due to the deaths of two children who were given a wrongly-mixed vaccine in 2018. The nurses responsible for administering the vaccine were sentenced to five years in prison. However, the incident caused significant distrust towards the health system and vaccinations, which was exploited by anti-vaxxers to spread misinformation.
In the case of the Samoa measles outbreak, anti-vaxxers attributed the deaths caused by the outbreak to poverty, malnutrition, or the vaccine itself, without providing any evidence for their claims. One prominent Samoan anti-vaccination activist, Edwin Tamasese, was charged with "incitement against a government order" for his online comments discouraging immunisation and even life-saving antibiotics. Tamasese's actions reflect the broader tactics of the anti-vaccination movement, which seeks to increase vaccine hesitancy by disseminating misinformation and exploiting sensitive events, such as the deaths of the two children in Samoa.
The rise of anti-vaccination activism has had detrimental effects on global health. In the context of the COVID-19 pandemic, anti-vaccine activism in the USA formed alliances with political groups and extremists, threatening childhood immunizations both domestically and globally. The movement's promotion of pseudoscientific claims and exaggeration of vaccine side effects have contributed to declining immunization rates in multiple countries. Additionally, anti-vaccine activism has been linked to the resurgence of measles in several countries, including the UK, which had previously been considered measles-free.
To address the challenges posed by anti-vaccination activism, governments and health organizations have implemented various strategies. These include mandatory vaccination campaigns, as seen in Samoa during the measles outbreak, and the introduction of laws requiring children to be fully immunized before enrolling in school. UNICEF has also played a crucial role in supporting countries during outbreaks and promoting vaccine uptake. However, it is essential to recognize that addressing vaccine hesitancy requires a multifaceted approach. This includes improving vaccine accessibility, ensuring well-trained healthcare workers, and effectively countering misinformation spread by anti-vaccination activists.
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Healthcare system distrust
The 2019 measles outbreak in Samoa was caused by a sharp drop in vaccination rates, which fell from 74% in 2017 to 31–34% in 2018. This decline in immunisation rates has been attributed to the deaths of two children who were given a wrongly-mixed vaccine in July 2018. The two nurses responsible pleaded guilty to manslaughter and were sentenced to five years in prison. However, the incident caused significant distrust towards the healthcare system and vaccinations, providing an opening for anti-vaxxers to spread misinformation.
Samoa's healthcare system is heavily hospital-centric, with patients often bypassing primary healthcare and overcrowding the main national referral hospital in the capital, Apia. The system is largely publicly owned and administered by the government, which provides free healthcare to the Samoan people. However, the current system faces significant challenges in addressing rising NCDs and improving the quality of healthcare delivery. There is a shortage of healthcare staff, with only 48 doctors per 100,000 people as recently as 2010, and a lack of specialists in certain areas, such as endocrinology.
The Samoan government has recognised the need for partnership and engagement with GPs and other healthcare providers to improve access to healthcare services, particularly in rural areas. Efforts have been made to revitalise primary healthcare and deploy multidisciplinary teams to rural health care facilities. However, the success of these initiatives may be hindered by the concentration of doctors in urban areas and the limited availability of healthcare staff.
Vaccine hesitancy was strong in Samoa at the start of the 2019 measles outbreak, with some parents shunning vaccines for philosophical, religious, or debunked concerns about their safety. The government implemented a compulsory mass vaccination campaign during the outbreak, which brought immunisation rates back up to 95%. To prevent future underimmunisation, the government passed a law requiring all children to be fully immunised before starting primary school.
The Samoan healthcare system has faced criticism and dissatisfaction from various stakeholders, including healthcare professionals, politicians, and the general public. Complaints range from concerns about the competence of healthcare providers and the lack of supplies and equipment to the high cost of off-island patient care. Financial constraints have also impacted the system, with shortages of vital equipment and supplies imperilling patients' lives.
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Mass vaccination campaigns
The 2019 Samoa measles outbreak was caused by a combination of factors, including a sharp drop in vaccination rates and the spread of misinformation by anti-vaxxers. The outbreak resulted in a high number of cases and deaths, particularly among children under the age of five.
To address the outbreak, the Samoan government implemented a mass vaccination campaign, which included mandatory vaccination for all citizens. The government also imposed a curfew, cancelled public gatherings, and asked families seeking vaccination to display a red cloth in front of their homes to alert mobile medical teams.
The success of mass vaccination campaigns in reducing measles incidence has been demonstrated in various countries. For example, the 1967–68 Measles Eradication Campaign in the United States reduced reported measles incidence by 90% within two years and led to an increase in educational attainment in the affected cohorts.
To support countries in their mass vaccination campaigns, the Pan American Health Organization (PAHO), the WHO Regional Office for the Americas, has provided training in rapid response, improved surveillance, and launched renewed high-quality follow-up vaccination campaigns. Despite these efforts, global measles deaths continued to climb prior to the COVID-19 pandemic, with over 207,000 measles deaths reported in 2019.
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Frequently asked questions
The 2019 measles outbreak in Samoa was caused by a sharp drop in measles vaccination rates. This was partly due to the deaths of two children who were administered MMR vaccines that were incorrectly prepared by two nurses.
No, the children who died from measles in Samoa were not vaccinated. The low vaccination rates are attributed to the deaths of two children in 2018 from incorrectly prepared MMR vaccines, which caused distrust in the health system and vaccinations.
In addition to the distrust caused by the 2018 incident, anti-vaccination sentiment and conspiracy theories, influenced by figures like Robert F. Kennedy Jr., also contributed to the low vaccination rates in Samoa.
