2019 Samoa measles outbreak

The 2019 Samoa measles outbreak began in September 2019.[5] As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874.[4][6] Over three percent of the population were infected.[7] The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%.

2019 Samoa measles outbreak
Samoa - Location Map (2013) - WSM - UNOCHA.svg
DiseaseMeasles
Virus strainD8 strain (genotype) of measles virus [1]
Index case30 September 2019
Dates30 September 2019 –
ongoing[2]
Confirmed cases5,707[3]
Deaths
83[4]
Government website
http://www.samoagovt.ws/

A state of emergency was declared on 17 November, ordering the closure of all schools, keeping children under 17 away from public events, and vaccination became mandatory. On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings. All unvaccinated families were ordered to display a red flag or cloth in front of their homes to warn others and to aid mass vaccination efforts. Some families added messages like "Help!" or "I want to live!".[8] On 5 and 6 December, the government shut down everything to bring civil servants over to the vaccination campaign. This curfew was lifted on 7 December when the government estimated that the vaccination program had reached 90% of the population. On 14 December, the state of emergency was extended to 29 December.[9] Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order". Finally, as of 22 December, an estimated 94% of the eligible population had been vaccinated.[7]

BackgroundEdit

 
Hypothetical measles timeline from exposure to illness

Measles first arrived in Samoa in 1893, carried by a steamer from New Zealand. By the end of 1893, over 1,000 people (of a total population of 34,500 at that time) had died from the disease.[10]

In the early part of 2019, measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, the Philippines and New Zealand.[11]

In March 2019, the WHO and UN children's agency UNICEF warned the Pacific to take proactive measures and improve immunisation rates.[12]

2019 outbreakEdit

In August 2019, an infected passenger on one of the more than 8,000 annual flights between New Zealand and Samoa probably brought the disease from Auckland to Upolu.[13] A full outbreak began in October 2019 and continued for the next four months. As of 22 December, there were 79 deaths (0.4 per 1,000, based on a population of 200,874,[7][6] a rate of 14.3 deaths per 1000 infected) and 5,520 cases (2.75% of the population) of measles in Samoa.[2][7][6] 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15.[14][15]

At least 20% of babies aged six to 11 months have contracted measles, and one in 150 babies have died.[16]

As of 20 December, 94% of the population had been vaccinated.[16][17] 95% is required to acquire herd immunity for measles.[16] Measles is much more contagious compared to other infectious diseases such as polio, which only requires an 80% vaccination rate for the population to attain herd immunity.[18]

Vaccine hesitancyEdit

The outbreak has been attributed to a sharp drop in measles vaccination from the previous year.

In 2013, 90% of babies in Samoa received the measles-mumps-rubella vaccination at one year of age.[8]

On 6 July 2018 on the east coast of Savai'i, two 12-month-old children died after receiving MMR vaccinations.[13] The cause of death was incorrect preparation of the vaccine by two nurses who mixed vaccine powder with expired anaesthetic instead of the appropriate diluent.[19] These two deaths were picked up by anti-vaccine groups and used to incite fear towards vaccination on social media, causing the government to suspend its measles vaccination programme for ten months, despite advice from the WHO.[20][21] The incident caused many Samoan residents to lose trust in the healthcare system.[22]

After the outbreak started, anti-vaxxers credited the deaths to poverty and poor nutrition or even to the vaccine itself, but this has been discounted by the international emergency medical support that arrived in November and December.[13] There has been no evidence of acute malnutrition, clinical vitamin A deficiency or immune deficiency as claimed by various anti-vaxxers.[13]

UNICEF and the World Health Organization estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018,[11][23] similar to some of the poorest countries in Africa.[8] Ideally, countries should have immunisation levels above 90%. Prior to the outbreak, vaccination rates had dropped to 31% in Samoa, compared to 99% in nearby Nauru, Niue, Cook Islands,[24] and American Samoa.[25]

Before seeking proper medical treatment, some parents first took their children to 'traditional healers' who used machines purchased from Australia that are claimed to produce immune-protective water.[8]

Samoa, Tonga, and Fiji have all declared states of emergency to tackle their 2019 measles outbreaks. The high mortality rate in Samoa is attributed to the country's low vaccination rate (31%). In Tonga and Fiji, the lack of fatalities is explained by far higher vaccination rates.[24]

Government responseEdit

Initially, schools remained open after the outbreak was declared. The Samoan government initially did not accept humanitarian support.[21]

A state of emergency was declared on 17 November, ordering the closure of all schools, keeping children under 17 away from public events, and making vaccination mandatory.[26] UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency.[27] Tonga closed all schools for several days, while American Samoa required all travellers from Tonga and Samoa to present proof of vaccination.[28] In Fiji, vaccines are being prioritised for young children and people travelling overseas.[29]

On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings.[30][31] All unvaccinated families were ordered to display a red flag or red cloth in front of their homes to warn others and to aid mass vaccination efforts.[32] As part of aid efforts, the Royal New Zealand Air Force has transported medical supplies and equipment to Samoa. Also, New Zealand, Australian, British, French Polynesian, and French medical teams have been assisting Samoan medical authorities.[33]

On 5 and 6 December, the government shut down everything other than public utilities to assign all available civil servants to the vaccination campaign efforts.[34]

Edwin Tamasese, an anti-vaccination activist with no medical training who is also the chair of a coconut farmers’ collective,[13] was charged with "incitement against a government order".[34] He had posted online comments like “Enjoy your killing spree.”[13] He encouraged people to refuse immunisation, as he believed the vaccine caused measles,[35] and even discouraged life-saving antibiotics.[13] Tamasese faces up to two years in prison.[13]

The curfew was lifted on 7 December when the government estimated that 90% of the population had been reached by the vaccination program.[36] Parliament passed a bill on 19 December to make measles vaccinations mandatory in 2020.[37]

Nevertheless, as of 29 December, a public inquiry into the government's role in suspending vaccinations had not been announced. Deputy director of health Gaualofa Matalavea Saaga stated, "Having our case blasted out to the world is the last thing we want." [13] Samoa's political opposition called for the health minister to be removed from his position.[13]

On 31 December, Tuilaepa Sailele Malielegaoi, the Prime Minister of Samoa, addressed the nation to ring in the New Year; the measles outbreak was a focus of his speech. He acknowledged the support of the Samoan diaspora and 49 medical teams from the following countries and organisations: Australia, China, France/French Polynesia, Fiji through UNFPA, Israel, United States/Hawaii, Japan, Papua New Guinea, New Zealand, Norway, United Nations Agencies, United Kingdom and UK Save the Children, Solomon Islands and Kiribati through the Pacific Community, American Samoa, Médecins Sans Frontières, Blacktown Doctors Medical Centre, and Samoan Doctors Worldwide.[38]

International responseEdit

The low vaccination rate of Samoa came as a surprise to New Zealand's government.[39] The Samoa Observer reported that New Zealand's Minister for Pacific People, William Sio, was" 'of the impression' that Samoa had high immunisation rates. So to learn they were in fact fatality [sic] low was a shock." [39]

Since the outbreak, several organisations and countries have responded:

  • Australian Medical Assistance Teams (AUSMAT) sent a team of nurses, doctors, and public health experts as well as medical equipment and supplies to Samoa and left on 3 January 2020 after eight weeks in Samoa in one of its longest-ever missions.[40][41]
  • New Zealand sent three rotations of the New Zealand Medical Assistance Team (NZMAT) of doctors, nurses and logistics specialists who supported Leulumoega Hospital and Faleolo Clinic to the west of Apia for six weeks. NZ also sent a team of nurse vaccinators, 3,000 vaccination doses and vaccine fridges to Samoa in mid-November,[42] and a small number of Intensive Care Clinicians. Residents of Rotorua, New Zealand sent two dozen infant-size coffins decorated with flowers and butterflies to Samoan families.[43] On 14 December 2019, New Zealand Foreign Minister Winston Peters announced $1 million in funds towards preventive efforts in the Pacific.[44]
  • The United Kingdom EMT sent two rotations of doctors, nurses, physiotherapists, an anaesthetist, and an epidemiologist for four weeks of support from the end of November to December 2019.[45]
  • French Polynesia sent a team of paediatric nurses
  • Israel sent Intensive Care teams to Samoa to help with relief efforts.[46]
  • Hawaii sent a medical mission of 75 doctors and nurses for two days at the beginning of December to assist with the mass vaccination campaign.
  • On 10 December, American Samoa declared a measles outbreak and closed public schools and park gatherings[47] and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa.[48]
  • UNICEF has sent 110,500 vaccines to Samoa.[27]
  • The World Bank gave a US$3.5 million grant to support the response to the outbreak and another US$9.3m grant over the next five years to improve the health system.[46]
  • Israel sent a team of two paediatricians, six nurses and one physiotherapist trained in disaster medicine from the Israel Center for Disaster Medicine and Humanitarian Response.[49]

OthersEdit

As of 24 December, the following agencies had sent Emergency Medical Team personnel to assist with the outbreak:[50]

  • Japan
  • PACMAT
  • Norway
  • Save the Children
  • UNFPA
  • Papua New Guinea
  • Samoa mo Samoa Doctors Worldwide
  • French Polynesia
  • Counties Manuka District Health Board
  • NZMAT
  • MSF
  • ADRA
  • Pacific Community (SPC)

AftermathEdit

Tuilaepa said he would propose legislation that would penalise parents who refused to vaccinate their children.[51] The Samoan government allocated US$2.5 million for relief work.[51]

Immunology experts are now questioning the role of social media, primarily Facebook, and how social media facilitated the spread of vaccination hesitancy during the lethal outbreak. The Immunisation Advisory Centre in New Zealand sees the Samoan crisis as a sign that social media needs to deal with dangerous misinformation.[52]

As of 25 January 2020, Tuilaepa has so far resisted calls for an inquiry.[53] Opposition MP Olo Fiti Va'ai continues to call for an inquiry and was "apologising on behalf of Parliament and telling the people of Samoa that the government had failed miserably." [54][21]

See alsoEdit

ReferencesEdit

  1. ^ "WHO/UNICEF Secretariat Supporting Measles Outbreak Preparedness And Response In The Pacific" (PDF). who.int. World Health Organization. 22 November 2019. Archived (PDF) from the original on 13 December 2019.
  2. ^ a b "Samoa, Fiji and Tonga - Measles outbreak (DG ECHO, WHO, UNICEF and media) (ECHO Daily Flash of 25 November 2019) - Samoa". ReliefWeb. UN Office for the Coordination of Humanitarian Affairs (OCHA). 25 November 2019. Archived from the original on 2 December 2019.
  3. ^ "Health Emergency Operation Centre: Update on the measles outbreak, January 20, 2020 - Samoa". ReliefWeb. Government of Samoa. 20 January 2020. Archived from the original on 15 February 2020.
  4. ^ a b "Two more deaths from measles in samoa over new year period". Radio New Zealand. 7 January 2020. Archived from the original on 7 January 2020.
  5. ^ "Ministry of Health Press Release 1 - Measles Epidemic - Samoa". ReliefWeb. Government of Samoa. 16 November 2019. Archived from the original on 1 December 2019.
  6. ^ a b c "Population & Demography Indicator Summary". Samoa Bureau of Statistics. 22 December 2019. Archived from the original on 8 December 2019.
  7. ^ a b c d Government of Samoa (22 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 36) 22 December, 2019". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
  8. ^ a b c d Kwai, Isabella (19 December 2019). "'Why My Baby?' How Measles Robbed Samoa of Its Young". The New York Times. US. Archived from the original on 31 December 2019.
  9. ^ "Samoa measles state of emergency extended". Radio New Zealand. 14 December 2019. Archived from the original on 14 December 2019.
  10. ^ Davies, Samuel H. (1894). "Epidemic Measles at Samoa". The British Medical Journal. 1 (1742): 1077. doi:10.1136/bmj.1.1742.1077. PMC 2404975. PMID 20754822.
  11. ^ a b Whyte, Chelsea (6 December 2019). "Samoan government takes drastic measures to fight measles outbreak". New Scientist. Archived from the original on 10 December 2019. Retrieved 8 December 2019.
  12. ^ Duckor-Jones, Avi (5 February 2020). "Tragedy in paradise: How Samoa is faring after the measles epidemic". The Listener. NZ: Bauer Media Pty Ltd. Archived from the original on 23 February 2020.
  13. ^ a b c d e f g h i j Deer, Brian (20 December 2019). "Samoa's perfect storm: How a collapse in vaccination rates killed more than 70 children". The Telegraph. London, UK. ISSN 0307-1235. Archived from the original on 21 December 2019.
  14. ^ Government of Samoa (9 December 2019). "National Emergency Operation Centre, update on the measles outbreak: (press release 23) 9 December". @samoagovt. Archived from the original on 16 March 2020. Retrieved 22 December 2019.
  15. ^ Barrett, Jonathan (9 December 2019). "Decorated with butterflies, infant-sized coffins sent to measles-ravaged Samoa". Reuters. New York, NY, US. Archived from the original on 10 December 2019.
  16. ^ a b c Gibney, Katherine (12 December 2019). "Measles in Samoa: how a small island nation found itself in the grips of an outbreak disaster". The Conversation. Melbourne, Australia: The Conversation Media Trust. Archived from the original on 12 December 2019.
  17. ^ Kerr, Florence (20 December 2019). "Samoa measles outbreak: Death toll continues to rise, 39 new cases". stuff.co.nz. NZ: Stuff Ltd. Archived from the original on 20 December 2019.
  18. ^ Belluz, Julia (18 December 2019). "Tiny Samoa has had nearly 5,000 measles cases. Here's how it got so bad". Vox. US: Vox Media LLC. Archived from the original on 8 January 2020.
  19. ^ Pacific Beat (2 August 2019). "Samoan nurses jailed over deaths of two babies who were given incorrectly mixed vaccines". ABC News. Australian Broadcasting Corp. Archived from the original on 14 December 2019.
  20. ^ Agence France-Presse (28 November 2019). "Samoa measles outbreak: WHO blames anti-vaccine scare as death toll hits 39". The Guardian. UK. Archived from the original on 29 November 2019.
  21. ^ a b c Jackson, Lagipoiva Cherelle; Lyons, Kate (17 December 2019). "'These babies should not have died': How the measles outbreak took hold in Samoa". The Guardian. UK. ISSN 0261-3077. Archived from the original on 18 December 2019.
  22. ^ Clarke, Melissa (8 December 2019). "Anatomy of an epidemic: How measles took hold of Samoa". ABC News. Australian Broadcasting Corp. Archived from the original on 10 December 2019.
  23. ^ "Samoa: WHO and UNICEF estimates of immunization coverage: 2018 revision" (PDF). World Health Organization. 2018. Archived (PDF) from the original on 8 December 2019.
  24. ^ a b "The wrong jab that helped cause a measles crisis". BBC News. UK. 2 December 2019. Archived from the original on 5 December 2019.
  25. ^ "American Samoa declares measles outbreak". SBS News. Australia. 8 December 2019. Archived from the original on 9 December 2019.
  26. ^ "Samoa declares state of emergency over deadly measles outbreak". ABC News. Australian Broadcasting Corp. 17 November 2019. Archived from the original on 2 December 2019.
  27. ^ a b "Samoa measles outbreak worsens". BBC News. UK. 23 November 2019. Archived from the original on 5 December 2019.
  28. ^ Wibawa, Tasha (19 November 2019). "'Deaths keep climbing': How did a measles outbreak become deadly in Samoa?". ABC News. Archived from the original on 2 December 2019.
  29. ^ "Authorities in Fiji urge public to respect quarantine". Radio New Zealand. 25 November 2019. Archived from the original on 2 December 2019.
  30. ^ "Children stay home, Christmas gatherings cancelled in Samoa". Radio New Zealand. 2 December 2019. Archived from the original on 26 February 2020.
  31. ^ "Samoa measles outbreak: Police urge public to keep to curfew". Radio New Zealand. 2 December 2019. Archived from the original on 21 December 2019.
  32. ^ Silk, John; AFP (4 December 2019). "Samoan measles epidemic: Unvaccinated advised to display red flags in front of their homes". Deutsche Welle. Germany. Archived from the original on 5 December 2019.
  33. ^ "NZDF supporting Samoa measles epidemic response". Radio New Zealand. 3 December 2019. Archived from the original on 3 December 2019.
  34. ^ a b Kennedy, Merrit (6 December 2019). "Samoa Arrests Anti-Vaccination Activist As Measles Death Toll Rises". NPR. US. Archived from the original on 31 January 2020.
  35. ^ Purtill, James (5 December 2019). "Samoan measles anti-vaxxer with links to Australia arrested after spreading conspiracy theories". triple j - Hack. Australian Broadcasting Corp. Archived from the original on 7 December 2019.
  36. ^ "Samoa measles vaccination hits target but new cases still rising". Al Jazeera English. 7 December 2019. Archived from the original on 9 December 2019.
  37. ^ "Samoa's measles death toll rises to 78". Radio New Zealand. 20 December 2019. Archived from the original on 20 December 2019.
  38. ^ Feagaimaali'i, Joyetter (1 January 2020). "Prime Minister addresses nation at start of 2020". Samoa Observer. Archived from the original on 1 January 2020.
  39. ^ a b Mayron, Sapeer (5 January 2020). "It's okay to vaccinate, Minister Aupito spreads the message". Samoa Observer. Archived from the original on 25 January 2020.
  40. ^ "Statement on Samoa measles outbreak". ReliefWeb. Government of Australia. 21 November 2019. Archived from the original on 22 November 2019.
  41. ^ Wilson, Soli (5 January 2020). "Australia's emergency measles mission ends". Samoa Observer. Archived from the original on 16 March 2020.
  42. ^ "Measles outbreak: Samoa declares state of emergency after 6 fatalities". Deutsche Welle. Germany. 18 November 2019. Archived from the original on 19 November 2019.
  43. ^ Gerson, Michael (10 December 2019). "Samoa has become a case study for 'anti-vax' success". Washington Post. US. Archived from the original on 10 December 2019.
  44. ^ "Samoa measles outbreak: New Zealand gives $1m for preventive action in Pacific". Stuff. New Zealand: Stuff Limited. 14 December 2019. Archived from the original on 14 December 2019.
  45. ^ Department for International Development (29 November 2019). "UK medics fight deadly measles outbreak in Samoa - Press release". UK Government. Archived from the original on 30 November 2019.
  46. ^ a b Meyer, Jenny; RNZ (10 December 2019). "Jabs could knock out kid-killing measles epidemic in Samoa". New Zealand Herald. NZME. Archived from the original on 10 December 2019.
  47. ^ Hofschneider, Anita (9 December 2019). "Hawaii Lt Gov Says Samoa Medical Mission Won't Be The Last". Honolulu Civil Beat. HI, US. Archived from the original on 10 December 2019.
  48. ^ "American Samoa tightens entry as measles fears grow". Radio New Zealand. 10 December 2019. Archived from the original on 10 December 2019.
  49. ^ Leichman, Abigail Klein (8 December 2019). "Israeli medical experts fly to help Samoan measles victims". Israel21c news. San Francisco, US. Archived from the original on 8 January 2020.
  50. ^ Govt Press Release (25 December 2019). "Emergency Medical Teams Work Through Christmas". Samoa Global News. Archived from the original on 16 January 2020.
  51. ^ a b "Samoa govt allocates more funds for measles epidemic". Radio New Zealand. 30 November 2019. Archived from the original on 30 November 2019.
  52. ^ Hendrie, Doug (11 December 2019). "Facebook challenged over spread of anti-vaccine content in measles-stricken Samoa". newsGP. The Royal Australian College of General Practitioners. Archived from the original on 18 December 2019.
  53. ^ "Samoa's measles crisis wanes, but questions remain unanswered". Radio New Zealand. 24 January 2020. Archived from the original on 25 January 2020.
  54. ^ "MP calls for inquiry into Samoa's measles epidemic". Radio New Zealand. 21 January 2020. Archived from the original on 25 January 2020.