2019 Samoa measles outbreak
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The 2019 Samoa measles outbreak began in September 2019. As of 6 January 2020, there were over 5,700 cases of
measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
and 83 deaths, out of a
Samoa Samoa, officially the Independent State of Samoa; sm, Sāmoa, and until 1997 known as Western Samoa, is a Polynesian island country consisting of two main islands ( Savai'i and Upolu); two smaller, inhabited islands ( Manono and Apolima); ...
n population of 200,874. Over three percent of the population were infected. 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%. A
state of emergency A state of emergency is a situation in which a government is empowered to be able to put through policies that it would normally not be permitted to do, for the safety and protection of its citizens. A government can declare such a state du ...
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. Families seeking MMR vaccination were asked by the government to display an item of red cloth in front of their homes so as to alert mobile medical teams traveling the island during the lockdown. Some added messages like "Help!" or "I want to live!". 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. Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order". Finally, as of 22 December 2019, an estimated 94% of the eligible population had been vaccinated.


Background

Measles Measles is a highly contagious infectious disease caused by measles virus. Symptoms usually develop 10–12 days after exposure to an infected person and last 7–10 days. Initial symptoms typically include fever, often greater than , cough, ...
first arrived in
Samoa Samoa, officially the Independent State of Samoa; sm, Sāmoa, and until 1997 known as Western Samoa, is a Polynesian island country consisting of two main islands ( Savai'i and Upolu); two smaller, inhabited islands ( Manono and Apolima); ...
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. In the early part of 2019, measles has been spreading throughout the Pacific region, with outbreaks in
Tonga Tonga (, ; ), officially the Kingdom of Tonga ( to, Puleʻanga Fakatuʻi ʻo Tonga), is a Polynesian country and archipelago. The country has 171 islands – of which 45 are inhabited. Its total surface area is about , scattered over in ...
,
Fiji Fiji ( , ,; fj, Viti, ; Fiji Hindi: फ़िजी, ''Fijī''), officially the Republic of Fiji, is an island country in Melanesia, part of Oceania in the South Pacific Ocean. It lies about north-northeast of New Zealand. Fiji consis ...
, the
Philippines The Philippines (; fil, Pilipinas, links=no), officially the Republic of the Philippines ( fil, Republika ng Pilipinas, links=no), * bik, Republika kan Filipinas * ceb, Republika sa Pilipinas * cbk, República de Filipinas * hil, Republ ...
and New Zealand. In March 2019, the WHO and UN children's agency UNICEF warned the Pacific to take proactive measures and improve immunisation rates.


2019 outbreak

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 Auckland (pronounced ) ( mi, Tāmaki Makaurau) is a large metropolitan city in the North Island of New Zealand. The most populous urban area in the country and the fifth largest city in Oceania, Auckland has an urban population of about I ...
to
Upolu Upolu is an island in Samoa, formed by a massive basaltic shield volcano which rises from the seafloor of the western Pacific Ocean. The island is long and in area, making it the second largest of the Samoan Islands by area. With approxi ...
. 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, a rate of 14.3 deaths per 1000 infected) and 5,520 cases (2.75% of the population) of measles in Samoa. 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15. At least 20% of babies aged six to 11 months have contracted measles, and one in 150 babies have died. As of 20 December 94% of the population had been vaccinated. 95% is required to acquire
herd immunity Herd immunity (also called herd effect, community immunity, population immunity, or mass immunity) is a form of indirect protection that applies only to contagious diseases. It occurs when a sufficient percentage of a population has become im ...
for measles. 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.


Vaccine hesitancy

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. On 6 July 2018 on the east coast of Savai'i, two 12-month-old children died after receiving MMR vaccinations. 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. 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. The incident caused many Samoan residents to lose trust in the healthcare system. 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. There has been no evidence of acute malnutrition, clinical vitamin A deficiency or immune deficiency as claimed by various anti-vaxxers.
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing humanitarian and developmental aid to c ...
and the
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
estimate that the measles vaccination rate in Samoa fell from 74% in 2017 to 34% in 2018, similar to some of the poorest countries in Africa. 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 Nauru ( or ; na, Naoero), officially the Republic of Nauru ( na, Repubrikin Naoero) and formerly known as Pleasant Island, is an island country and microstate in Oceania, in the Central Pacific. Its nearest neighbour is Banaba Island in ...
,
Niue Niue (, ; niu, Niuē) is an island country in the South Pacific Ocean, northeast of New Zealand. Niue's land area is about and its population, predominantly Polynesian, was about 1,600 in 2016. Niue is located in a triangle between T ...
,
Cook Islands ) , image_map = Cook Islands on the globe (small islands magnified) (Polynesia centered).svg , capital = Avarua , coordinates = , largest_city = Avarua , official_languages = , lan ...
, and American Samoa. 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. 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.


Government response

Initially, schools remained open after the outbreak was declared. The Samoan government initially did not accept humanitarian support. A
state of emergency A state of emergency is a situation in which a government is empowered to be able to put through policies that it would normally not be permitted to do, for the safety and protection of its citizens. A government can declare such a state du ...
was declared on 17 November, ordering the closure of all schools, keeping children under 17 away from public events, and making vaccination mandatory. UNICEF has sent 110,500 vaccines to Samoa. Tonga and Fiji have also declared states of emergency. Tonga closed all schools for several days, while
American Samoa American Samoa ( sm, Amerika Sāmoa, ; also ' or ') is an unincorporated territory of the United States located in the South Pacific Ocean, southeast of the island country of Samoa. Its location is centered on . It is east of the Internatio ...
required all travellers from Tonga and Samoa to present proof of vaccination. In Fiji, vaccines are being prioritised for young children and people travelling overseas. On 2 December 2019, the government imposed a
curfew A curfew is a government order specifying a time during which certain regulations apply. Typically, curfews order all people affected by them to ''not'' be in public places or on roads within a certain time frame, typically in the evening and ...
and cancelled all Christmas celebrations and public gatherings. 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. As part of aid efforts, the
Royal New Zealand Air Force The Royal New Zealand Air Force (RNZAF) ( mi, Te Tauaarangi o Aotearoa, "The Warriors of the Sky of New Zealand"; previously ', "War Party of the Blue") is the aerial service branch of the New Zealand Defence Force. It was formed from New Zeal ...
has transported medical supplies and equipment to Samoa. Also, New Zealand, Australian, British,
French Polynesia )Territorial motto: ( en, "Great Tahiti of the Golden Haze") , anthem = , song_type = Regional anthem , song = "Ia Ora 'O Tahiti Nui" , image_map = French Polynesia on the globe (French Polynesia centered).svg , map_alt = Location of French ...
n, and French medical teams have been assisting Samoan medical authorities. 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. Edwin Tamasese, an
anti-vaccination Vaccine hesitancy is a delay in acceptance, or refusal, of vaccines despite the availability of vaccine services and supporting evidence. The term covers refusals to vaccinate, delaying vaccines, accepting vaccines but remaining uncertain abou ...
activist with no medical training who is also the chair of a coconut farmers’ collective, was charged with "incitement against a government order". He had posted online comments like “Enjoy your killing spree.” He encouraged people to refuse immunisation, as he believed the vaccine caused measles, and even discouraged life-saving antibiotics. Tamasese faces up to two years in prison. The curfew was lifted on 7 December when the government estimated that 90% of the population had been reached by the vaccination program. Parliament passed a bill on 19 December to make measles vaccinations mandatory in 2020. 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." Samoa's political opposition called for the health minister to be removed from his position. On 31 December, Tuilaepa Sailele Malielegaoi, the
Prime Minister of Samoa The prime minister of the Independent State of Samoa ( sm, Palemia o le Malo Tuto’atasi o Sāmoa) is the head of government of Samoa. The prime minister is a member of the Legislative Assembly, and is appointed by the O le Ao o le Malo (He ...
, 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 A diaspora ( ) is a population that is scattered across regions which are separate from its geographic place of origin. Historically, the word was used first in reference to the dispersion of Greeks in the Hellenic world, and later Jews after ...
and 49 medical teams from the following countries and organisations: Australia, China, France/French Polynesia, Fiji through
UNFPA The United Nations Population Fund (UNFPA), formerly the United Nations Fund for Population Activities, is a UN agency aimed at improving reproductive and maternal health worldwide. Its work includes developing national healthcare strategies a ...
, Israel, United States/Hawaii, Japan,
Papua New Guinea Papua New Guinea (abbreviated PNG; , ; tpi, Papua Niugini; ho, Papua Niu Gini), officially the Independent State of Papua New Guinea ( tpi, Independen Stet bilong Papua Niugini; ho, Independen Stet bilong Papua Niu Gini), is a country i ...
, New Zealand,
Norway Norway, officially the Kingdom of Norway, is a Nordic countries, Nordic country in Northern Europe, the mainland territory of which comprises the western and northernmost portion of the Scandinavian Peninsula. The remote Arctic island of ...
, United Nations Agencies, United Kingdom and UK Save the Children,
Solomon Islands Solomon Islands is an island country consisting of six major islands and over 900 smaller islands in Oceania, to the east of Papua New Guinea and north-west of Vanuatu. It has a land area of , and a population of approx. 700,000. Its capit ...
and
Kiribati Kiribati (), officially the Republic of Kiribati ( gil, ibaberikiKiribati),Kiribati
''The Wor ...
through the Pacific Community, American Samoa,
Médecins Sans Frontières (MSF; pronounced ), also known as Doctors Without Borders, is a humanitarian medical non-governmental organisation (NGO) or charity of French origin known for its projects in conflict zones and in countries affected by endemic diseases. ...
, Blacktown Doctors Medical Centre, and Samoan Doctors Worldwide.


International response

The low vaccination rate of Samoa came as a surprise to New Zealand's government. The Samoa Observer reported that New Zealand's Minister for Pacific People,
William Sio Aupito Tofae Su'a William Sio (born 1960) is a politician who became a member of the New Zealand House of Representatives on 1 April 2008 for the Labour Party as a list MP. Since the November , he has represented the Māngere electorate. Perso ...
, was" 'of the impression' that Samoa had high immunisation rates. So to learn they were in fact low was a shock." 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. * 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, and a small number of Intensive Care Clinicians. Residents of
Rotorua, New Zealand Rotorua () is a city in the Bay of Plenty region of New Zealand's North Island. The city lies on the southern shores of Lake Rotorua, from which it takes its name. It is the seat of the Rotorua Lakes District, a territorial authorities of New ...
sent two dozen infant-size coffins decorated with flowers and butterflies to Samoan families. On 14 December 2019, New Zealand Foreign Minister
Winston Peters Winston Raymond Peters (born 11 April 1945) is a New Zealand politician serving as the leader of New Zealand First since its foundation in 1993. Peters served as the 13th deputy prime minister of New Zealand from 1996 to 1998 and 2017 to 2020, ...
announced $1 million in funds towards preventive efforts in the Pacific. * 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. * French Polynesia sent a team of paediatric nurses * Israel sent Intensive Care teams to Samoa to help with relief efforts. * 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 and suspended all entry permits for those travelling through Samoa and Tonga to American Samoa. *
UNICEF UNICEF (), originally called the United Nations International Children's Emergency Fund in full, now officially United Nations Children's Fund, is an agency of the United Nations responsible for providing humanitarian and developmental aid to c ...
has sent 200,000 vaccines to Samoa. * The UN
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
deployed 128 medical teams to assist in vaccination efforts. The UN
Central Emergency Response Fund The Central Emergency Response Fund (, CERF/FCIU) is a humanitarian fund established by the United Nations General Assembly on December 15, 2005 and launched in March 2006. With CERF’s objectives to 1) promote early action and response to redu ...
(CERF) allocated $2.7 million to support the response in Samoa as well as
Tonga Tonga (, ; ), officially the Kingdom of Tonga ( to, Puleʻanga Fakatuʻi ʻo Tonga), is a Polynesian country and archipelago. The country has 171 islands – of which 45 are inhabited. Its total surface area is about , scattered over in ...
and
Fiji Fiji ( , ,; fj, Viti, ; Fiji Hindi: फ़िजी, ''Fijī''), officially the Republic of Fiji, is an island country in Melanesia, part of Oceania in the South Pacific Ocean. It lies about north-northeast of New Zealand. Fiji consis ...
. * The
World Bank The World Bank is an international financial institution that provides loans and grants to the governments of low- and middle-income countries for the purpose of pursuing capital projects. The World Bank is the collective name for the Inte ...
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. * 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.


Others

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


Aftermath

Tuilaepa said he would propose legislation that would penalise parents who refused to vaccinate their children. The Samoan government allocated US$2.5 million for relief work. 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. As of 25 January 2020, Tuilaepa has so far resisted calls for an inquiry. 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." Following the ousting of the HRPP in the
2021 Samoan general election General elections were held in Samoa on 9 April 2021 to determine the composition of the 17th Parliament. In March 2021, Fiamē Naomi Mataʻafa, a former member of the ruling Human Rights Protection Party (HRPP) and a former Deputy Prime Minis ...
, new Health Minister Valasi Toogamaga Tafito announced he was considering establishing an inquiry into the epidemic.


See also


References

{{DEFAULTSORT:Samoa measles outbreak, 2019 Measles outbreak 2019 measles outbreaks 2019 disasters in Oceania 2019 measles outbreak Disease outbreaks in Samoa October 2019 events in Oceania November 2019 events in Oceania December 2019 events in Oceania