IMPORTANT LANCET ARTICLE ON THE SAMOAN MEASLES OUTBREAK, May 2020

I was wrong--it occurred in the other (nearby) Samoa--the former territory of New Zealand, not the US territory. I visited the US' Samoa.

The Lancet published this review of the Samoan measles epidemic, which reveals it had nothing to do with antivaxxers or Mr. Kennedy.

Addendum: This photo is just to give you an idea of the Samoan physique. Dwayne Johnson is part Samoan.

Lancet. 2020 May 14;395(10236):1535–1536. doi: 10.1016/S0140-6736(20)31137-5

https://pmc.ncbi.nlm.nih.gov/articles/PMC7255155/ or see this site for the pdf:

https://pmc.ncbi.nlm.nih.gov/articles/PMC7255155/pdf/main.pdf

… There is some sensitivity about the roles of doctors in vaccination. Immunisation rates declined in Samoa after two babies died on Savai'i island following measles, mumps, and rubella (MMR) vaccinations that were wrongly prepared by nurses who were later jailed. The Expanded Programme of Immunization was interrupted for 8 months while the incident was investigated and, afterwards, the Ministry of Health ordered that doctors check all babies before immunisations by nurses. This approach was found to be impractical and taking away doctors from where they were most needed.

However, health officials say that vaccination rates fell for multifactorial reasons and were already declining before this incident. WHO data show a dramatic dip in coverage in 2004, which recovers, then drops again from 2014 onwards.

In this period, families were moving to the Apia urban area away from their villages, which had historically supported immunisation through the local, influential women's committees. By far the area worst hit by the outbreak was the capital and its surroundings.

But undoubtedly the MMR deaths played a significant part. Nurses recall that it became very personal: when they did home visits, mothers would chase them away. Nurse manager Lonise Malo Time says, “They would say ‘get out of our place, you are killing our babies.’ We were not trusted by the public anymore.” Palanitina Tupuimatagi Toelupe, the former director general of health who was general manager of the Samoan National Health Service at time of the deaths, called the incident a “wake-up call” for nurses that made them re-examine their practices and accept retraining.

UNICEF's Yett agrees that vaccine hesitancy was still strong at the start of the outbreak, but says that demand grew as the outbreak mushroomed. He adds, “The situation turned very quickly.” A compulsory mass vaccination campaign brought rates back up to 95%. To prevent underimmunisation in the future, the government introduced a new law in December requiring all children to be fully immunised before starting primary school, evidenced by a special yellow certificate.

Part of the recovery plan also includes an ambitious project to prevent immunisation gaps by reconciling the three sources of data on vaccination—the family hand-held record, the vaccinator's paper record, and the digital data sent to the main hospital. Data collection has already begun by this year's nursing graduates.

While mothers are being encouraged to get children immunised at hospital clinics, nurses are going out in teams to homes in a catch-up programme, vaccinating the children in the shade of a Ministry of Health minivan. It is not easy—roads are poor and torrential rain frequently cancels these trips.

But now, when the nurses arrive, the mothers welcome them. Malo Time says there has been a shift in what is expected of health-care professionals. She tells the mothers to go to immunisation clinics. But, she adds, “These days the world is moving. They expect the services to be provided in the homes.”

WHO's Kate O'Brien, director of the department of immunization, vaccines and biologicals, says that to combat vaccine hesitancy, it is vital that vaccines are made easily available, along with well trained health-care workers. “If clinics are only open Monday 10–12, that is not giving confidence that it's an important thing for families to do.”

UNICEF is heartened by the turnaround in approach by Samoa. Yett says that governments tend to want “fancy, expensive, high-tech equipment” for their health departments, but the Samoa experience shows that it is the basics that matter. “We have to invest in basic public health. We have to invest in routine immunisation. If we don't do that, we have a much bigger problem on our hands.”

Samoa was one of the first to introduce travel restrictions and quarantine when the COVID-19 pandemic began. As of May 6, the country has had no cases.