Pasifika Medical Association support team in Samoa and [inset] government announcement. Montage by Debbie RansomePasifika Medical Association support team in Samoa and [inset] government announcement [source: government Facebook page]

A measles epidemic in Pacific islands killed 83 people and infected more than 5,600 in Samoa, prompting a six-week state of emergency and a programme of compulsory vaccination.

Even as five new cases were being diagnosed every hour in November, the Samoan government also found itself fighting ‘anti-vaxxers’, who were spreading conspiracy theories about the pernicious effects of inoculations and offering vitamins, ionised water or plant-based remedies instead.

Although Fiji and Tonga also suffered outbreaks, the epidemic was most devastating in Samoa, where the death toll relative to population was equivalent to 135,000 fatalities in the United States. Measles, which mainly affects babies and young children, can also cause blindness, encephalitis and severe respiratory infections such as pneumonia. The outbreak is believed to have spread from Auckland as the New Zealand city is a hub for travel across the Pacific.

Samoa closed schools and restricted travel, businesses and public gatherings; a curfew was imposed and those in need of immunisation asked to use a red flag outside their homes as a signal to mobile vaccination teams. In a couple of weeks, Samoa’s health authorities successfully vaccinated 58,150 people.

Unicef and the World Health Organization (WHO) estimated that vaccination coverage in Samoa fell from 58% in 2017 to 31% a year later, ‘largely due to misinformation and mistrust among parents’. Tonga, by contrast, has a rate of 99%; levels of 95% are considered necessary to provide ‘herd immunity’. Samoa’s sudden drop followed the deaths of two babies in a tragic mistake by two nurses, who mixed the measles vaccine with an expired anaesthetic. The United Nations’ resident coordinator in Samoa, Simona Marinescu, said: ‘The system was in place and capable of providing vaccination, it’s just that mothers did not want to come.’

Samoa’s leading anti-vaccination activist, Edwin Tamasese, was arrested in early December after breaching a written warning ordering him to stop his campaign under emergency provisions making it illegal to discourage or prevent anyone from receiving vaccinations. Tamasese, who calls himself a taulasea, or traditional healer, had been giving out doses of vitamin A and C, as well as other alternatives to the vaccine, the Samoa Observer reported. A message he posted on social media about the vaccinations read: ‘Enjoy your killing spree.’ A prominent Australian anti-vaxxer, Taylor Winterstein, backed him and referred to ‘Nazi Samoa’ on social media because of the enforced vaccinations, which she claimed contributed to the epidemic. Winterstein, a rugby player’s wife, later claimed she had never told anyone not to vaccinate.

Another Samoan offering alternative remedies for measles to desperate parents was a local businessman, Fritz Filisi Alai’asa, who was spraying customers with ‘kangen water’ (alkaline water that has become a ‘wellness’ fad globally). Although the water has no medicinal properties, he reportedly said the spray, for which people were paying 10 Samoan tala (nearly $4), could alleviate measles’ symptoms. However, he admitted the water could not cure measles and as more people brought their children to him (2,000 customers in a fortnight, the Samoa Observer reported), the gatherings – banned under the emergency order – increased the risk of the disease spreading.

In 2018, more than 140,000 people died from measles worldwide; among Commonwealth states, there are major outbreaks in Nigeria and Cameroon. While the rising numbers are attributable to poor health infrastructure in developed countries, it is more often down to misinformation spread by ‘anti-vaxxers’ in the west – the US has reported its highest number of measles cases in 25 years. Samoans had learned a ‘painful lesson’ from the crisis, the prime minister, Tuilaepa Sailele, said. ‘There are parents who did not believe their children should be vaccinated. It’s imperative … to strengthen the culture of acceptance of vaccination.’