Vaccine Smarts - Learning vaccine lessons from a Samoan tragedy


vaccine_l_45610128Samoa is a small island nation halfway between Hawaii and New Zealand with a population slightly more than 200,000 people. A traveler, probably from New Zealand, brought measles into the country this past August. By September, a full-blown measles outbreak was underway.

The government responded by declaring a state of emergency in November. It closed all schools, banned children from public events and mandated measles vaccination.

At the beginning of December, the government cancelled all public Christmas celebrations and public gatherings. Households with unvaccinated children were ordered to display a red flag to warn others away as well as to signal public health workers to come and vaccinate.

All government services except public utilities were shut down for two days, so government employees could help with the vaccination drive. The efforts paid off in that 94 percent of the eligible population was up to date with vaccination by the end of December.

The outbreak is fading. Sadly, over 5,700 people were stricken and 87 died of the infection. Most of the deaths were among children younger than 4 years old.

So how did this happen? Compared to most developing nations, Samoa had a relatively decent measles vaccination rate of 90 percent at the beginning of the decade. The Samoan government admits it became complacent, allowing the vaccination rate to fall to 74 percent, which is well below the 95 percent threshold necessary to prevent measles outbreaks.

Making things worse, the government suspended measles vaccination when two children died suddenly while receiving their measles shots. Although Samoa was advised by the World Health Organization to restart vaccination, the suspension continued until an investigation was completed more than 10 months later.

The investigation concluded a pair of nurses had mixed the vaccine powder in a liquid muscle relaxant, which killed the children. The nurses received five-year prison sentences after pleading guilty.

Using the situation to their advantage, anti-vaccination groups from the United States and Australia sowed doubts about vaccination among the islanders via social media. They claimed the investigation was a cover-up hiding the dangers of the measles vaccine.

The government responded by arresting and charging a prominent Samoan anti-vaccination activist with “incitement against a government order during the state of emergency.” Controversy surrounding the arrest and investigation fueled parental fears, resulting in only about a third of families having their children vaccinated after the lifting of the vaccination suspension.

Families lacking faith in their health care system looked elsewhere for help when the outbreak began. They turned to unproven alternative health treatments such as machines that produced “immune protection water.”

Such bogus treatments often delayed the parents from seeking appropriate medical care when their children fell ill with measles. In some cases, the delay led to severe complications and death.

There are lessons in this tragedy. First, measles is a serious, life-threatening illness. Second, vaccination works, and herd immunity is important. Samoa had been safe until vaccination rates fell. Conversely, high vaccination rates squashed the outbreak. Lastly, complacency about low vaccination rates is dangerous.

Published Feb 25, 2020

Vaccine Smarts is written by Sealy Institute for Vaccine Sciences faculty members Drs. Megan Berman, an associate professor of internal medicine, and Richard Rupp, a professor of pediatrics at the University of Texas Medical Branch. For questions about vaccines, email


Also see:  General Academic Pediatrics at UTMB Health Pediatrics

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