Samoa’s measles reversal offers stark warning for Covid-19 pandemic

Measles was not always a problem for the Pacific island of Samoa. A high percentage of the population was vaccinated for the illness, making it difficult for the contagious disease to spread if it arrived on the island.

But all this changed when the vaccination of one-year-old babies collapsed to a rate of just 31 per cent in 2018, in the wake of a safety scare. The controversy led to international vaccine deniers focusing their efforts on the island. A vicious measles outbreak followed, killing 83 people, mostly babies and toddlers, a devastating toll on a community of just 200,000 people.

How it happened is a cautionary tale for Europe about the dangers of disinformation and vaccine scaremongering as vaccination campaigns attract a political polarisation they never have before.

It all began in 2018 when two children died shortly after receiving their vaccine against measles, mumps and rubella. The vaccine itself was not the cause – it was medical error. The vaccine substance was accidentally mixed with an expired muscle relaxant anaesthetic instead of water. Two nurses were later jailed for the incident.

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But the case shook faith in the vaccination campaign, and the Samoan government suspended its rollout for 10 months against the advice of the World Health Organisation.

The episode came to the attention of anti-vaccine campaigner and conspiracy theorist Robert F Kennedy jnr, a nephew of the former United States president. His organisation, Children's Health Defense, spent months posting about the deaths on Facebook as evidence of the danger of vaccines, without sharing that an investigation had established the cause to be medical error.

Star impact

From Australia, Taylor Winterstein, a Samoan-Australian influencer and the wife of a star rugby player, weighed in on events in Samoa over her popular Instagram account, questioning the efficacy of vaccines and exaggerating their risks. Both Kennedy and Winterstein travelled to the island in June 2019. Winterstein attempted to host a $200-ticket seminar promoting vaccine scepticism, while Kennedy travelled to "discuss with the government" funding a medical information system.

“Government officials, including the prime minister, were curious to measure health outcomes following the ‘natural experiment’ created by the national respite from vaccines,” Kennedy wrote on his website.

The outbreak began that September, when an infected passenger is thought to have flown to the island from New Zealand. Infection quickly spread among the island's by then substantial population of unvaccinated children. According to Dr Katherine Gibney of the Peter Doherty Institute for Infection and Immunity, one in every 150 babies aged between six and 11 months died.

The vaccine deniers insisted it was the jab, rather than the measles, that was causing the deaths. Winterstein blamed poor nutrition. As the Samoan prime minister shut down businesses to contain the outbreak and asked unvaccinated families to hang out red cloths so mobile teams of vaccinators could come to them, Winterstein compared the island to Nazi Germany. Kennedy lobbied the Samoan government to question the safety of the vaccine.

The two both promoted a local anti-vaccination campaigner, Edwin Tamasese, a farmer and avid Facebook user who pushed herbal and vitamin remedies in lieu of medical treatment. He was later arrested for likening the vaccination drive to a "killing spree".

Same tactics

The same tactics and rhetoric used on Samoa have become familiar to us during the pandemic. Winterstein has always rejected the label “anti-vaxxer”, insisting she is merely advocating for freedom of choice and informed consent. Such a stance of playing up people’s fears, while stopping short of vaccine denialism, is now prominent in Irish social media networks. Kennedy launched a European branch of Children’s Health Defense to a cheering anti-lockdown crowd in Berlin last summer.

Irish accounts with significant followings have pivoted from their posts about politics of the pre-pandemic days to embrace vaccine scaremongering and underplay the deadliness of Covid-19. There is a market for this in the social media economy: it offers clout, opportunities, and sometimes cash. Never has the market been as great as it is now as the pandemic rages, people feel anxious and frustrated, and governments attempt to organise mass vaccination campaigns to quell the spread of the disease.

Ultimately, little Samoa prevailed against the tide of vaccine denialism that pummelled it from abroad. In late December 2019 its government announced it had reached a vaccination rate of 94 per cent. Strict border controls have largely spared it from Covid-19.

The success of Covid-19 vaccines in saving lives, preventing illness and re-establishing normal life could reaffirm public trust in science and evidence-based medicine. But the stakes are high. The pitfalls are many. And vaccine deniers and like-minded opportunists see in the pandemic an opportunity for a broad audience and a political relevance that they never had before.