Samoa at 'real risk' of epidemics, health expert warns

Vaccination rates in Samoa are in freefall and have plummeted threefold in just five years.

This has left children in Samoa at real risk of infectious disease outbreaks, including the current global measles outbreak, new figures show. 

In 2013, some 90 per cent of Samoan infants received their first routine Measles, Mumps and Rubella (M.M.R.) vaccines. 

Last year that figure fell to just 31 per cent, according to new data from the World Health Organisation (W.H.O.) and U.N.I.C.E.F. 

The data shows sharp drops across the board for infant inoculations including for tuberculosis, diphtheria and tetanus, polio, measles, hepatitis, and pneumonia.

Dr. Nicola Turner, a member of the W.H.O’s Strategic Advisory Group of Experts (S.A.G.E) on immunisation, says the precipitous fall reflects the loss of public trust in vaccination programmes.

It follows the death of two one-year-olds last year, the long-term effects of which will leave Samoan children highly vulnerable to contagious disease for some time to come. 

“Samoa [has] got real risk of quite large amounts of disease,” said Dr. Turner said.

She said until vaccination rates go back up, Samoa is at risk of not only measles but childhood diseases like whooping cough, a highly contagious respiratory tract infection.

“It only takes one measles virus to arrive on the plane and it would spread very rapidly through the Samoan community, within weeks and months, so Samoa is at high risk of a measles outbreak," she said. 

“There is urgency for the community and the healthcare services to work closely together to ensure they can restore trust and that people really understand that this was not a vaccine problem, this was a service delivery problem."

The Samoa Observer yesterday reported that an expert warned the arrival of measles in Samoa from Auckland, currently in the throes of its worst measles outbreak in two decades was "inevitable". 

An estimated four-in-ten of New Zealand measles patients have required hospitalisation. 

Measles is spreading dramatically across the globe due to declining vaccination rates. The W.H.O. said twice as many people became infected with the disease in the first six months of this year compared to the first six months of 2018. 

In Samoa, the M.M.R vaccine was halted after two babies died after being given the vaccine. The courts found the nurses who administered the vaccine were negligent in preparing the vaccine, and they have been sentenced to five years’ in jail.

“The services need to ensure to the population that they have responded to that and improved the way they deliver services so it will not happen again," she said. 

In 2013, Samoa reached a nearly ideal rate of measles vaccination of the first dose, hitting 90 per cent coverage after a steady climb since 2007. But the rates have been dropping ever since, for both the first and second dose of the vaccine.

Data on coverage of the second dose of measles, typically recommended for children aged four to six, shows a lower coverage rate. 

Just 13 per cent of children were immunised with their second dose in 2018, the report shows, a drop of 70 per cent from 2017.

Made with Flourish

The coverage estimate reports come from the World Health Organisation (W.H.O) and United Nations Children’s Fund (U.N.I.C.E.F) review of national immunisation data in Samoa.

Dr. Turner said restoring confidence in vaccines “doesn’t happen overnight".

“We have seen it right back to the 1990’s with the UK loss of confidence in the measles vaccine, across many countries we saw a drop off in coverage for many infant immunisation programs," she said. 

“We have seen a similar situation recently in the Philippines with the concern about the Dengue vaccine, which has affected confidence in other children’s vaccines as well. This is a significant concern". 

The Director General of the Ministry of Health, Leausa Dr. Take Naseri, said: 

"We don’t have an outbreak (for measles) Those who are hesitant to take the vaccine should take it. We have officials at the border control to check passengers."

In August, the Philippines declared a national dengue epidemic after more than 600 people died of the disease, and it is facing a measles epidemic too.

There is a nationwide ban on the only dengue vaccine, Dengvaxia, after dozens of children given it died, leading to a nationwide drop in vaccination rates, and today the country has more than 35,000 recorded cases of measles and almost 500 deaths.

Dr. Turner said in light of the vaccine suspension in August 2018, the international community and the W.H.O should work with Samoa to ensure healthcare services are safe, and to help Samoa communicate they are safe to apprehensive communities, Dr. Turner said.

Ideally, 95 per cent of children would be immune, and it will take time for Samoa to get there. And with a record outbreak in Auckland, the risk of an outbreak in Samoa is high.

“Samoa will need to go out and catch up the children who have missed out,” she said.

“Unfortunately measles is one of the most highly infectious viruses we have in the world today."

Dr. Turner is the chair of that the S.A.G.E subcommittee on Measles and Rubella, and is the University of Auckland’s Associate Professor in the Department of General Practice and Primary Care of the University of Auckland and Director of the Immunisation Advisory Centre.

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