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Government needs to dispense hard truths to cure vaccine mistrust

The wrenching irony about vaccinations in Samoa is that parents’ most primal instinct to protect their children’s lives now seems like it could cost them. 

Driven by fear following the tragic death of two one-year-olds in Savai’i, Samoan parents have been shunning public vaccinations at dramatic rates.

We empathise with these parents acting upon the most natural instincts. But ironically, as the outbreak of contagious illnesses, especially measles grows worldwide, and now seems inevitable to reach Samoa, the lives of these children are now seriously at risk.

In his remarks during the sentencing of two nurses to five years’ jail for preparing and administering a Measles, Mumps, Rubella (M.M.R.) vaccine lethally contaminated with expired anaesthetic, Acting Chief Justice Vui Clarence Nelson forensically demolished the idea that vaccines themselves were unsafe.

But he also exposed deep flaws in Hospital procedure. Anaesthetic was not kept in a separate cupboard as required. Justice Vui condemned a nurse manager for not halting vaccinations once a first baby had died. But he noted that a hospital duty doctor, too, had raised no alarm either.

We applaud the decision to hold a separate coronial inquest into the circumstances of these babies’ deaths and how these lapses occurred.

If we are to recover from this situation, it will require the health system to regain trust in the public’s eyes.

A full and unflinching cataloguing of the failings of Samoa’s vaccine programmes, nurse training and hospital procedures is the only possible first step towards a return to credibility. 

A loss of trust in vaccine safety is becoming a worldwide problem and driving the worldwide resurgence in diseases such as measles. But for Samoa it is perhaps more serious as any country in the world.

Falling rates of vaccination are ringing alarm bells in the wealthiest countries of the world. This is mostly focused on the rise of ‘anti-vaxxer’ parents who read social media material falsely claiming vaccines are dangerous.

Some Governments are experimenting with punishing them or denying their children access to public playschools.

But let’s put the declining vaccination rates that have experts in these countries so concerned in perspective for Samoa.

In Britain, where newspapers have been ringing the alarm, 95 per cent of infants get the M.M.R. jab.  The World Health Organisation (W.H.O.) recently raised “deep concerns” about the global average of infants receiving M.M.R injections being too low at 85 per cent.

Last year the number of Samoan children who received this vaccine stood at just 31 per cent, according to a W.H.O.-U.N.I.C.E.F. study published in Tuesday’s Observer.

Some of this was due to a nine-month moratorium imposed on vaccines while the deaths in Savai'i were investigated. 

But that is only part of the story.

M.M.R. vaccine rates in Samoa have been falling steadily for five years. In 2017, before the Savai’i scandal, just 58 per cent of infants received M.M.R. vaccinations.

We applaud the Ministry for resuming the routine M.M.R. programme in April and undertaking to catch up on all children who missed vaccinations.  

But that will be a massive, crucial undertaking and it's unclear if Samoa's health data system is capable of rising to the challenge. 

Yesterday the Director-General of the Ministry of Health, Leausa Dr. Take Naser, said 46 per cent of eligible children who had missed out on vaccines during the moratorium at Moto’otua Hospital had now been vaccinated.

But when pressed he could not provide figures for District Hospitals. 

That simply isn't good enough. 

The potential implications of Samoa's falling vaccination numbers are are chilling. In 2012 90 per cent of children were vaccinated against measles; last year just one-third of that number were.

A 2017 student in America found that every five percentage point drop in vaccination rates saw the number of children infected with measles rise by three times.

Measles is on the march world over. It is the most infectious disease known to man. Infection rates across Europe have doubled this year. Auckland is in the grips of its worst outbreak in two decades with Samoans among the worst affected making the disease's arrival here "inevitable" according to one expert. 

But even if Samoa does manage to escape the recent outbreak the effects of having a poorly immunised generation can present problems for decades to come. 

But if the outbreak threatening our shores does arrive, the stakes are very high. Even countries with higher rates of vaccination than Samoa have suffered terribly from local outbreaks. 

In the Philippines, which recently underwent a similar vaccine scandal to Samoa, some 55 per cent of infants in the Philippines received the M.M.R. injection last year.

According to Government estimates published in the Philippine Daily Inquirer some 40,000 people have caught measles in that country this year. More than 500 have died; 80 per cent of those were infants. 

It took this newspaper to uncover the publicly available figures about Samoa’s vaccination programme and bring them to the public's attention.

We have not heard enough from the government about what is doing to solve this problem. And in an environment where a lack of trust is a major factor, vacuums are liable to be filled by online misinformation.

The looming human cost is now too high for anything less than a transparent and proactive overhaul of the government’s approach with the aim of restoring public faith.

That means admitting to some hard truths about deficiencies in the health system. We call for frequent updates on the progress of the Government's vaccine program, including its failures and information about how many parents are refusing to have their children vaccinated.

The Government is facing a looming crisis and it’s more than partly one of confidence.

Usually only time can repair broken trust. We may not have that luxury.

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