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Samoa's perfect measles storm

The following news feature is a co-production between the Guardian Australia and the Samoa Observer

Fa’aoso Tuivale sleeps on the fresh cement of her children’s grave during the day, when she misses them most. 

She and her husband, Tuivale Luamanuvae Puelua, told the Samoa Observer yesterday about the week that has passed since they buried their three year old and 13 month-old twins: Itala, Tamara and Sale.

“Sale was the quiet one, he was usually well-behaved,” Tuivale recalls. 

“Tamara and Itila are known to be the ones that argue and fight all the time.

“My father’s garden is usually used as a playground for the three-year-old; he would mess up the plants and give his grandfather headaches.”

The Tuivales are perhaps the worst affected family by a disease that has been ravaging the tiny island of Samoa for over a month, in which it has claimed the lives of 42 people; and 38 of them under four. 

The world’s most infectious disease has spread throughout much of the developed world earlier this year with comparatively little loss of human life. New Zealand recently suffered its worst epidemic in 20 years; nearly 20,000 people were infected. None died. 

But a huge diaspora in a former colony to which it remains hugely connected made its reaching Samoan shores inevitable.

The global outbreak’s devastating impact on Samoa was paved by a perfect storm.

Two one-year-old babies were killed by a measles vaccine. Two nurses were found by a court to have mixed with the vaccine powder with a fatal dose by anaesthetic; they were jailed for five years for negligent manslaughter.

Samoa’s Pacific neighbours, such as Tonga and American Samoa boast immunisation rates of over 90 per cent, close to or matching recommended rates for achieving immunity.

Samoa’s total population immunity has been estimated by the WHO to be as low as 30 to 40 per cent.

Much of this is driven, on its own admission, by mistrust of the government. Some of that mistrust was no doubt stoked further by social media influencers.

Kate O’Brien, the head of vaccinations for the WHO said that the influence is now being measured in human lives. 

But among its most vulnerable Samoa had been making up ground; some 85 per cent of one-year-olds had been receiving the vaccine less than five years ago. It had fallen steadily in those intervening years - lower than 60 per cent the year before the scandal. 

Since then it truly plummeted; below one-third of all one-year-olds received their routine vaccines at one-year of age last year.

This now has a human cost: according to Government figures those aged 0-4 make up the largest mortality group. 

Peter von Heiderbrandt was the first child the measles took; he died on White Sunday, the national children’s holiday on October 13.

“No one ever thinks about burying their children, you always think my children will bury me,” his father, Jordan von Heiderbrandt said.

Complications such as pneumonia have taken even more lives, an Australian doctor, Dr. Dan Holmes says, especially when treatment is too much for the small bodies to handle. 

“There is undoubtedly a chance that there is a burden on those children who have had those very severe infections, that they will go on to have some more problems in the future.”

“It is obvious from the huge rise in numbers of those affected that there has been no huge immunity in the population against measles,” the founding professor of the country’s School of Medicine Aiono Dr. Alec Ekeroma said.

“Now they are vaccinating everyone, [and] that is the right thing to do.”

But health authorities, previously comparably lax in immunisation coverage, were, arguably too slow in their declaration of an epidemic given the global precedent. 

Several weeks into the epidemic, after 200 suspected cases with one 14-month-old boy dead, the Ministry of Health officially stated it was dealing with an epidemic. 

A month later, on November 15 and the death toll at 16, the Government declared a national State of Emergency for the next 30 days.

Under the proclamation, vaccinations are mandatory, and a mass campaign began the following Monday. To date more than 30 stations inside church halls and primary schools, and even one outside a supermarket, have been set up to vaccinate every last person in the country. 

There are dozens of mobile clinics, vans packed with nurses and armed with megaphones trying to reach every last person.

First to be immunised are children under 19 and women between the ages of 20 and 35, considered to be the two groups most vulnerable to measles. Police are empowered to “keep the peace” at vaccination clinics.

Under 19’s are banned from public gatherings. Schools are closed, with exams incomplete and prize giving and graduation cancelled.

The Government’s proclamations have not been entirely welcomed. A primary school snubbed the ban on prize giving and held theirs anyway.

Lately, surgical masks have become commonplace accessories in the markets, banks and workplaces across town. Pharmacies have reported selling out of them, and other essentials like hand sanitiser and even gloves.

Apia’s coffee shops are sitting empty, market vendors’ stocks are unsold. Scared for their young ones, families have cancelled flights home to Samoa for the Christmas season, usually the busiest time of the year for tourism.

How long these consequences continue remains to be seen. 

With daily infections rising to as much as 200 people, the epidemic is yet to reach the critical inflection point at which the disease stops spreading. 

“This is unprecedented… Everybody is thinking on their feet,” said Le Mamea Dr. Limbo Fiu, president of the Samoa General Practitioners Association said. At least 20 doctors have extended their private practice hours and discounted services to attend to patients no longer going to hospital while measles occupies the brunt of the public workforce.

“We anticipate this to go on for quite some time.”

Translation by Adel Fruean. Co-produced with the Guardian Australia

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