Anatomy of an epidemic: How measles took hold of Samoa

Sixty-three children in Samoa have died from measles. After a mass vaccination campaign, authorities are hopeful the spread of the highly contagious virus has been contained, but remain on edge. How did it come to this?

The family of 10-year-old Fa'auuga Iosefa crowd around his grave.

As his body is lowered, Fa'auuga's older brother wails in grief.

His sisters clutch photographs of him, then clutch each other for support.

The little boy's final resting place will be in the front yard of the family home.

It's the traditional place to keep ancestors close — except he's the wrong generation, dying far too young.

But this way, he will never be far from his mother.

Alieta Iosefa weeps.

"Having to bury your own son is the most complicated and painful thing in life. Especially a son that was just 10 years old, who was full of life and very active. Having to bury him is a void."

"He survived cancer but caught [measles] from hospital. His immunity was low and his heart was very tiny. He tried to fight, but the more he fought, the more damage it did."

Fa'auuga is one of 70 people who have been killed by measles in Samoa since October, and all but seven were aged under 15. Nearly 4,700 other Samoans have been infected.

Samoa's measles epidemic grew slowly, then swelled suddenly.

A few cases appeared in October. By November, the Samoan Government had declared a state of emergency. Schools were closed and vaccinations made mandatory.

But it was not enough to halt the spread of the virus.

Measles infections had popped up around the Pacific, but the virus only took hold in Samoa, where the national immunisation rate had fallen to a low of 30 per cent.

A preventable crisis

The troublesomely low immunisation rate was borne of an earlier tragedy.

In 2018, two babies died shortly after getting measles vaccinations. The nurses who administered the injections had incorrectly mixed an expired anaesthetic with the vaccine.

It prompted the Government to suspend the nation's vaccination program and though it was eventually restored, many Samoan mothers no longer trusted the vaccination process.

The Samoan Government took the drastic step of arranging a nation-wide shutdown to get people vaccinated.

Businesses were ordered to close and all citizens placed under a curfew to allow mobile vaccination teams to go door-to-door.

Residents were told to hang a red flag outside their house to indicate there was someone inside who needed vaccination.

Everything from crimson leis to the red-and-blue Samoan flag to were put to use.

Over the two days, around 120 medical teams traversed the roads of Samoa in vehicles commandeered from across government agencies and NGOs.

Fast and efficient, the teams vaccinated approximately 40,000 people, around 20 per cent of Samoa's entire population.

Most of those getting a jab were welcoming, enthusiastic to contribute to a project akin to a national reparation.

"It hurts, it hurts," said Iani Sheppard, wincing and laughing all at once.

"Good to have it done, it's a relief to have it done. Likewise, everyone else … it's a must for everyone.

"Most people don't have the transport … so this is very good, a good initiative for the Government to do, to come visit door to door and have this done.

"I pray that everyone will have this injection done so that this can be eliminated, this virus, from us."

But not everyone heeded the call.

'There was no trust'

Some of the nurses reported seeing people run away as mobile vaccination teams neared.

Others stayed but refused to be treated. Some parents turned to traditional healers first, only seeking help from the medical system when it was too late.

After the two deaths last year from incorrectly administered vaccines, there has been a new audience for anti-vaccination campaigners.

Both local and foreign 'anti-vaxxers' peddled their messages on social media, a potent act in a country where Facebook is a key source of information.

It has prompted heated debate amongst Samoans about who is to blame for the scale of the measles crisis — parents who did not vaccinate their children, or the Government for not addressing their mistrust in the system sooner?

Samoa's Prime Minister Tuilaepa Sailele is blunt.

"Parents should bring their children for vaccination," he said.

But he rejects suggestions that such remarks put the blame on parents.

"There are parents who did not believe that their children should be vaccinated … it is a question of educating our people to understand what they must do," he said.

"It is imperative … to strengthen the culture of acceptance of vaccination in order to create herd immunity.

"This is a painful lesson we have learnt from the current crisis."

The United Nations' resident coordinator in Samoa, Simona Marinescu, had a similar take.

"The system was in place and capable of providing vaccination, it's just that mothers did not want to come," she said.

"It is very difficult to convince mothers to come back to get their babies vaccinated, seeing what happened to the two families last year.

"There was no trust."

In 2018, measles caused close to 142,000 deaths around the world and the United Nations' sees in Samoa's epidemic echoes of global problems.

"Scepticism regarding the safety of the vaccine and the expanding atmosphere of doubt around vaccination — even in the most advanced countries — are among the underlying causes of the dramatic expansion of the disease," said Ms Marinescu.

Church on Sunday

Churches are the central pillar of community life in Samoa, a deeply religious nation.

Services have been cut and children discouraged from attending in an effort to limit the spread of measles in community gatherings.

But Sunday mass remains a source of solace for Samoans at a time when there seems little to be grateful for.

Lina Chang from the Samoa Victim Support Group has found the families of children suffering with measles struggling to remain positive.

"It's too early to say something about it because there's still suffering," she said.

"For our vulnerable families now, this is the only resort, turning to God."

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