Samoa lifts measles state of emergency

The state of emergency in Samoa over the devastating measles epidemic ended on December 29, following a special cabinet meeting. The Pacific country’s government declared a so-called “state of recovery,” which requires the Ministry of Health and the Ministry of Foreign Affairs to prepare a recovery plan.

The six-week emergency was called off after the government claimed that 95 percent of all eligible people in Samoa had been vaccinated against measles following an intensive month-long compulsory vaccination period. Before then, vaccination rates had been allowed to plummet, particularly among children. Last year, just 28 percent of Samoa’s population had the two required doses of the measles vaccine.

The official death toll stood at 81 at the end of December, with no new fatalities over the Christmas period. However, there are still 46 victims in hospital, including nine critically ill children and a pregnant woman.

Samoa’s Ministry of Health confirmed 5,655 measles cases had been reported since the outbreak started in October. The total number admitted to hospitals to date is 1,844.

The official figures, showing that nearly three percent of the country’s population caught the disease, may well be an underestimate. Television New Zealand’s Pacific correspondent Barbara Dreaver claimed that the notified deaths do not give a full picture of the tragedy. She reported last month from several isolated villages where some families, often too poor to travel and obtain medical help, had buried deceased infants without informing the authorities. The government could accurately gauge the final toll, Dreaver said, only by conducting a full nationwide investigation.

The lifting of the emergency could be premature. In the 24 hours preceding the government’s announcement, 21 new measles cases were reported. Financial considerations are no doubt at play. Finance Minister Sili Epa Tuioti revealed in a supplementary budget last month that Samoa’s economy has been hit with at least a one percent drop in economic growth due to the outbreak.

The minister declared the National Provident Fund, the country’s compulsory savings scheme, would release $US3 million to finance a special dividend of 1.1 percent for the institution’s 85,000 members, in a bid to generate spending and stimulate economic activity. The government also aimed to reboot the badly hit tourism industry by marketing a “safe Samoa.”

The Ministry of Health’s mental health unit has warned of the growing psychological impact of the epidemic. Spokesman Dr George Leao Tuitama told media that the unit had so far assisted more than 600 families. The epidemic has “pushed many people’s coping mechanisms to the breaking point,” he said.

Prime Minister Tuilaepa Sa’ilele Malielegaoi, in the face of deepening popular anger, has repeatedly attempted to defend his government’s response to the entirely avoidable epidemic. Replying to a question posed at a press conference the week before Christmas, Tuilaepa flatly declared “Samoa couldn’t do more” to prevent the outbreak.

In fact, Samoa was warned repeatedly to improve measles vaccination rates several months before the arrival of the epidemic. According to Radio NZ, as early as last March the World Health Organisation and UNICEF had identified Samoa’s extremely low vaccination rates as a key risk amid the global resurgence of measles.

A letter issued to all Pacific Island governments at the time urged them “to take proactive measures to close immunity gaps and strengthen their systems to rapidly detect and respond to measles cases,” a UNICEF spokesperson said. The messages were also delivered at an April meeting of Pacific health leaders in Fiji, and again at a Pacific Health Ministers meeting in French Polynesia.

Samoan Director-General of Health Leausa Dr Take Naseri had attended both meetings. At the April meeting, the threat posed to the Pacific by a measles outbreak in the Philippines was raised directly by officials, according to Dr Siale Akauola, the chief executive of Tonga’s Ministry of Health. Samoa did not begin its mass vaccination campaign in earnest until 15 November. By then, seven people were suspected to have died, and hundreds more were infected.

There are demands for a national inquiry into how the measles epidemic spread so quickly. Medical academic Toleafoa Dr Viali Lameko, from Oceania University of Medicine, said he believed most doctors were backing his call.

Toleafoa told the Samoa Observer that he was “not here to attack anyone or any sector, but perhaps it is time to return to the drawing board and ask some serious questions about the health profile of our population.” Tuilaepa only declared there will be an inquiry into the government’s response in “due time.”

Equally culpable for the devastating crisis is New Zealand’s Labour-led government of Prime Minister Jacinda Ardern. On December 13, the New Zealand Ministry of Foreign Affairs and Trade (MFAT) issued a statement officially confirming New Zealand as the likely source of Samoa’s measles epidemic.

The Samoan government had reported the first measles case arrived from New Zealand in late August. “International travel means that measles can spread quickly from country to country. It is highly likely that New Zealand is the main source for the outbreak in Samoa,” a MFAT spokesperson admitted.

Leading health experts have condemned New Zealand’s role. Otago University public health professor Michael Baker told Radio NZ on December 16 there had been “ongoing problems… with leadership and applying effective immunisation systems.”

Gaps in New Zealand’s health system led to its own measles outbreak that sparked the deadly epidemic in Samoa. From January to December 18 there have been 2,172 confirmed cases of measles notified. Of these, 1,726 are in the Auckland region, concentrated in the city’s working-class suburbs with large Pacific Island populations.

Baker said the broader provision of public health needed better funding to fix current failings. New Zealand had to get its “act together on public health policy,” he declared.

Baker continued, “We have wound down our national public health capacity hugely during my working life… That’s been the real gap. New Zealand has no excuse for having big measles epidemics because we have all of the infrastructure we need to prevent these, and we’re just not using it adequately.”

MFAT’s statement was the first public admission of responsibility for the epidemic, after government ministers either evaded questions on where the disease came from or categorically denied New Zealand was the source. When Radio NZ earlier asked Foreign Affairs Minister Winston Peters whether New Zealand gave Samoa measles, he retorted: “That is speculation, the answer is most probably not.”

The latest Pacific Community (SPC) health bulletin for the region meanwhile shows Kiribati confirmed its first measles case before Christmas, while the Marshall Islands has tightened its requirements for people entering and leaving the country. Fiji, Tonga, American Samoa and Hawaii are all currently reporting cases.

The author also recommends:

Research explains how the measles virus destroys immune “memory”
[27 December 2019]