Measles in Samoa – a couple of referenced facts

Measles has killed 81 people in Samoa so far, mostly children. Meanwhile, like a pack of hyenas laughing maniacally off stage, the anti-vaccination cult is drooling over the harm and sorrow they’ve helped inflict. But let’s throw a couple of referenced facts at some of the mythical claims they’ve made using their social media megaphones.

Measles epidemic announcement from the Government of Samoa’s Facebook page @samogovt [29]

Anti-vaxxers didn’t cause the epidemic, a weak vaccination program did

Sorry, but antivaxxers didn’t do all this. Everything suggests they had a role, but to say that a poorly immune population developing an epidemic, when exposed to the causative agent, was due to a small vocal anti-vaccination extremist group misses the bigger picture.

Vaccination programs are run by health departments and ministries. They aren’t run by loud voices from overseas or by traditional healers (who are not necessarily against medications) or by those with limited understanding of the science underpinning viruses and vaccines.

World Health Organization (WHO) data show that Samoa’s first dose of measles-containing vaccine (MCV1) was given to well under 80% of eligible people across 11 of the 15 years between 2004 and 2018.

In four of those years levels fell to below 50% and in 2004 and 2018 were below 40%. These are levels that won’t stop measles transmission.

But between 1985 and 2002 – levels of the MCV1 were at 90% or above. So vaccination rates have been problematic for about 15 years but before 2003 they were as good in Samoa as the best nation anywhere. Something changed that might be worth dwelling on.

World Health Organization (WHO) data showing the percentage of eligible (I presume) Samoans vaccinated with one (MCV1) or both (MCV2) measles-containing vaccines (MCV).[10]

What about the second dose (MCV2) of the measles vaccination course? This seemed to come into routine use in Samoa from around 2006 after which it only reached higher than 80% of the eligible population once during those 13 years.

Painfully apparent is the specific plummet in 2018 of either dose. This was influenced by the deaths of two infants following a human error during the preparation of a measles-containing vaccine. A vial of muscle relaxant was used instead of one of water to prepare the injection.[6,7,8] However, rates were already low. This epidemic can’t be pinned on any one event or dose of antivaxxer poison. This is a bigger and much more complex failure.

Official and estimated data for the number of people in Samoa who have received the second measles-containing vaccine (MCV2) measles-containing vaccine, over time.[9]

On a side note, the pattern of low vaccination rates among the people on Samoa also extends to expatriate Samoan communities.[3,5]

So unless there are old links between antivaxxers and Samoa’s government that have influenced its vaccination decisions over a number of years, this epidemic is not caused by antivaxxers. It’s more likely caused by the interplay of a complex host of barriers to and influences on vaccine uptake which may include…

  • Past experiences with vaccination
  • Cultural norms
  • Family structure
  • Language barriers (moreso among ex-pats [3])
  • Low health literacy about certain diseases, transmission, viruses, bacteria, and the importance of vaccines
  • A functional vaccination record/reminder system
  • Ease of availability of vaccines
  • Increased training of health workers to update knowledge, skills and interpersonal communication
  • Provision of cold chain supplies and training in its use and need
  • Poorly communicated incentive programs
  • Not making it clear that vaccination can complement traditional medicine
  • Too little support for vaccination from public figures and Government
  • Insufficient funding for all of that to be made possible, forever

These issues are examined in more depth elsewhere.[3,4,11]

Measles infection can’t be prevented using vitamins.

Wouldn’t that be great if vitamins were an easy fix? And wouldn’t we all be so healthy because of all the vitamins we’d swallow? But they don’t work in this way.

KOALA Ward: an Australian Medical Assistance Team (AUSMAT) portable eight-bed critical care unit expanding the National Hospital’s capacity.
Source: Government of Samoa Facebook page [30]

There is no scientific evidence I’m aware of to show that vitamins alone can prevent measles virus from infecting our cells. And there is none which shows the use of vitamins prevent uncomplicated measles disease either.

Apparently there’s also no clear evidence for vitamin A deficiency among cases in Samoa, despite the cries of malnutrition and poor sanitation from anti-vaxxer outsiders.[31]

“We’re not really seeing evidence of acute malnutrition,” says the British paediatrician Dr Owens, who arrived from the UK on the same flight as me. “As I understand it, there is very little evidence of clinical vitamin A deficiency. And I’ve not met a patient yet with a defined immune deficiency.”

A review of other scientific studies actually found that vitamin A has no effect on preventing lower respiratory tract infection and even found some studies that suggested its use made things worse.[14]

Vitamin A is useful for preventing measles death

However, vitamin A is known – in high and multiple doses – to reduce deaths and pneumonia in those already infected by measles virus, even if they are well-nourished.[12,13,14,20] That’s why it was rushed to Samoa in the early stages of the outbreak.

Vitamin C is not going to prevent anything

Vitamin C is important for life but its curative and preventative effects on virus infections are mostly driven by old thinking, myths and profit.[17,18] Vitamin C is readily available in diets that have some fruit and vegetables in them.

There just isn’t any solid evidence that its use prevents infection. It may have a role in shortening symptoms [16] due to infection by some viruses but only by an insignificantly small amount.[18] And importantly for measles in Samoa, it seems that in the absence of a vitamin deficiency, the evidence isn’t strong that its use can prevent serious disease.[15,19]

You can see then how incredibly unlikely are any claims that a very short period after vitamins were given to a child “on death’s door”, they got up and were perfectly healthy.

The only current way to prevent infection is with a previously exposed immune system which is primed and ready to fight any new infection. The safest and easiest way to prime that immune response is through immunisation via the safe and effective vaccine we’ve had for a long time now.

From Upolu, Samoa
Photo by Wilson Stratton on Unsplash

Measles isn’t spread by poor sanitation, it’s spread by infected droplets

Some still have to roll out their paternalistic, probably racist and colonialist opinions that nations which don’t live in concrete and glass canyons will, of course, have measles because of poor sanitation. Measles spreads largely by droplets expelled from an infected and highly infectious person. These droplets land on surfaces and spread through the air. They also do this in the aforementioned utopian cities…when immunisation rates are low.

Improved sanitation reduces all-cause mortality, but not specifically the measles virus. Measles vaccination reduces measles.

The Samoan epidemic didn’t start once vaccination commenced

This anti-vaxxer theory is just simple ignorance. The first case (an infected traveller from New Zealand [28]) visited and left Samoa by August 19, 2019. The next cases were brewing in September and were laboratory confimred from samples sent to a laboratory in Australia in late September and more in early October. UNICEF started sending the first of its 115,500 doses of MCV vaccine and 30,000 vitamin A pills on October 1, 2019.[21]

Approximately 33,000 people had been vaccinated up to November 20,[22] after when a mass measles vaccination campaign began in earnest and culminated with December 5 and 6 government shut-down to complete a door-to-door vaccination campaign across Samoa.

Vaccination didn’t begin until after cases emerged. As is the usual reactive approach to things like this.

A timeline of the measles epidemic in Samoa.

Measles cases actually peaked in the week of the door-to-door campaign.

Vaccine and epidemic viruses are genetically different

Another fanciful anti-vaxxer theory follows on from the last one. It ludicrously posits that the vaccine virus is causing disease in Samoa. Apart from the outbreak being underway before vaccination started, there is another big spanner in this wheel.

The vaccine uses a weakened measles virus that belongs to genotype A. Genotype A viruses don’t circulate naturally anywhere in the world today because they don’t transmit and cause measles. Genotype A measles vaccine virus genetic material can be detected for a time after vaccination, but the transmission of vaccine virus has not been documented.[23]

Why ludicrous? Because the MeV driving the epidemic in Samoa is a virus of genotype D8.[24] This is a genetically different virus.

Sure, not every sample was genotyped, but enough were at the outset of the epidemic. Once you know that you have an ongoing epidemic of a clinically distinguishable disease on your hands, and you know the initial viral cause, you’re set.

While it is possible that another genotype dropped in partway through the epidemic, it’s unlikely. But it can happen; New Zealand’s epidemic is an example in which D8 and B3 genotypes were co-circulating). Still, that doesn’t change patient management, there is only need for a single vaccine, and it still isn’t going to have anything to do with vaccine virus.

So this one is easily disproved as wrong.

Measles is not just a mild disease

Your experience may have been that you had measles…most likely quite some years ago (thanks vaccines)…and you were fine. From this, you think everyone should have your experience?

Chances are, in a room full of people, there will be some who die tomorrow; they kill themselves, die of a heart attack, are poisoned, get run over, crash their car, get shot to death…and so on. Does this mean that mental health, heart disease, cars and guns are not dangerous just because none of these things happened to you? Of course not!

Measles virus is a debilitating and deadly virus. Not all the time. Not even most of the time. But enough of the time that it warrants the development of a safer preventative medicine; a vaccine.

Symptomatic measles infections usually don’t cause death, or hospitalisation, or encephalitis, convulsions, deafness, intellectual disability, pneumonia, premature birth, low-birth-weight babies SSPE Subacute sclerosing panencephalitis (SSPE). But it does sometimes. Perhaps more often than you think.[1]

From this table of confirmed measles cases during the recent epidemic in New Zealand, it is sobering to see over a quarter (25%-39%) of several ethnic groups hospitalised as a result of measles infection.[27] Evidence that measles is not just a mild disease.

Have a look at New Zealand (above) and Samoa.

Measles has caused high rates of hospitalisation among children and adults in New Zealand. It has killed children and adults. Open your eyes and look at the reality of this. Most of these have been in unvaccinated people – and nothing else has helped them.

Most confirmed cases of measles had not been vaccinated at all.
Source: [27]

Why didn’t measles cause more cases and deaths in the parallel ongoing outbreaks in Tonga (596 cases, 15 hospitalisation and zero deaths [25]) and Fiji (25 cases, zero deaths [26])? Perhaps because they have higher rates of vaccination than Samoa.

Facts still matter to people – if they can find them

None of the anti-vaxxer arguments have held up to even the slightest of scrutiny during the tragedy of the Samoa measles epidemic.

While that lack of robust logic won’t surprise anyone who has engaged them, it might surprise those who are still a bit unsure about vaccination because the cult makes a lot of noise and sound very sure of themselves.

Keep communicating realities in ways that the public can understand them. That’s where all the hot air may actually be of some use. We currently waste too much of it on each other.

References…

  1. Complications of Measles
    https://www.cdc.gov/measles/symptoms/complications.html
  2. Measles rash photo from Public Health Image Library (PHIL), Centers for disease control and prevention (CDC)DC
    https://phil.cdc.gov/Details.aspx?pid=1151
  3. The health of Queensland’s Samoan population 2009
    https://www.health.qld.gov.au/__data/assets/pdf_file/0026/388430/health-data-samoan.pdf
  4. CDC Goes to Samoa to Battle Measles & U.S. Anti-Vax Disinfo
    https://www.thedailybeast.com/cdc-goes-to-samoa-to-battle-measles-and-us-anti-vax-disinfo
  5. Responding to a measles outbreak in a Pacific island community in western Sydney: community interviews led to church-based immunization clinics
    https://ojs.wpro.who.int/ojs/index.php/wpsar/article/view/277/461
  6. Samoan nurses jailed over deaths of two babies who were given incorrectly mixed vaccines
    https://www.abc.net.au/news/2019-08-02/samoa-nurses-sentenced-manslaughter-infant-vaccination-deaths/11378494
  7. How a wrong injection helped cause Samoa’s measles epidemic
    https://www.bbc.com/news/world-asia-50625680
  8. Infant deaths in Samoa a tragic outcome from error preparing MMR vaccine
    https://www.immune.org.nz/hot-topic/infant-deaths-samoa-tragic-outcome-error-preparing-mmr-vaccine
  9. https://www.who.int/immunization/monitoring_surveillance/data/wsm.pdf
  10. WHO vaccine-preventable diseases: monitoring system. 2019 global summary | Coverage time series for Samoa (WSM)
    http://apps.who.int/immunization_monitoring/globalsummary/coverages?c=WSM
  11. Government of Samoa, National Measles Response and Recovery Plan
    https://reliefweb.int/report/samoa/national-measles-response-and-recovery-appeal-6-december-2019?utm_medium=social&utm_campaign=shared&utm_source=facebook.com&fbclid=IwAR2YCWf-u_gNHApQlkOvYdUi1yIDcQcZPTj7C15Da5apw8p_NAF8-A8gpMg
  12. A Randomized, Controlled Trial of Vitamin A in Children with Severe Measles
    https://www.nejm.org/doi/full/10.1056/NEJM199007193230304
  13. Vitamin A Treatment of Measles | Committee on Infectious Diseases
    https://pediatrics.aappublications.org/content/91/5/1014
  14. Vitamin A for treating measles in children
    https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001479/full
  15. Mythbusters: Does Vitamin C Really Help?
    http://www.yalescientific.org/2015/03/mythbusters-does-vitamin-c-really-help/
  16. Vitamin C and Infections
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5409678/
  17. How Linus Pauling duped America into believing vitamin C cures colds
    https://www.vox.com/2015/1/15/7547741/vitamin-c-myth-pauling
  18. Vitamin C for preventing and treating the common cold
    https://www.cochrane.org/CD000980/ARI_vitamin-c-for-preventing-and-treating-the-common-cold
  19. Vitamin C for preventing and treating pneumonia
    https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD005532.pub3/full
  20. Measles
    https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31463-0/fulltext
  21. UNICEF delivers over 260,000 vaccines and medical supplies to fight measles outbreaks in Samoa, Fiji and Tonga
    https://www.unicef.org/press-releases/unicef-delivers-over-260000-vaccines-and-medical-supplies-fight-measles-outbreaks
  22. (PRESS RELEASE 11) November 27, 2019
    https://www.facebook.com/samoagovt/photos/a.900118486685841/2777759758921695/?type=3&theater
  23. A Systematic Review of Human-To-Human Transmission of Measles Vaccine Virus
    https://pubmed.ncbi.nlm.nih.gov/27083423-a-systematic-review-of-human-to-human-transmission-of-measles-vaccine-virus/
  24. WHO/UNICEF SECRETARIAT SUPPORTING MEASLES OUTBREAK PREPAREDNESS AND RESPONSE IN THE PACIFIC
    https://www.who.int/docs/default-source/wpro—documents/dps/outbreaks-and-emergencies/measles-2019/measles-pacific-sitrep-20191122-docx.pdf?sfvrsn=d8166638_2
  25. https://reliefweb.int/report/tonga/tonga-measles-outbreak-2019-situation-report-11
  26. https://reliefweb.int/report/fiji/media-release-18-measles-26-dec-2019
  27. Measles weekly report, Institute of Environmental Science and Research Ltd (ESR) and Ministry of Health, New Zealand Week 51: 14–20 December 2019
    https://surv.esr.cri.nz/surveillance/WeeklyMeaslesRpt.php?we_objectID=5066
  28. Measles alert for passengers on flight from Samoa to NZ [thanks JL]
    https://www.rnz.co.nz/international/pacific-news/397791/measles-alert-for-passengers-on-flight-from-samoa-to-nz
  29. Government of Samoa, Facebook page, NATIONAL EMERGENCY OPERATION CENTRE: (PRESS RELEASE 43) December 29, 2019 https://www.facebook.com/samoagovt/posts/2851440981553572
  30. Press Release: AUSTRALIAN MEDICAL ASSISTANT TEAMS
    https://www.facebook.com/samoagovt/posts/2831747036856300?__xts__[0]=68.ARC6y9qjDRicwYZqOJL3M8NZvuUpVJmDrqnr7x4Zuhx-bZkJQr124DSXqAjlIlK-ASxToWXQ3WFCqChPGT89Ps6yA4JxKkG6u2860M9jG3AJVCyUwNj7_bcKQ9pWcQu90s-xTDczIAPW2d6J6XMmXoVg0J-vKuINnXJrVKOQl3_PeveDHKNKmMYZSTlhH7xkO6DrHSVkAcxgf6c7iUY3faY1LnMM_ORfSS28Gix9zPon9EuUAoMjilrmAp7hU9BQk_6BK8WBImXsy8OQQSchBjRSW_2xxC0rqI2vmLJeA4yfnEK8XHdF89n_NNO3LUIbCn5mINnJI1efxV-b0cuVjL_heg&__tn__=-R
  31. Samoa’s perfect storm | How a collapse in vaccination rates killed more than 70 children
    https://www.telegraph.co.uk/news/measles-in-samoa/

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