In six weeks, a measles outbreak has infected 3,000 people out of a population of 200,000, killing 42, mostly children
Fa’aoso Tuivale sleeps on her children’s grave during the day, when she misses them most.
She and her husband, Tuivale Luamanuvae Puelua, are sitting on the newly-dried concrete that mark the graves of their three-year-old Itila and 13-month-old twins, Tamara and Sale, talking about the week that has passed since they buried them.
“My children’s deaths came like a thief in the night, so sudden and unexpected,” Puelua said.
“Your mind becomes empty and you are speechless because there are no words on this earth to describe how my wife and I feel having to say goodbye to our children.”
The Tuivales are the worst affected family by a disease that has been ravaging the tiny south Pacific of Samoa for over a month.
Samoa, which is 4,300km east of Sydney and graduated to developing country status in 2014, is known to most people outside it as a peaceful, tropical holiday destination. But over the last six weeks, the country has been gripped by a devastating measles outbreak. There have been more than 3,000 confirmed cases in a country of just 200,000 people and 42 people have died, 38 of them children under four.
The Tuivale family live in the village of Lauli’i, 9km from the capital of Apia. Their home, tucked among their plantation of pineapple, banana, taro and papaya trees is at the very back of a long dirt road that follows the Namo river.
“Sale was the quiet one, he was usually well-behaved,” Tuivale recalls of the children he has lost. “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.”
‘No one ever thinks of burying their children’
A perfect storm of events has meant that the global measles outbreak that has ripped through so many countries over the last year has had such a devastating impact as it reached Samoa’s shores.
The world’s most infectious disease has spread throughout much of the developed world this year, and while some countries have suffered devastating losses as a result, developed countries have seen comparatively little loss of human life. New Zealand recently suffered its worst epidemic in 20 years – 2,000 people were infected, none died.
Samoa has a huge diaspora community in New Zealand making it inevitable that measles would eventually reach Samoan shores. When it arrived, it reached a population with devastatingly low vaccination rates and a health service ill-equipped to meet the challenge of such an epidemic.
Samoa’s total population immunity has been estimated by the WHO to be as low as 30-40%, compared with its Pacific neighbours, such as Tonga and American Samoa, which boast immunisation rates of over 90%, close to or matching recommended rates for achieving immunity.
The immunisation rates of babies have plummeted in recent years. Four years ago, roughly 85% of one-year-olds were vaccinated, in 2017 that dropped to 60%.
But since then the rate plummeted sharply, after a scandal that rocked Samoa in 2018, when two Samoan nurses administered MMR vaccines to babies who subsequently died. The nurses pleaded guilty to negligence causing manslaughter and were sentenced to five years in prison after it emerged that one of the nurses mixed the MMR vaccine powder with expired muscle relaxant anaesthetic instead of water for injection.
People lost trust in the government and in immunisation programs, meaning that by 2018, only 31% of children under five had been vaccinated.
Peter von Heiderbrandt was the first child killed in the outbreak; he died on White Sunday, the national children’s holiday on 13 October.
“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 Dan Holmes told the Samoa Observer, 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.”
State of emergency
Not only had health authorities been lax in immunisation coverage, once measles arrived they were slow to declare that the country faced an epidemic, waiting until several weeks after the outbreak, after 200 suspected cases were confirmed and one child had died. A month later, on 15 November, when the death toll had climbed to 16, the government declared a national state of emergency.
Since the declaration, the country has changed dramatically.
Vaccinations became mandatory and a mass campaign began the following Monday, leading to more than 30 stations set up inside church halls and primary schools, and even one outside a supermarket.
Dozens of mobile clinics – vans packed with nurses armed with megaphones – are driven around the country trying to reach every person and police are deployed to keep the peace at vaccination clinics.
Under the state of emergency rules, people under the age of 19 are banned from public gatherings. Schools have been closed, with exams incomplete and prize-giving and graduation ceremonies cancelled.
Apia’s coffee shops are sitting empty and 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, while pharmacies have reported selling out of hand sanitiser and surgical masks, which have become commonplace accessories in the markets, banks and workplaces across town.
After the Samoan government reached for help, in just two weeks nearly 100 extra medical personnel have arrived from Australia, New Zealand, French Polynesia and the United States. A team of doctors, nurses and epidemiologists from the UK flew out to the country on Friday and hundreds of thousands of vaccines have been shipped from New Zealand and the United Nations Children’s Fund.
‘People are desperate’
The government’s best efforts to fight the epidemic are being challenged by online influencers peddling alternative “cures”. Vitamins and kangen water – alkalised water made using a Japanese machine – are both touted as cures.
Anti-vaxxers have spread their message online, including one – who is also a social media influencer and the wife of a Samoan rugby league player – who likened Samoa to Nazi Germany for its mandatory vaccination program.
Some families are opting for Samoan traditional healers who use remedies like tea leaves, which are effective in reducing fever, but can do little for the actual virus.
The WHO has debunked all such “cures” and warned that there is no evidence to suggest any of those treatments work.
“To delay or to obscure with treatment that does not work, I think, is conning people unfairly into not getting treatment,” said Nikki Turner, WHO Chair of the International Committee on measles and rubella.
Samoa’s director general of health, Take Naseri is urging families and the traditional healers to come to the hospital first, before the complications are irreversible.
“When people are desperate, they look for other ways to get assistance and we cannot stop that right of people to choose where they want to go. We give them all the information so they have an informed decision, and that is the very difficult part.”
With infections rising to as much as 200 people a day, 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 Limbo Fiu, president of the Samoa General Practitioners Association.
“We anticipate this to go on for quite some time.”