Measles in Samoa: Why are So Many Dying?

by Marco Cáceres

Published December 15, 2019 | Opinion

A total of 72 people have died in Samoa during the current outbreak of measles there that began in mid-October. Most of the deaths have involved children under five years of age. U.S. and global media outlets have been following this story closely, providing regular updates on the number of people in Samoa who have been infected with measles—4,995 as of Dec. 11, 2019—and the number of associated deaths.^{1 2 3}
As reported in The Vaccine Reaction last week, there has been widespread media coverage of the
extreme measures taken by the government in Samoa to “lockdown” the country, including closing all businesses and non-essential government services.⁴ Private vehicles have been banned from roads and children under 17 years of age have been prohibited from gathering in public. The government has implemented a mass door-to-door vaccination campaign. The families of children who have not been vaccinated have ordered to hang pieces of red cloth outside their homes so that Samoan health officials can be alerted where to go and administer the MMR (measles, mumps, rubella) vaccine.^{5 6}
The Samoan government is receiving assistance from international organizations and other governments, including shipments of MMR vaccines from UNICEF and advice from health officials at the U.S Centers for Disease Control and Prevention.^{3 7 8}

Sensational Headlines Blaming “Anti-Vaxxers” for Measles Deaths

An over-abundant number of news articles have blamed “anti-vaxxers” for the measles outbreak and deaths in Samoa, alleging that people publicly questioning vaccine safety and effectiveness are hindering Samoan government’s vaccination efforts. Articles are given sensational headlines such as “UN says online anti-vaxxers fuelling Samoa measles deaths;” “CDC Goes to Samoa to Battle Measles & U.S. Anti-Vax Disinfo;” “Samoa Arrests Anti-Vaccination Activist As Measles Death Toll Rises;” and “American Anti-Vaxxers Target Samoa, Severe Measles Outbreak Reported.”^{1 3 5 6 9 10 11}
There is a long list of headlines making unsubstantiated allegations to promote hatred among Samoans toward anyone who is critical of vaccine policies and instill irrational fear of people who are unvaccinated, regardless of their health status. One article titled “The Anti Vax Movement Is Being Blamed For A Measles Epidemic Overseas,” begins, “Really great job, anti-vaxxers. Once again, anti-vaxxers have a lot to answer for.”
A similar war-like drumbeat can be heard in the United States, although it is not as loud. That is because there is a difference between what is happening with measles in the U.S. and what is happening with measles in Samoa. Unlike in the U.S., children in Samoa are dying of measles.¹²
Curiously, no mainstream media outlet covering the measles outbreak in Samoa is asking why there have been so many deaths in that country, yet there have been no deaths associated with measles outbreaks in the U.S. From Jan. 1 through Dec. 5, 2019, there have been 1,276 confirmed measles cases in the U.S. but no child or adult has died.¹³
What makes measles a far more serious disease in developing countries than it is in developed countries like the U.S.? It is important to understand the history of measles and measles vaccine because it is different for different countries.¹⁴
There are many factors that affect morbidity and mortality associated with measles, including standard of living conditions and access to health care, but a major one is malnutrition. When it comes to lowering mortality from measles, the nutritional status of a country matters a great deal, especially for children.
As I wrote in a Nov. 25, 2019 article in The Vaccine Reaction:

[M]easles mortality rates in the U.S. dropped by more than 90 percent during the first half of the 20th century prior to the introduction of the first measles vaccine in 1963. Deaths from measles had decreased from 21 deaths per 1000 reported cases during 1911-1912 to less than one death per 1000 reported cases in 1953-1962. This improved measles mortality rate was owed to several factors unrelated to the measles vaccine, including better sanitation and living conditions, as well as better nutrition and improved access to health care.¹⁵

The World Health Organization (WHO) states that the “overwhelming majority (more than 95%) of measles deaths occur in countries with low per capita incomes and weak health infrastructures.” This insight may help explain why so many Samoans are dying, especially since it is known that Samoa has high levels of malnutrition. Samoans, in particular, suffer from a low intake of protein in their diet. The most common form of malnutrition in Samoa is known as Protein-Energy Malnutrition (PEM), which affects children the most.¹⁵
Substandard nutrition, especially among children, may be a big clue as to what is going on with measles in Samoa. Simplistically blaming vaccine critics for measles deaths is a convenient way to deflect attention away from the urgent need to eliminate poverty and improve nutrition and living conditions in developing countries like Samoa.

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