Several months before the COVID-19 (Coronavirus Disease) pandemic began, schools across the Pacific Islands had closed and large social gatherings had been banned in an effort to control a measles outbreak . American Samoa, Fiji, Samoa, and Tonga declared a measles outbreak, with the earliest case cluster occurring in Samoa on October 16, 2019 . As of mid-January 2020, the World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) reported a total of 6,390 cases of measles and 83 deaths due to measles in the Pacific Islands . A large majority of those cases and all 83 deaths occurred in Samoa . While there are fewer cases on the islands neighboring Samoa, banning large gatherings and limiting travel was enacted in late 2019 to restrict transmission within and between the islands .
Measles is a virus that infects the mucus in the nose and throat . Its symptoms include a fever, runny nose, cough, and rash, however the potential severe complications such as pneumonia and encephalitis are what make it so dangerous . While measles is highly contagious and often has the greatest impact in children, the vaccine has been shown to be safe and effective . A single dose of the Measles, Mumps, and Rubella Virus Vaccine, Live (MMR) is 93% effective; and when combined with a booster shot it is 97% effective . In Samoa, where the outbreak is taking the greatest toll on the population, vaccination rates have been particularly low this past year, at about 31% . There is a large anti-vaccination movement in the Samoan population and a distrust of the country’s health system, which was fueled by an incidence in 2018 where two children died after a vaccine was improperly prepared with muscle relaxant, leading parents to believe that their children were safer without the vaccine [5-6]. The government has tried to reassure the population that vaccines are safe, but have been met with much resistance . The Samoan government even arrested anti-vaccination activist Edwin Tamasese for “incitement against a government order” . Tamasese, like many other anti-vaccination leaders, have used Facebook and other social media platforms to disseminate false information about vaccinations in an effort to prevent participation in recent vaccination efforts .
Mass vaccination campaigns were implemented at the start of the outbreak across the Pacific Islands with aid and support from the WHO and UNICEF . Over 1.27 million vaccines have been administered among Pacific Island countries, with additional vaccines scheduled for delivery . The Pacific Island governments aim to get over 90% vaccination participation to provide herd immunity for those who are unable to be vaccinated . Throughout the mass vaccination efforts, houses in Samoa with unvaccinated children hung red flags indicating the need for vaccination services . This created a streamline method for healthcare workers and volunteers to go to each house to provide vaccinations and boosters . The Samoan prime minister, Tuilaepa Sailele Malielegaoi, showed additional support for the campaigns by posting images of himself getting vaccinated on social media . The Samoan government has also taken the initiative to make immunization records digitized, to allow for better record keeping . As the need for a mass vaccination campaign declines, healthcare facilities will still offer vaccines and booster doses to maintain effective immunization .
Mass vaccination campaigns have now been shifted to focus on other Pacific Island countries that are at high risk of an outbreak . Kiribati is considered high risk because of a current increase in acute diarrhea and vomiting (ADV)/rotavirus (RDT), and the Republic of the Marshall Islands is dealing with both influenza A and dengue outbreaks . The Pacific Island governments have made an effort to develop emergency preparedness plans for measles with the help and consultation of the WHO . Fortunately, the number of new (confirmed) cases has been decreasing in the Pacific Islands, with no new cases in American Samoa since the start of February 2020 . However, as a precaution measure, mass-gatherings and travel restrictions remain in place due to the ongoing COVID-19 pandemic outbreak [2,7].