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It was probably inevitable that the success of the anti-vaccination movement would eventually lead to an outbreak with substantial casualties. It has now happened in Samoa, where 48 people so far have died from measles, including 22 infants. Public health officials do not believe the outbreak has peaked, and expect those numbers to rise, possibl considerably. Why is the outbreak (which has hit much of Oceania in recent months) particularly bad and particularly deadly in Samoa?

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.

As you might expect, the decline in vaccination rates wasn’t due solely to domestic causes; it was assisted by a well-resourced global movement, with some familiar faces.

Anti-vaccine activist Robert F. Kennedy Jr., a nephew of President John F. Kennedy, visited the country in June, appearing next to officials at Samoan independence celebrations. His visit was “for a program that is not government-related,” an official in the prime minister’s department told Samoan news media at the time.

Kennedy has asserted that vaccines cause autism, a claim disproved by extensive research. Members of the Kennedy family have publicly criticized him for helping “spread dangerous misinformation.”

An Instagram photo shows Kennedy embracing the Australian Samoan anti-vaccine activist Taylor Winterstein in Samoa on June 4. “I am deeply honored to have been in the presence of a man I believe is, can and will change the course of history,” Winterstein wrote in the caption, adding hashtags #makinginformedchoices #investigatebeforeyouvaccinate.

Winterstein, who is married to a rugby star and has 25,000 Instagram followers, planned to hold an anti-vaccine workshop in Samoa as part of an international tour. She sold $200 tickets for the meetings, titled “Making Informed Choices.” After opposition from Naseri and other health officials, she canceled the anti-vaccine seminar scheduled for the Samoan capital, Apia.

As appalling and reckless as their advocacy is in their home countries, it’s considerably moreso in lower income countries like Samoa, where measles fatality rates are likely to be considerably higher, as we’re seeing here.

Public health officials in New Zealand, along with UNICEF, are rushing to get as much MMR vaccine to Samoa as quickly as possible, while prominent members of the American anti-vaccination community are responding with cringe-worthy condescension disguised as assistance.

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