A Perfect Storm: The Social and Institutional Contexts of Samoa’s 2019-2020 Measles Epidemic and the Lessons learned for the COVID-19 Pandemic

Abstract

In late 2019 and early 2020, an epidemic of measles ravaged Samoa, and nearly three people in every hundred (2.83%) in the small population were infected, with 1860 hospitalizations and 83 deaths, mainly children. In the circumstances of the 2020 Covid-19 pandemic, this case study shows that even when a proven vaccine exists for an infectious disease, circumstances may prevent its effective use. As academics and researchers who live and work in Samoa, this article seeks to shed some light into contributing factors to the measles outbreak. These include inadequate data collection, low vaccination coverage, weak institutional capacity, unpreparedness for an epidemic, lack of public information, vaccine hesitancy and anti-vaccine propaganda and public recourse to traditional and ‘alternative’ therapies. Through a combination of personal observation, analysis of media articles, government reports and historical documents, we present an overview of the circumstances of the measles epidemic. We trace the circumstances of low vaccination coverage, institutional weaknesses and an uninformed public resulting in a delayed an effective response. In conclusion we reflect on the lessons that history offers on public health services in Samoa. Keywords: Measles, Epidemic, Samoa, public health, Covid-19, vaccination.