SEATTLE, Washington — Samoa is no stranger to infectious disease. The small island nation of 200,000 located between New Zealand and Hawaii in the Pacific Ocean is especially vulnerable to disease outbreaks due to its isolation. COVID-19 in Samoa had the potential to overwhelm the population, but a measles outbreak helped the nation avoid catastrophe.
During the 1918 Spanish Flu Pandemic, Samoa, unlike its neighbor American Samoa, elected to keep its borders open. The two island groups saw very different outcomes. American Samoa patrolled its coastal waters and maintained a total quarantine for nearly two years, resulting in zero cases of Spanish Flu. On the other hand, Samoa saw one of the most devastating outbreaks of an infectious disease in modern history. More than 8,000 people died totaling nearly 25% of the island’s population. A century later, the lessons from that outbreak needed to be relearned.
Measles in Samoa
Late in the summer of 2019, an airline passenger traveling from New Zealand brought measles to Samoa. Most countries in the Pacific have measles vaccinations rates around 99%, so the population is protected from an outbreak. In Samoa, however, the vaccination rate fell to 31%, following campaigns by anti-vaccination activists and a tragic incident, in which two children died after a vaccine was accidentally mixed with the wrong liquid. In order to protect a society from measles via herd immunity, 95% of the population needs to be vaccinated.
The measles outbreak in Samoa infected nearly 6,000 and killed 83, mostly children under the age of 5. In response to the growing outbreak, the Samoan government instituted drastic measures. The entire country was put under a two-day lockdown during which public health officials went door to door administering mandatory vaccines. Schools were closed, roads were blocked and anti-vaxxers were arrested and jailed for endangering the public. After the lockdown, the Samoan government estimated that 90% of the population was vaccinated and lockdown measures were eased. In late December, 94% of the population had been vaccinated and the state of emergency ended.
Measles Prepares Samoa for COVID-19
One silver lining of the 2019 measles outbreak is that it prepared the nation for the threat of COVID-19. The nation already had new medical facilities developed by UNICEF ready to be used to isolate patients who were showing symptoms of the virus. The Samoan healthcare system was also greatly improved during the measles outbreak. Donations from foreign governments and the help of medical professionals from overseas who passed their knowledge onto local health providers aided in this. Trust in Samoan health authorities grew after the success in stopping the measles outbreak. Further, the government learned valuable lessons about getting accurate information out to the public and quelling disinformation campaigns.
Thanks to quick thinking on the part of the Samoan government, the country was locked down in early March. There have been zero cases of COVID-19 in Samoa as of late September. Life on the islands is relatively normal, albeit with fewer tourists and the economic struggles that most countries currently face. Most businesses, public services, schools and universities are operating normally, though large gatherings are not permitted and social distancing is enforced. International travel to the island is shut down with only essential flights for Samoan citizens allowed to take place.
Samoa’s experience with measles allowed it to improve its healthcare infrastructure and increase citizens’ trust in the government just as the world learned about COVID-19. While early and continued preventive measures were effective in stopping the virus from reaching the islands, the country has shown it would be capable of stopping its spread were it to arrive. Other island nations should look to Samoa as an example of how to get through pandemics without disaster.
– Jeff Keare