In this November, image from video, masked children wait to get vaccinated at a health clinic in Apia, Samoa. Samoa has closed all its schools, banned children from public gatherings and mandated that everybody get vaccinated after declaring an emergency due to a measles outbreak. For the past three weeks, the Pacific island nation of 200,000 people has been in the grip of a measles epidemic that has been exacerbated by low immunization rates. TVNZ via Associated Press

WASHINGTON — Federal health officials are sending teams of experts to Pacific island nations in response to measles outbreaks amid concerns that a major outbreak on Samoa could heighten the spread of disease.

The Centers for Disease Control and Prevention already deployed two experts to Samoa, where measles has overwhelmed the health system in a country with a population of about 200,000. Measles has sickened nearly 4,900 people, killing 71, most of them children under 5.

This week, in response to requests for help from individual countries and United Nations groups, additional CDC teams are flying to Tonga, Fiji and American Samoa, where there are ongoing, smaller measles outbreaks that could intensify, CDC officials said.

One CDC expert will focus on fighting misinformation about measles and other vaccine-preventable diseases, in response to requests from UNICEF.

Health officials want to make sure “to communicate that the disease is dangerous and that the vaccine is good,” Robert Linkins, a global immunization official at CDC’s headquarters in Atlanta, said in a recent interview.

“These other countries are also seeing cases of measles, and they are at risk for importation” from the Samoa outbreak, he said. “The need is very big. There are a lot of Pacific islands. All are at risk of seeing cases. You need a lot of people to get on planes to go to these islands to get them the information they need.”


In many Pacific island countries, measles vaccine coverage is below the level recommended by the World Health Organization to protect against the disease. Last year, coverage for one dose of measles vaccine ranged from 73 percent in the Federated States of Micronesia to 75 percent in Vanuatu and to 83 percent in the Marshall Islands, according to the World Health Organization and UNICEF. The WHO recommends that 95 percent vaccination with two doses is needed to protect against the disease.

Samoa has been the target of anti-vaccine activists, and the WHO estimated that in 2018, only 31 percent of children received the measles vaccine during their first year of life, a drop from 60 to 70 percent in previous years. The WHO attributed the extremely low rate in part to a public health scandal: Last year, two infants in Samoa died within hours of receiving the MMR vaccine. The country temporarily halted its vaccine program, but the vaccine did not cause the deaths. Two nurses improperly mixed the vaccines with a liquid muscle relaxant instead of water. The pair were sentenced to five years in prison for manslaughter.

Last week, Samoan officials arrested a local anti-vaccine activist and charged him with “incitement” for claiming that the government’s vaccination campaign would result in mass deaths.

Emergency medical teams have deployed to Samoa from around the world, including a group of 70 doctors and nurses from Hawaii led by Lt. Gov. Josh Green, to help with last week’s vaccination campaign. Additional teams are arriving to help with pediatric intensive care, a WHO spokeswoman said.

An Israeli team of pediatric specialists and nurses arrived Sunday.

“Because the Samoan health care system has been simply overwhelmed by the sheer number of cases, we have been asked to bring hands and heads to the affected areas,” said Elhanan Bar-On, director of the Israel Center for Disaster Medicine and Humanitarian Response at the Sheba Medical Center.


The local staff are exhausted, he said. A large number of children are suffering from complications of measles, like pneumonia, he said, and many of them are in intensive care, requiring ventilation to help them breathe.

“It’s a severe crisis,” Bar-On said in a recent interview from Israel. “If children have support and treatment, a lot of them can recover. The babies are most at risk.”

A team of midwives and a doctor from Save the Children’s emergency health unit has also deployed to Samoa. Measles is a critical risk for pregnant women, and the team will be working in the maternity and reproductive health units to help pregnant women and women who have recently had babies, a spokesperson said.

Hawaii’s Green, a family physician with emergency room training, has deployed on previous medical missions around the world. At a hospital on the western side of the island, he said the facility was operating at 600 percent above capacity because of so many sick patients.

“I’ve never seen anything like this,” Green said in an interview with Radio New Zealand last week. “It was unbelievable the extent to which people were devastated by measles, with the rash all over their body and high fevers.”

Green condemned misinformation spread by anti-vaccine activists in Samoa and from outside the island. Anti-vaccine activist Robert F. Kennedy Jr., a nephew of President John F. Kennedy, visited the island in June and met with an Australian Samoan anti-vaccine activist. Both the activist and Kennedy said they met by chance in Samoa while staying at the same resort in June.

Kennedy has also written to the government of Samoa questioning the safety of the MMR vaccine.

Hawaii’s Green said in the radio interview that misinformation aimed at scaring people was “unacceptable.” He added: “I believe in free speech, but I don’t believe in denying science. . . . To send anti-vax messages from another country is really quite terrible unless those individuals are willing to come here and suffer with the measles and see their own children get sick or die.”

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