Samoa is one of my favorite places. I’ve only been to Upolu, the most populated island (est. population 145,000) where the capital of Apia is located, but I’ve been there several times and enjoyed myself every time.
The island is as I imagined Hawaii once was, in its not too distant past, where the natural beauty of the island and its incredibly warm, kind people are not yet dominated by a western presence.
This beautiful place and its jovial people are currently in the grips of a devastating measles outbreak. To date, 32 people have died. The overwhelming majority of them have been children. Close to 2,500 residents are infected, with hundreds of new cases being diagnosed daily.
The reasons for the outbreak are important to understand, because facts are important and can potentially serve as a warning to other small island communities struggling with questions around vaccinations.
In June 2018, two infants in Samoa died shortly after receiving their measles, mumps, and rubella immunization shots. Understandably, these deaths caused both wide-spread panic in the island community and considerable mistrust of immunizations. The government went so far as to recall the vaccine.
The Samoan Ministry of Health and Samoan police immediately opened investigations into the deaths. The Samoan Ministry of Health sought additional support from both the World Health Organization and New Zealand Ministry of Health to assist with their investigation. As the investigation was underway, the New Zealand Ministry of Health sought to reassure the Samoan community about the safety of the MMR vaccinations in Samoa.
The official investigation concluded that two nurses improperly administered the vaccinations. MMR needs to be diluted prior to being administered, but the two nurses mixed the vaccine powder with an expired anesthetic instead of the proper diluent.
The human error first resulted in the death of a 1-year old girl. Then a second mother asked that her 1-year old son not be immunized. The hospital proceeded to immunize the child anyway, and he died as a result of receiving the erroneously mixed vaccination.
Both nurses were charged and tried for manslaughter. Both received prison terms of a minimum of five years for their roles in the infants’ deaths.
Despite government efforts to reassure the community about the safety of vaccinations while the investigation was underway, the vaccination rates dropped significantly in Samoa after the two deaths. The United Nations Children’s Fund estimated the percentage to be between 30% to 40%, although Samoa government estimates were higher.
Yet, now a measles epidemic has erupted in the small island community. After the first 16 children died and more than 1,100 potential cases were identified, schools were closed indefinitely. Hundreds of people have been hospitalized. Public gatherings are being restricted.
The government in Samoa has made vaccinations mandatory for children in a mass vaccination campaign, a move which has been met with resistance from some anti-vax groups.
I’m not unsympathetic to the anti-vax movement. If two infants died in my community, I would have surely second guessed vaccinating my child, too. Vaccinations are a terrible experience, for both parents and children. It’s absolutely nerve-wracking to watch your child being treated, and it’s a thousand times worse to watch someone inject something into your child.
It’s also a necessity.
I am a well-educated woman, but a medical degree is not among the degrees I hold. This means I need to put faith into those individuals who committed their time and energy into obtaining that expertise. I honestly don’t care what someone on Facebook managed to find on the internet, a Google search is not the equivalent of a formal education or real-world healthcare experience, and it’s ridiculous for anyone to think so.
The over-whelming majority of physicians and nurses support vaccination. These are the people on the front lines of our global health realities. It is important to value their expertise, their experience, and above all else, the fundamental reality that all these people are all part of our communities and care, deeply, about our communities.
Now, I can already hear the outrage. I can see people rushing to their keyboards to cherry-pick an internet site or the malfeasance of a few individuals to try to paint the entire system as wrongful or untrustworthy. There are millions of health professionals worldwide and thousands upon thousands of studies who do good work with integrity. One does not negate the whole.
I honestly don’t care what someone on Facebook managed to find on the internet, a Google search is not the equivalent of a formal education or real-world healthcare experience.
For a society to work in which a large number of individuals collectively share space and resources, people must commit to contribute in both large and smalls ways to the good of the whole. This need for conscious commitment to the collective good is particularly pronounced in an island community, where space and resources are often scarcer. We must trust each other, and we must contribute, even if it sometimes makes us uncomfortable or acts against our own individual gain.
Parents need to be mindful. They should ask questions. They should understand the recommendations. They should feel free to consider alternative vaccination schedules.
But if you or your family plan to utilize public resources, like public schools and other services, where you would be exposed to the many people in our community who may be immunocompromised or otherwise cannot receive vaccinations for medical reasons, certain vaccinations should be required, particularly for those diseases that are highly contagious and have the potential to become epidemics or pandemics quickly.
I’ll be honest: to me, I view the anti-vaxxers as being equal to the climate change deniers. The quality of evidence is overwhelming. The professional community is in consensus as to the facts. People are certainly entitled to their own opinions; they are not entitled to their own baseless facts. And the facts, in both cases, call for us to collectively to take important steps toward protecting the well-being of our community and future generations.
Whether vaccinations or climate actions, at some point we need to accept that many current and future crises are preventable. The seemingly small, individual actions we take today can have large, irreparable impacts on our communities tomorrow. I only hope that we do not wait until crisis befalls us before we find the courage and good sense to act.
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