The week before her three children died, Fa’aoso Tuivale and her husband took them for a dip in the river that flowed behind their home in the Samoan village of Lauli’i.
Itila, 3, and his twin siblings, Tamara and Sale, 13 months, had a fever and their parents hoped to cool them down. The children had measles and had not been vaccinated. When they deteriorated, Fa’aoso took them to the hospital in Apia, 9 km away, one Sunday. They were seen and sent home.
The next day they took Itila back to the hospital. He died the same day. Tamara was admitted and died the following Friday in intensive care. Fa’aso was shocked at the sight of her little daughter connected to so many tubes. She felt helpless. Sale was in better condition, so she took it home.
The family crushed the fruit of the nonu tree so that he could drink from it. They prayed for him. They went to a traditional healer, who held it under the tap.
“He was crying, and I grabbed him, wrapped a towel around him, held him to my heart and I knew he was gone,” said Fa’aoso, sitting on her children’s grave in the front yard of their banana and taro. plantation. “I did everything I could.”
In the small island of Samoa, lives were changed forever by an outbreak of the disease in 2019, which at least 83 deaths and 1,867 hospitalizationsespecially of babies and young children. Thousands of others fell ill. The preventable disease was able to spread among the small, close-knit population of about 200,000 people thanks to record low vaccination rates – due to a medical vaccination error, the Samoan government. Public health mismanagementand fueled by anti-vaccine sentiment, including Donald Trump’s choice to head the US Department of Health, Robert F Kennedy Jr.
In Samoa today, mothers are afraid.
“I’m always worried,” said Shuvourn Samuelu, who held her one-year-old son Leiato Samuelu in the emergency room of a hospital in Apia last week. She had brought him in to have a fever checked. Five years ago, the hospital was flooded when her son Lologa Samuelu, then 14 months, and cousin Isaako Junior, six months, died after complications from measles. They had not been vaccinated.
“I knew they were sick, but I never thought they would die. We learned it the hard way.”
Now, five years after an epidemic that traumatized a generation, Samoan health officials are among those raising the alarm over Kennedy’s nomination as US health secretary.
“We cannot and must not remain silent. We know what this appointment means. It means more platforms for anti-vaxxers and less funding for vaccines and health programs,” Aiono Prof Alec Ekeroma, Samoa’s director-general of health, told the Guardian.
“It should be treated as a threat to our health care.”
Kennedy’s visit to Samoa
The roots of the tragedy date back to July 2018 and the deaths of two infants due to a medical error in the administration of an MMR vaccine, after the vaccine powder was mixed with expired muscle relaxants instead of water. The government stop the vaccination program for 10 months to investigate – preventing thousands of babies from being vaccinated, against World Health Organization advice, and creating room for rumours.
During the same period, Kennedy, who denies being anti-vaccine, was hosted in Samoa. He visited the country four months before the measles outbreak was declaredin October 2019, meeting with government officials and anti-vaccine influencers in what health advocates and Ekeroma claim was a “significant disinformation campaign” fueling distrust in vaccines.
Kennedy and his wife, Cheryl Hines, were special guests at Samoa’s 57th independence celebration in June 2019, part of a trip that came about after the anti-vaccination nonprofit Kennedy founded, Children’s Health Defense, linked to vocal Samoan vaccine critic and traditional healer Edwin Tamasese.
Tamasese was arrested during the measles epidemic for incitement against a government vaccination order. The charges against Tamasese was later droppedwhere a judge cites insufficient evidence.
Kennedy, who would later hail Tamasese as a “hero” in a blog post and describe the situation epidemic as “mild”also met with Australian Samoan anti-vaccine influencer Taylor Winterstein. She posted a photo of the couple on her social media using anti-vax hashtags and said his visit was “very monumental” for the movement.
Months after his visit, Kennedy wrote a letter to then Samoan Prime Minister Tuilaepa Sailele Malielegaoi, who urged him to investigate whether the infant deaths were caused by a “defective” vaccine or by a “mutant strain” of measles caused by it. Neither is plausible.
Emails sent to Kennedy’s team and Children’s Health Defense went unanswered. A man who answered the phone at a press number for Kennedy said he would not give media interviews until confirmed.
Misinformation about vaccines is spreading
Samoa is a deeply Christian country, where traditional cultural practices, such as natural healing, find their home alongside ‘palagi’, white, Western medicine, which is still distrusted by many. A central government runs in tandem with a fa’a matai (main) system that organizes society into villages where life is lived communally. The average hourly wage is US$1.30 (£1).
A broken healthcare system and lack of trust in vaccines confronted Dr. Take Naseri as Director General of Health.
“We got caught and it exposed all the holes in our healthcare system,” says Naseri from his general practice in Apia. There was a delay in announcing the outbreak, he said, because it took more than a fortnight to get confirmation of the first case of measles. When asked why it took so long to restore the MMR vaccine programme, he said: “We had to put an end to it… We had to rebuild trust.”
He met Kennedy during his visit, on Malielegaoi’s advice, for a conversation that he said revolved around Kennedy’s fears about vaccine safety.
“He told me he doesn’t think the data is solid, but I told him that with our small country we are very vulnerable to this disease. We are not rich. We don’t have the tools to manage it, we just have the tools to prevent it, and that’s what the vaccine does.”
Kennedy and his Children’s Health Defense group walked into this vacuum of mistrust — toward Western medicine, toward the government — said Helen Petousis-Harris, a New Zealand-based vaccinologist and co-director of the Global Vaccine Data Network.
When the government restarted the vaccination program, people were reluctant: when the epidemic was declared on October 16the rate had dropped to 31%According to WHO data, that figure was 84% four years earlier.
‘The Samoan Establishment handled the whole situation very poorly and did not take the support and advice offered to them at the time, which allowed this to unravel and RFK to come in,” Petousis-Harris said.
“When you throw rich and influential people into a fragile environment, it’s like the top of the food chain comes to visit and meets people who act as megaphones. The impact was devastating.” The resurgence of diseases when vaccination rates drop is predictable, she said.
Kennedy has spreading false claims that the MMR vaccines cause autism. According to the Center for Countering Digital Hate, he is one of the world’s best main super spreaders of disinformation. Public health officials in Samoa said anti-vaccination activists had been empowered by Kennedy, which had affected vaccine uptake.
Photo: Jack Taylor/Alamy
“The Samoan incident showed us how misinformation can kill,” said American pediatrician Dr. Paul Offit, who has followed Kennedy’s anti-vaccination activism. since 2005. “He sowed even more distrust, he jumped all over it – he met with anti-vaxxers in Samoa to promote the idea that ‘it’s not the measles, it’s the vaccine’, and immunization rates fell.”
In an interview for the film Shot in the ArmKennedy denies any responsibility for the declining vaccine numbers. “I had nothing to do with people who did not get vaccinated in Samoa. I have never told anyone not to get vaccinated. I didn’t go there for whatever reason.”
In November 2019, when New Zealand nurse and vaccine educator Lisbeth Alley joined mobile teams sent to vaccinate Samoan villagers during a mass campaignshe said local nurses were still afraid to give vaccines.
“No one had talked to them about it, no one knew, so of course what do people think. It was a ripe environment for fear mongering,” she said. As measles spread, desperate families rushed to get vaccinated, Alley said. “As soon as they saw us coming, they rolled up their sleeves.”
And in developing countries suffering from measles is always worse. Many rural Samoans lacked transportation, were afraid to go to the hospital, or tried traditional healers first. By the time people brought their babies in, they were extremely sick, said Australian anesthetist Dr Dan Holmes, who led Australia’s emergency medical team and was among more than 100 medical staff deployed to Samoa in the midst of the epidemic .
He spent two “relentless” weeks rescuing babies with complications from measles, including pneumonia, collapsed lungs, dehydration and encephalitis.
“Your day could start at six in the morning with a baby unconscious and not breathing, and you could lose that baby, and then there’s another baby, day after day,” Holmes said. “It has had more impact on me than anything I have done. It makes me so angry that it could have been prevented.”
MMR vaccination in Samoa is now mandatory for babies over nine months of age. But in another small village outside Apia, where mother of eight Siiae Olilefauaitu sits in the gathering darkness on the grave of her one-year-old baby Moana, none of this offers any comfort.
Her family lives at the end of this muddy path without power. They use a gas stove and go to bed at nightfall. They could move in with family elsewhere, but Olilefauaitu does not want to leave Moana, who is buried in front of the front door.
“She’s the first thing we see every day,” Olilefauaitu says. “She was a character, she crawled, she smiled a lot. I can never forget her.”