Portal de Periódicos da CAPES

Lessons from the tragic measles outbreak in Samoa

2020; Wiley; Volume: 56; Issue: 1 Linguagem: Inglês

10.1111/jpc.14752

1440-1754

David Isaacs,

COVID-19 epidemiological studies

On 18 November 2019, Samoa declared that their measles outbreak constituted a national emergency, and mandated that all 200 000 people on the Pacific island should be vaccinated (Fig. 1). The government closed all schools and banned children from public gatherings. Families hung red flags outside their houses to indicate they needed to be vaccinated.1 On 28 November 2019, the Samoa Ministry of Health reported 2936 cases with 250 new cases within 24 h. At that time 39 deaths had been recorded, 35 (90%) of them children <5 years old.2 By 9 December, the number of cases had reached 4357 with 70 deaths (61 < 5 years).3 New Zealand is sending infant coffins, because Samoa is running out.4 Routine measles immunisation rates, always sub-optimal, fell to 31% by November 2019, as a result of a vaccine tragedy on 6 July 2018, when two infants died within minutes of being administered MMR vaccine.2, 5 The Government suspended the MMR immunisation programme after the July administrative error. The cause of this vaccine tragedy was not made public for months, even after re-starting MMR vaccine in November 2018. In July 2019, two nurses were sentenced to 5 years' prison for inadvertently using a curare-like muscle blocking agent instead of water to dilute lyophilised (powder) MMR vaccine. This sort of disaster is not new: 15 infants died in northern Syria in 2014 when atracurium was used as a diluent instead of water.6 It is unclear why muscle relaxants were kept in immunisation facilities in Syria or Samoa. Lessons learnt from tragedies such as these are costly: for the infants' grieving families and for a community that has allowed fear to erode confidence in immunisations. The Samoa measles outbreak shows the diseases against which we give routine childhood immunisations are not benign and will return if we stop immunising. We have a moral imperative to promote immunisation. However, using the tragedy as a cudgel to beat anti-vaxxers7 is likely to be counter-productive.8 Although this sort of vaccine disaster is completely preventable, if an iatrogenic disaster does occur we need to be honest and transparent about the contributory causes of systems and human error rather than abandoning communities to the erroneous belief that the vaccine itself caused harm. If not we risk losing the public confidence and therapeutic trust which is the mainstay of immunisation programmes.