Anti-vax roots of Samoa’s measles tragedy: ‘It’s like a war zone’
Abigail Trewin has tackled bombings, tsunamis and cyclones in 20 years as a paramedic but even she has been shocked by the tragedy of the measles epidemic in Samoa.
Since October, more than 4200 Samoans have caught the most infectious virus in the world, with a death toll heading toward 70 - most of them children under the age of four.
"As a paramedic, I've seen a small number of children lose their life but here it is daily, that impacts on all of us," Ms Trewin told The Sunday Telegraph.
Ms Trewin has spent 11 years with the National Critical Trauma Care and Trauma Centre and is now mission head of the Australian Medical Assistance Team in Samoa, which is trying to help control the runaway epidemic on our Pacific neighbour.
It has meant the Tupua Tamasese Meaole Hospital in Samoa's capital Apia has effectively doubled in size, with every available room now turned into a paediatric ward to deal with the 140 infected children are coming in each day.
"It is emotionally very challenging for all the staff," she said.
We are in a hospital with enormous numbers of children and that is what makes it unusual. "We are sitting around the 90 per cent mark of paediatric patients and you just don't see that, and the kids are very sick."
Measles is the world's most contagious disease. If one person has it, nine out of 10 unvaccinated people around that person will be infected.
The only thing that stops it is vaccination.
What is happening in Samoa is the end result of a community without effective vaccination.
Measles can cause pneumonia or encephalitis - brain swelling. It will kill one in 1000 but, in countries with inadequate health care, the death rate is as high as one in 10.
Measles made its way to Samoa by plane from New Zealand and, with only one in three vaccinated in the tropical island nation, it quickly took hold.
Some turned to village traditional healers such as Fritz Alai'asa, who was running a clinic in Apia, spraying "kangen water", which is nothing more than alkaline water. He claimed that could heal measles.
He was only shut down by the Samoan government this week.
Edwin Tamasese, a coconut farming "traditional healer" who claims vitamins can cure measles, was arrested on Thursday. Both have had support form anti-vaccine advocates in first world countries.
Most children arriving at the hospital have first been to "traditional healers" such as these, said emergency nurse Dominic Sertori. This has cost lives.
"The majority are seeing their local healer in their villages and they are being sprayed with water, which doesn't do anything for measles and the children are getting sicker and sicker and then they are presenting at the hospital at the end of the disease process," he said.
"They have pneumonia or encephalitis and they are critically unwell.
"The families are so scared when they get to the hospital, you can see the fear on their faces, they fear they may lose their little ones, so it is quite confronting.
"There was a case where a family lost three of their children, which is horrific for them.
"Two children a day die, on average."
"We are seeing many children suffering with the secondary infections you get from measles," Ms Trewin added.
"We are seeing nasty pneumonias that are very difficult to treat and high pressure in the lungs which cause pneumothoraxes, basically holes in the lungs and they are also suffering from sepsis as a result of their pneumonia, which is why we are seeing such high mortality rates.
"When you see a seasoned doctor with 20-30 years under his or her belt and they say: 'I've never seen anything like this' and they are in tears, you know that this is having an impact.
"As a mum and the majority of my staff are parents, that makes it more emotional.
"You are invested in that care and that child and it is what makes the deaths more tragic.
"It is not only the loss of the lives and the sheer numbers of those but the investment you make in that family and that child's recovery and then they die, that is just horrific.
"Some staff are saying they can't remember each individual death because there have been that many."
In Australia, where vaccination rates are at a record high of nearly 95 per cent, measles cannot get a foothold because of herd immunity.
Samoa's vaccination rate in October, when the epidemic began, was around 31 per cent, down from around 70 per cent in 2016.
How quickly that happened is a lesson in how dangerous the anti-vaccine movement has become - and how their messages are amplified by social media giants including Facebook and Instagram, which continue to allow anti-vaccine misinformation on their platforms.
In June 2018, two babies died after receiving a measles, mumps and rubella vaccine that had been mistakenly mixed with an expired muscle relaxant, instead of water.
Both nurses pleaded guilty and are currently serving time for manslaughter.
The tragic mistake resulted in the temporary suspension of the country's immunisation program and undermined trust in the vaccine program.
Then the anti-science mob, who are forever searching for poster children to support their cause, swooped on the tragedy, flooding social media with false claims the babies were "vaccine-injured".
UNICEF's Pacific Representative Sheldon Yett said at the time that "stopping immunisation would be a disaster for children in the South Pacific and around the world".
It took only 15 months for that disaster to ignite but the anti-vaccine movement fanned the flames.
Taylor Winterstein, wife of Samoan-born football player Frank Winterstein, is an "Instagram influencer" who has no medical or scientific training.
Ms Winterstein planned one of her "Making Informed Choices" workshops, which are aimed directly at undermining confidence in the vaccination program, for Samoa last June.
The government banned her but she still travelled to Samoa and caught up with Robert F Kennedy Jr, one of the world's leading anti-vaccine campaigners.
"Yes, there were plenty of individuals who gave damaging information online," Mr Yett said from Samoa this week
"A lot of bad information out there and misrepresentation and that has clearly been an issue here. (Kennedy) was here and I don't know why he was here," Mr Yett said.
Mr Kennedy, nephew of former US president John F Kennedy, is the chairman of anti-vaccine lobby group Children's Health Defence, which was recently identified as one of the main funding sources of anti-vaccine misinformation on social media.
Ms Winterstein has also been supporting Edwin Tamasese, even calling him a "true hero" while comparing the government's rushed mass immunisation to Nazi Germany.
She told The Sunday Telegraph: "The Samoan government is responsible for putting a hold on MMR vaccination for eight months late last year after the vaccine-related death of two children. This, along with a mistrust of the MMR vaccine is the main contributing factor of low vaccination rates at the moment."
But Samoans have now enthusiastically hung red flags on doors to alert the mobile door-to-door mass vaccination program underway. It is reminiscent of the days when parents queued for the polio vaccine.
From the safety of her Australian home, where her two unvaccinated children receive the benefit of 95 per cent of the population being vaccinated, Ms Winterstein is outraged by this medical response to save the children of Samoa.
"Three things that immediately come to mind which are representative of Nazi Germany are forced medical interventions, painting of household doors for identification of particular residents and card carrying or symbol wearing of individuals," she said.
But Mr Yett said vaccines were a "magic bullet" to save children, adding that nearby counties such as Papua New Guinea are now also very worried.
"The entire Pacific is concerned. It is very transmissible and we know all it needs is someone to get on a plane and introduce it to another community, or get on a boat or a canoe," he said.
"This is the worst kind of shock to the system, you can't escape it here, it is a small country and everyone is affected on way or another, you cannot escape the impact of this."