Natalia Sutherland travelled to Samoa with Barbara Dreaver to see first-hand the terrible consequences of the Samoa measles epidemic.
It’s early in the morning, yet families are already queuing outside of Samoa’s Ministry of Health building in Apia desperately waiting for the doors to open.
It’s an hour until they will be let inside, but none of the families with their small children straddled to their hips want to miss out on a vaccine that will save their lives.
Panicked parents have been flooding special immunisation centres like this one all around Samoa to get the measles, mumps and rubella (MMR) vaccine and protect their children against the deadly measles virus which is taking lives throughout the country.
In just a few short weeks the highly infectious disease has claimed the lives of dozens of people, most of them are children under the age of four.
As the disease creeps across the tiny island nation, hundreds of new cases are diagnosed, sending an already skyrocketing total into the thousands.
Hospitals overwhelmed with an unprecedented number of patients begin to turn away sick children and erect tents as makeshift ICU units for the critically ill.
Samoa is caught in the grip of a measles epidemic, with the bereaved growing daily and a government battling to keep the outbreak under control.
It begs the question, how does a disease that was once in decline suddenly send a small country like Samoa into a state of emergency in a matter of weeks?
It’s July 2018 and a family visits Safotu Hospital on the island of Savai’i with their one-year-old daughter. They’re there for a routine MMR immunisation given by a nurse.
Three minutes after the baby is injected with the vaccine she is dead.
Two hours later at the same hospital, a one-year-old boy dies only a minute after he received the same vaccine.
The tragic death of two babies during a routine and safe immunisation process sends two families into grief and a nation into shock.
An immediate withdrawal of the vaccine is ordered by Samoa’s Ministry of Health and hospital staff involved are stood down.
The heart-breaking loss of life through human error could not have come at a worse time for Samoa as an ever-growing backlash against immunisation begins to take full force.
Nearly a year later in June 2019, just a couple of months before the measles outbreak, a group met to hear American vaccination critic Robert Kennedy Jnr., the nephew of former President John F. Kennedy.
The meeting had been organised by a US Embassy staff member and the invitation list included Australian anti-vaccination blogger Taylor Winterstein.
The wife of NRL player Frank Winterstein, Ms Winterstein had planned to host seminars in New Zealand and Samoa but was forced to cancel after being called a “public health threat” by the Samoan Health Minister Leausa Take Naseri.
Despite not hosting the seminars, Ms Winterstein boarded a plane and flew to Samoa.
Using social media as her platform, Ms Winterstein was quick to post about her meeting with the high-profile Mr Kennedy.
The drive of the anti-vaccination message by the likes of Ms Winterstein and Mr Kennedy’s in Samoa perpetuates the fear of many locals towards hospitals and immunisation, the Samoan government claims.
Adding to that, an already low immunisation rate of 41 per cent and lack of access for many poor families to health care creates the cocktail for a highly infectious disease to spread.
It begins like any other virus. A cough, runny nose, sore throat and eyes and a temperature. Then a red blotchy skin rash begins to appear on the head and covers the body.
But it’s long before these symptoms emerge that the virus is already inside a patient and can be spread to others.
It can take seven to 14 days from first exposure to see the first symptoms of the virus and by then dozens of people could have been exposed to the highly contagious disease.
On a flight from New Zealand to Samoa sits a passenger unaware they’re carrying one of the world’s most infectious viruses towards an unprotected population.
That’s the most likely scenario of how the disease was exported to Samoa, New Zealand’s Ministry of Foreign Affairs and Trade (MFAT) told media following the outbreak.
Only months before the virus took a toll on Samoa, New Zealand was battling the peak of our measles outbreak.
Those unvaccinated were being told to be fully immunised before they travelled to New Zealand and parents with young children were warned to stay away from cities like Auckland that had serious outbreaks of the disease.
Once the virus lands in Samoa it begins its ugly attack on the unimmunised population, hitting young children the most.
The country is unable to cope with the ferocity at which the virus spreads through its young population.
Years of complacency by the government, with a lack of immunisation programmes and health education takes a devastating toll on the people of Samoa, forcing Samoa’s Director General of Health Leausa Take Naseri to admit his ministry’s failure.
“I think we’ve been very complacent,” he told 1 NEWS Pacific Correspondent Barbara Dreaver back in November.
“It’s our fault [the government] for failing to convince them to immunise.”
That failure would claim the lives of the most vulnerable in the weeks that followed that interview.
Two mothers cling to their children, sobbing, not wanting to let their babies go. A church congregation sits at the back of the room singing, hoping to comfort the distraught family grieving the death of two young lives.
Only one-year-old and six-months-old, the two cousins were unable to fight off the vicious virus which attacked their young bodies.
The devastation of losing young lives and scenes of grief would be replayed countless times in countless homes across Samoa as more and more families said goodbye to their children lost, at the hands of measles.
For one little cancer survivor contracting measles at the hospital was a death sentence. With compromised immunity the 10-year-old didn’t have the resources to fight the disease.
Stories of young children dying or contracting measles at hospital creates panic for parents already too afraid to seek help from medical professionals.
To ease the suffering of their young ones, parents turn to traditional healers to treat their children.
For generations, long before western medicine reached the shores of Samoa, traditional healers have treated the ill.
They are so respected in Samoa that hospitals allow those with certification from the government into hospitals.
Despite the deep respect, concerns about people turning to traditional healers over doctors begins to worry officials trying to tackle the disease.
“I would never encourage them to take them to a traditional healer and give them medications … we don’t know what dose it is, we don’t know what ingredient it is, and it may compromise the child’s immune system,” Health Minister Dr Naseri told 1 NEWS.
The fear of reaching out for help has been taken advantage of during the health crisis.
Edwin Tamasese hits send on a social media post. It reads: “I’ll be here to mop up your mess, enjoy your killing spree.”
That one line sends police to Tamasese’s home where he’s charged under new emergency laws and taken to prison.
For one week, Tamasese sits in prison, unable to administer vitamins provided by international anti-vax groups to measles patients, in place of life-saving antibiotics.
On being released from prison, Tamasese has to hand in his travel documents and is ordered by a judge not to post anything to social media.
For now, he’s silenced.
Tamasese was just one part of an anti-vaccination movement that spreads its message through social media, warning families not to vaccinate or treat their children with antibiotics.
As the death toll rises and the disease spreads the Samoan government plans to legislate for compulsory vaccination and is taking no chances with local or foreign anti-vaxxers.
“Whoever wants to delay vaccination and treatment, the law will be on them. And you can see there are anti-vax people already arrested so everyone else, if you come in the country and you do the same thing and then we are on you, the law is on you,” Communications Minister Afamasaga Rico Tupai said.
Down a deserted street in Apia, a red flag hangs outside every house. Families inside wait for medical teams to come, hoping they will be given the MMR vaccine.
In a state of emergency, the only option the Samoa government feels it has left to stem the tide of a growing health crisis is to shut down the government for two days to vaccine as many people as possible.
From 7am till 5pm the people of Samoa are not allowed to open for business and drive on the roads.
Obeying government orders to place a red flag outside their home indicating that those living there are not vaccinated, they sit and wait.
As dawn breaks on December 5, day one of the shut-down, medical teams from around the world gather at a hospital in Apia and pick up their supplies.
Carrying large plastic containers with the MMR vaccine inside, they jump into vans and make their way across Samoa.
Loud speakers and police sirens announce the arrival of medical teams as they drive through empty village streets.
A monumental 48 hours has begun.
Over the next two days 102 teams made up of international and local medical volunteers vaccinate over 30,000 people taking the total of those vaccinated to 93 per cent.
Those who couldn’t be vaccinated over the two-day campaign have been noted and will be followed up by Samoa’s Ministry of Health.
As December 6 draws to an end the mass vaccination campaign is lauded a success.
But the worry is far from over for the families of those with sick children, with even more dying during the government shutdown.
Nearly five weeks after a state of emergency was called in Samoa to tackle the measles epidemic an extension of the state of emergency until December 29 has been announced.
The extended state of emergency will mean children under 14 cannot be at public gatherings. All children under 14 will also require proof of immunisation to travel between islands.
Since the outbreak started, over 5000 cases of measles have been diagnosed. More than 70, mainly children, have died.
Teams from Israel, Norway, US, UK, Australia and New Zealand continue to supply medical personnel to Samoa.
The hospital system continues to be working far beyond its capacity with staff working around the clock in overflowing wards and makeshift tents treating critically ill children.
Money from around the world including $1 million from New Zealand is put into a joint UNICEF and WHO fund to help with further outbreaks.
For the Samoan government, the crisis has prompted a massive rethink on how they will reach and educate families about immunising their children, preventing another devasting outbreak.
This sees a return to traditional ways with chiefs and women’s groups becoming more involved in health education and nurse visits to remote areas.
But the impact of the devastating outbreak will remain with a generation of Samoan families as a large majority of the population have lost or know of families who have lost a loved one.
The death toll is 70, but with many deaths going unreported there are fears the number could be much higher.
As a new year and decade looms more coffins are being sent to Samoa from New Zealand as families bury their young. The battle has not yet been won.