Recently, the Samoa measles epidemic has been in the news, with at least 60 individuals who have died as the result of the virus (as of 4 December 2019). The vast majority of these deaths could have been prevented with the extremely safe measles vaccine.
Of course, those of us on the science side are appalled what is going on there. Children (and some adults) have died from a disease that should have been exiled to history books as a result of vaccines.
Once this Samoa measles epidemic hit the news, the vaccine deniers came out of their putrid swamps to use the epidemic as some sort of condemnation of vaccines. Their twisted logic would be the envy of pretzel manufacturers worldwide.
This article is going to review what’s going on in Samoa. And we are going to take a look at a couple of responses and lies from the usual anti-vaccine pseudoscience.
A measles primer
Measles (also called rubeola, not to be confused with rubella, or German measles) is a respiratory disease caused by the Measles morbillivirus. This virus normally grows in the cells that line the back of the throat and lungs.
The virus is spread through respiration (contact with fluids from an infected person’s nose and mouth, either directly or through aerosol transmission), and is highly contagious — 90% of people without immunity sharing living space with an infected person will catch it.
There are no specific treatments for the disease. There are no miracle preventions – except, of course, for the MMR vaccine (for measles, mumps, and rubella). And just to be clear, there is no link between the vaccine and autism – this is settled science.
The oft-repeated, and highly inaccurate, claim that vitamin A supplements can cure or prevent measles completely misses the mark. It’s important to supplement with vitamin A to prevent blindness as a result of measles, but it doesn’t reduce mortality or prevent some neurological issues unless there is chronic vitamin A deficiency.
According to the CDC, some of the many measles complications are:
- About 30% of measles cases develop one or more complications.
- Pneumonia, which is the complication that is most often the cause of death in young children.
- Ear infections occur in about 1 in 10 measles cases and permanent loss of hearing can result.
- Diarrhea is reported in about 8% of cases.
- As many as 1 out of every 20 children with measles gets pneumonia.
- About 1 child in every 1,000 who get measles will develop encephalitis, an inflammation of the brain that can lead to convulsions, deafness, and other long-term neurological deficits.
- A measles infection can result in short- and long-term immune system dysfunction which can leave the child susceptible to other diseases early in life (which is in direct opposition of claims by anti-vaccine activists that it helps “boost” the immune system).
- About 1-2 children, out of 1000 who contract measles, may develop subacute sclerosing panencephalitis (SSPE), a rare chronic, progressive encephalitis that affects primarily children and young adults– it is caused by a persistent infection of the measles virus. The disease starts with measles infection, usually before the age of 2 years, followed by approximately 6-15 asymptomatic years. Some researchers think the asymptomatic period is around 5-8 years after the initial disease. Gradually, the disease progresses with psychological and neurological deterioration, which can include personality changes, seizures, and coma. It is always ultimately fatal.
- And sadly, for every 1,000 children who get measles, 1 or 2 will die from it.
I’m not here for fear-mongering – but real science tells us that measles is a dangerous, debilitating disease that has both short and long-term consequences.
Samoa measles epidemic – a brief history
This isn’t the first time that measles has been in the news with respect to the Pacific nation of Samoa. In 2018, two Samoan children died soon after receiving the MMR vaccine, a story which, predictably, was abused by the anti-vaccine religion based on zero legitimate information.
In 2019, two Samoan nurses pleaded guilty to manslaughter and obstruction of justice charges. The children’s deaths resulted from improper reconstituting of the vaccines (the MMR vaccine is shipped in a lyophilized form and must be reconstituted with a buffer solution, called diluent).
Before the Samoan government uncovered the negligence of the two nurses, the country suspended its MMR vaccine program which I suppose was prudent, given the lack of information at the time. Unfortunately, that meant a large group of children lacked immunity to the dangerous disease, and it probably contributed to the current Samoa measles epidemic.
Unfortunately, the negligence of these two nurses was combined with a decreasing MMR vaccine uptake in the country. Dr. Vince Ianelli, in his excellent vaccine blog, Vaxopedia, wrote a detailed history of the Samoa measles epidemic. He stated that:
On October 9, we got the first report of a measles case in Samoa and that it was related to a someone who visited from New Zealand for a conference at the end of August.
Measles vaccine uptake in Samoa since 2007.
According to WHO, the vaccine uptake had dropped to below 40% prior to this epidemic. So piling on the negligent nurses, the government delay in reinstituting MMR vaccinations, and the nascent vaccine refusal in Samoa lead to this epidemic.
Since Samoa is a tiny country, with less than 200,000 people, 60 deaths is a huge number. I, on the other hand, think that even one preventable death is too large, but many anti-vaxxers seem to ignore this.
Let’s put this number in context with other countries (using the 42 measles-related deaths in Samoa as of 29 November 2019).
Using the current number of 60 deaths in Samoa, an incidence rate of 306.4 deaths per 1,000,000 individuals.
- For the USA, this would translate to 100,182 deaths.
- For Canada, 11,521 deaths.
- For the UK, 20,682 deaths.
- For Australia, 7,813 deaths.
- For Germany, 25,431 deaths.
- For Japan, 38,698 deaths.
OK, I could go on and on for every country in the world, but that would take forever.
But there’s one thing that we’re overlooking with these numbers. If we actually had an epidemic that large in the USA (or almost any other country in the world), the healthcare system would be overwhelmed. The number of ICU beds per capita in the USA has dropped by 75% since the 1960s partially as a result of the reduction in numbers of children with infectious diseases.
That’s what we call irony.
As you might expect, these numbers aren’t what we would actually expect, because…wait for it…of the high measles vaccination rate in these developed countries.
But the mortality rate is actually worse than just raw population numbers. Those 60 deaths occurred among 4,052 measles cases in the country. That’s a mortality rate of 14.8 deaths per 1,000 individuals, approximately 14 times higher than expected by the CDC.
A coconut farmer is an expert in these, but not in measles.
Samoa measles epidemic – here come the vaccine deniers
Let’s start with this Facebook post from Edwin Tamasese, a coconut farmer in Samoa. No, he is not a physician. He is not a vaccine scientist.
And Mr. Tamasese has been recently arrested by Samoan authorities for spreading false information about vaccines.
Mr. Tamasese was arrested by Police in Savaii at an unnamed Police station, following what Police say was the breach of a written warning asking him to formally cease his anti-vaccination activities.
I’m sure that the anti-vaxxers will claim that this is some conspiracy by Merck to suppress The Truth™ about the MMR vaccine. Or Paul Offit called his friends in the Samoan government and offered them free Vaccine Shill Bucks™ to arrest him.
Or maybe, the facts are that he lied about vaccines putting children at risk of death in their country. Now, if only the FBI could deal with our anti-vaccine liars – one can dream.
Anyway, back to Tamasese.
He probably knows more about coconuts than I do, but infectious diseases and public health? Nope, not even close.
Many of his points are based on anecdotes or aren’t supported by any evidence whatsoever. For example, he claims that “several documented cases of fully vaccinated cases who are catching severe measles.” How would that happen?
Of course, if the vaccine actually caused these “severe measles,” we would expect that these children would present with the measles strain A, which are in vaccines. But real science tells us that nearly all of the cases are measles strain D8, the wild version of the virus.
That’s real science, instead of the babblings of a coconut farmer.
Vitamin C has zero effect on measles – I could find no reliable, repeatable, peer-reviewed evidence that it could be used to treat measles. In fact, there were studies that showed it did not have an effect.
The coconut farmer relies upon claims of “orthomolecular medicine,” a pseudoscience that believes that high quantities of vitamins have some miracle effects on health. It’s simply quackery.
The same can be said of his vitamin A claims. There are a lot of sources of vitamin A in the typical Samoan diet, which includes a lot of fish, as one would expect for an island nation. Unfortunately, the introduction of the “Western diet,” has reduced the consumption of vitamin A, although there isn’t a severe deficiency like in African countries where there are few sources of it.
Although vitamin A does reduce the mortality rate from measles, it does not eliminate it. And it doesn’t reduce the risk of complications like SSPE. Furthermore, the World Health Organization has a strict protocol for treating individuals who have measles, and the doses are much higher than what is being pushed by this coconut farmer.
WHO recommendation for vitamin A and measles. Thanks to Vincent Iannelli at Vaxopedia.
And let’s remember another important point – it does not prevent measles.
Throwing a bunch of vitamin A supplements to the population is counterintuitive. Prevent measles, then you don’t have to rely upon treatments after the fact.
Ironically, the nearby Pacific island country of Tonga, which presumably has a similar diet as Samoa, but has a nearly 100% MMR vaccine rate. And guess what loyal readers? There is not a measles epidemic there, because the vaccine prevents measles!
One more point about our coconut farmer – he refers to Jim Meehan, MD, a serious anti-vaccine quack. Professor Dorit Rubinstein Reiss has written about Jim Meehan previously:
He has no publications indexed in PubMed and no publications are listed on his site. He has published nothing that shows he seriously engaged with the extensive literature on vaccines. That may not disqualify him from criticizing a specific scientific article, but it also does not qualify him to counter the scientific consensus of those who are familiar with the literature and do understand infectious diseases and vaccines.
In other words, he’s just another false authority to whom the anti-vaccine zealots attach themselves because they have nothing else. Nevertheless, Meehan had to pontificate about pseudoscience with regards to the Samoa measles epidemic:
Meehan is a typical pseudoscience-pushing anti-vaxxer – he takes a little bit of science and then gish gallops right to some conclusion. For example, acetaminophen does bind to glutathione, an important biochemical that gobbles up (scientific word) certain free radicals. The acetaminophen-glutathione complex is quickly excreted.
However, humans (and all animals) produce massive amounts of glutathione in every single cell. It is one of the most common thiols in cells.
Moreover, acetaminophen can be indicated for high fevers, since that is a risk factor for death from measles.
Dr. Paul Offit, writing in the first chapter, “Treating Fever Can Prolong and Worsen Illness,” in his upcoming book Overkill: When Modern Medicine Goes Too Far (to be published in April 2020),:
Fever comes with a high metabolic cost, about a 12 percent increase in basal metabolic rate per degree Centigrade. Some people, like those with chronic lung or heart disease, or those who are immune-compromised, or those who are malnourished, are less capable of paying that cost. So the physician must decide who can handle the fever and who can’t. But it is clear that reducing fever also reduces the immune response. So, as I said, it’s a balancing act.
Thus, Dr. Offit, who is despised by the anti-vaccine world, agrees that reducing fever may be detrimental to the immune response, but that’s not a broad claim. Like he said, “it’s a balancing act” meaning each case of measles should be evaluated for the proper treatment.
As opposed to Dr. Offit, Meehan and his coconut farmer pal think they know more than the World Health Organization, New Zealand and Australian public health officials, the CDC, and extremely competent physicians and scientists on the ground in Samoa dealing with this epidemic.
Meehan is firing potshots from his comfortable estate in the USA with precisely zero knowledge of vaccines and of what’s going on there. It’s almost unethical because some people in Samoa are listening to him.
Or not, since the MMR vaccine is now mandatory in the country.
And next up, Robert F. Kennedy Jr. again
RFK Jr has been a subject of numerous articles on this blog, since he continues to push falsehoods and misinformation about vaccines, despite being criticized by his own family and most real scientists.
Recently, he wrote, under the Children’s Health Defense letterhead, a letter to the Prime Minister of Samoa, Tuilaepa Aiono Sailele Malielegaoi. There are several points that RFK Jr makes that have been refuted over and over:
- He asks about the ages of the “victims,” since the MMR vaccine is generally not recommended for children until they reach the age of twelve months. This is because the vaccine provides better protection as the child’s immune system develops. However, it is not an absolute – in the case of a massive epidemic, it may be prudent to protect the child.
- He presumes that the experts from the CDC, WHO, and various other public health organizations are not intelligent enough to understand this issue. I guess RFK Jr thinks his zero education in vaccine science is so much better – yeah this kind of Dunning-Kruger level arrogance provokes all kinds of anger.
- He completely misunderstands the passive immunity provided by the mother to the infant. The antibodies (against measles presumably) are transferred from the mother to fetus during development. This gives a temporary immunity for the child against measles, but it gradually leaves over the first few months after birth. This is why the vaccine is necessary. And no, the mother’s breast milk does not send those anti-measles antibodies to the baby – antibodies, which are proteins, are just digested by the child into simple amino acids for absorption (see Note 1). Typically, an attorney like RFK Jr, who obviously has not a single minute of immunology studies, would make up this kind of nonsense.
- Based on #3, he claims that the MMR vaccine has caused a “crisis” whereby children who were once protected “naturally” against the virus are now at risk. There is just no evidence of this since he’s completely wrong about passive immunity.
- He claims that there’s a possibility that the measles strains in Samoa are not targeted by the MMR vaccine. We’ve addressed that above, and RFK Jr is wrong. The MMR vaccine protects against ALL measles strains because the vaccine has antigens that are common to all of the separate strains.
- He claims that the Samoa measles epidemic is caused by the vaccine itself. Again, real scientists have already debunked this nonsense.
- He accuses Merck (the manufacturer of the MMR vaccine) of fooling us because they claimed back in the late 1960s that only one dose would be necessary. Again, typical of pseudoscience-pushers, RFK Jr. believes that science is static. Researchers (inside and outside of Merck), discovered that one dose was about 93% effective after one dose (extraordinary), but it was 97% effective (even more extraordinary) after two doses. That’s how science works, but, like most pseudoscience lovers, believes in the Nirvana fallacy and dogma. Science relies on evidence, period, and as we get more evidence, we change what we consider is settled science.
Update – 5 December 2019
Although this article was originally written in a mocking tone because dangerous individuals like RFK Jr, Jim Meehan, and the criminal coconut farmer need to be mocked.
However, there are serious consequences from this epidemic which has killed at least 60 Samoans. On 4 December 2019, Brian Deer, who exposed Andrew Wakefield’s fraudulent claims about the MMR vaccine, reported that:
From 6am today, all public and private services, offices, and businesses, will be closed during two twelve-hour, daytime curfews, while road travel will be prohibited to all except emergency, medical-related, or essential utility traffic.
The draconian restrictions come as the administration of prime minister Tuilaepa Sailele Malielegaoi faces mounting public anger for its failure to prevent what critics say was an accident waiting to happen.
Figures reported from the World Health Organization (WHO) reveal that in the last five years, levels of vaccination against measles, mumps and rubella have collapsed in Somoa, from 90 to just 31 per cent of eligible infants.
Relatives of children who have died in the present crisis say the government must have known the likely result: a population left wide open to infection.
This is what happens when we don’t vaccinate our children.
Summary
The Samoa measles epidemic is a horrible tragedy – too many people have died because of it. And it probably arose not from a concerted anti-vaccine effort, but because of criminal negligence of two Samoan nurses.
Of course, the anti-vaccine movement had to jump into the fray by pushing fake information and completely ridiculous claims that will cause grievous harm to the children (and many adults) in Samoa. It is both frightening and frustrating.
I don’t understand why anti-vaxxers have to jump into any tragedy, whether it’s people making erroneous claims that vaccines caused the deaths of children or a whole country dealing with way too much sorrow. They have to do this because they have zero evidence supporting their religious beliefs about vaccines.
Unfortunately, the lies and pseudoscience from these people just compound the harm. I wish they would stop.
Notes
- Breastmilk, specifically the colostrum, does provide certain antibodies to the baby that protects against ingested pathogens. This is also temporary, and generally, the baby produces these antibodies themselves within a few weeks. This type of antibody has nothing to do with protection against measles.
Citations
- Jarvis WT. Food faddism, cultism, and quackery. Annu Rev Nutr. 1983;3:35-52. doi: 10.1146/annurev.nu.03.070183.000343. Review. PubMed PMID: 6315036.
- Mahalanabis D, Jana S, Shaikh S, Gupta S, Chakrabarti ML, Moitra P, Wahed MA, Khaled MA. Vitamin E and vitamin C supplementation does not improve the clinical course of measles with pneumonia in children: a controlled trial. J Trop Pediatr. 2006 Aug;52(4):302-3. doi: 10.1093/tropej/fmi100. Epub 2005 Nov 16. PubMed PMID: 16291830.
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