Did Mr. Kennedy have a role in the measles outbreak in Samoa?

No. Firstly, MMR refusal across Samoa was well under way in 2017 when rates were at 67% for one-year-old children, and went into overdrive in July 2018 when two infants died within minutes of being administered the MMR vaccine, at which point the Samoan government paused the MMR program for nearly a year. [47][48] Mr. Kennedy did not travel to Samoa to attend the 57th Independence Celebrations until the summer of 2019, just a few months before the measles outbreak.

Compounding matters for the worse, recent studies reveal that Samoan children are malnourished, which was a suspected contributing factor to the outbreak’s 1.45% case fatality rate. [49] Researchers found that Samoan children are deficient in calcium, potassium, and vitamins A and E. [50]

Historically, mothers who acquired natural measles in childhood went on to confer excellent passive immunity to their babies, which protected those babies from measles infection until they were young adolescents. This is not the case for vaccinated mothers. The unforeseen consequence of vaccinating the globe for measles is that infants are no longer born with passive measles immunity, as immunity cannot be passed on by a vaccinated mother who lacks naturally-acquired antibodies. In 60 years of measles vaccination, infants under 12 months have shifted from being the most protected demographic to being the most at risk. This fact may also help to explain the very high mortality in Samoan infants.

In addition, vaccination sites are often not sanitized against infectious disease, turning vaccine clinics into infection-spreading hot spots, rapidly accelerating infection rates. Jose Hagan, Immunization Specialist for the World Health Organization (WHO), suspected this paradoxical outcome was the case in Samoa. "This is a feature of almost every outbreak I've ever been a part of," he told The Guardian in December 2019. [51]

Lastly, while the D8 measles strain was present in the outbreak, we do not know if D8 was the only strain, or if vaccine strain measles also played a role. [52] Regardless, according to pediatrician and vaccinologist Dr. Stanley Plotkin, the D8 strain is "not as well neutralized by antibodies to the vaccine genotype." [53] In other words, it was not unexpected that the D8 strain that was circulating in the fall of 2019 could cause an outbreak in even highly vaccinated populations because researchers already knew that the vaccine is not as effective against D8.

While we may never have all of the information regarding the Samoa tragedy, here is a brief timeline of the weeks leading up to the 2019 measles outbreak: 

  • On September 3, 2019, Samoa's Director of the Ministry of Health reported there was no measles outbreak on the island. The average incubation period for measles is 10-14 days. [55]

  • Beginning Oct 1, 2019, vaccines were delivered to Samoa to begin the mass vaccination drive–vaccinating children with MMR for the first time since the government paused the program in 2018. [56] The measles outbreak was declared 15 days later, on Oct 16, 2019. [57]

  • According to the first two Ministry of Health press releases, there were 8 confirmed measles cases in the first week. The first press release stated that of the 28 suspected cases, results for 12 were received, and of those 12, only 5 people were positive for measles. [58] A second set of 8 results revealed only 3 were positive for measles. [59] This is a negative rate for suspected measles cases of 58% and 63%, respectively. Subsequently, the Ministry of Health stopped reporting negative test results.

  • While it is standard WHO protocol to administer high dose vitamin A to vulnerable populations during measles outbreaks, vitamin A supplementation didn’t arrive in Samoa until mid-November, when the outbreak was peaking. [60]

The Samoan Ministry of Health never shared any specific information about the vaccination status of the people who tested positive for measles, so we do not have numbers for those who were twice-vaccinated, once-vaccinated, or never-vaccinated. While there were 601 measles cases in kids and teens aged 10-19, there were 724 cases in the 20-29 age group. [61] This surprising spread of infection through the adult community points to the likelihood that waning vaccine efficacy played a role in the outbreak. Many of those who were twice-vaccinated as infants and children experienced vaccine failure.

[47] https://www.biointeractive.org/sites/default/files/media/file/2023-06/ModelVaccinationMeasles-StudentHO-act.pdf
[48] https://www.cnn.com/2018/07/10/health/samoa-mmr-baby-deaths-intl/index.html
[49] https://pubmed.ncbi.nlm.nih.gov/37166449/
[50] https://pubmed.ncbi.nlm.nih.gov/29877157/
[51] https://www.theguardian.com/world/2019/dec/18/these-babies-should-not-have-died-how-the-measles-outbreak-took-hold-in-samoa
[52] https://reliefweb.int/report/samoa/national-measles-response-and-recovery-appeal-6-december-2019
[53] https://academic.oup.com/jid/article/221/10/1571/5610905?login=false
[54] https://www.rnz.co.nz/international/pacific-news/398066/no-measles-outbreak-in-samoa-says-health-chief
[56] https://www.unicef.org/press-releases/unicef-delivers-over-260000-vaccines-and-medical-supplies-fight-measles-outbreaks
[57] https://crisis24.garda.com/alerts/2019/10/samoa-nationwide-measles-epidemic-declared-october-16
[58] https://reliefweb.int/report/samoa/ministry-health-press-release-1-measles-epidemic
[59] https://reliefweb.int/report/samoa/ministry-health-press-release-2-measles-epidemic
[60] https://www.samoaobserver.ws/category/samoa/52796
[61] https://reliefweb.int/report/samoa/national-emergency-operation-centre-update-measles-outbreak-press-release-23-december-9

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