In 2019, only a few months before Covid-19 hit, Samoa suffered a disastrous measles epidemic. The lessons from that epidemic have shaped Samoa’s hardline response to Covid-19 and offer important insights about maintaining public trust in government vaccination programs.

The tragic consequences of the measles epidemic prepared the Samoan public to accept strict Covid-19 countermeasures, with the result that Samoa has had just a single case and no deaths.

Those measures included the speedy decision to close the country’s international borders ^[1] on 20 March. Yachts, cruise ships and fishing boats were prohibited. Cargo ships were allowed to enter to ensure the availability of food and other required goods, but only after crews were screened.

Schools were closed and church services, weddings, birthdays, chief title bestowments, village and church meetings, and swimming were banned. Opening hours for shops and restaurants were also restricted. A maximum of five people were allowed to attend funeral services or ride on public buses. Even inter-island travel was restricted. Public-sector workers with school-aged children were allowed to stay home to mind the children.

Travel to Samoa was severely restricted. Those over 60, including Samoans stranded overseas, were granted special leave with pay. People repatriated from New Zealand went into quarantine for 14 days at the expense of the Samoan government. Samoans repatriated from the US will undergo three weeks ^[2] of quarantine.

Overall, the government acted quickly and comprehensively with hard-hitting policies, which the public appeared to readily accept despite the economic consequences for the country.

The border closure, unemployment and reduced hours of work have had drastic effects on tourism, which is one of Samoa’s most important income earners. According to a July 2020 UN report ^[3], two-thirds of households reported a decline in their main income and almost half experienced the loss of at least one job due to pandemic-related restrictions. This has led to an increase in subsistence production. Fish and vegetable stalls are seen almost everywhere in the township of Apia, local chicken farms have been revived, and people are again working the land.

The speed and comprehensiveness of the government’s response to Covid-19 appears to have been significantly influenced by the consequences of its slow response ^[4] to the measles epidemic in 2019. Then, global health warnings on measles went unheeded by health officials as the epidemic was rampant in Southeast Asia and spreading to the South Pacific.

Two months elapsed between the first reported case of a measles-infected traveller to Samoa and the health ministry’s issuance of a notice ^[5] confirming measles in mid-October. On the same day, Samoa recorded its first infant death due to measles. A month later, the government declared a state of emergency ^[6] in the wake of more than 700 cases and six more deaths, mainly of unvaccinated infants under the age of two. By the time the state of emergency was lifted ^[7] at the end of December 2019, more than 5,600 Samoans had been infected and 81 were dead. The tragedy for Samoa was that much of this could have been avoided. The extent of the casualties stemmed from a national failure to vaccinate against measles.

Until 2002, Samoa had relatively high vaccination rates for measles, but for several reasons ^[4] immunisations dropped off over the following years. Parents’ mistrust of the health system, their trust in traditional healers and medicine and the influence of anti-vaxxers all contributed. The dwindling number of children vaccinated left the country seriously exposed. When the measles epidemic hit, the vaccination rate was as low as 30%.

The government’s response to the measles epidemic was seriously hampered by the death of two babies ^[8] in mid-2018 due to the negligent preparation of vaccines by nurses. That led the government to initially withdraw vaccines from use. Afterwards, there was strong public resistance to an aggressive program to roll out a measles vaccination campaign, even after the mistake by the nurses was identified and they were sentenced to jail.

In November 2019, after the measles epidemic hit, the government instituted a compulsory immunisation campaign ^[9]. Given initial shortages of vaccine and staff, the campaign was rolled out in stages, prioritising children aged six months to 19 years and non-pregnant women aged between 20 and 35. Mobile vaccination teams, supported by a 48-hour shutdown of businesses and government services, went door to door ^[10] administering vaccine to unvaccinated households, which had been asked to display red flags.

The Samoan Government has learned some sobering lessons about maintaining confidence in public health. Proactive awareness programs to encourage and educate people on the importance of public health initiatives must be continued and evaluated to ensure their effectiveness. People’s confidence in the system must be regained; otherwise, public health programs will be ignored and resources wasted.

To that end, the government has provided additional funding to village-level women’s committees ^[11] as a way of enhancing primary healthcare and awareness programs at the grassroots level. Since colonial times, local women’s committees have played an important role in promoting hygiene and preventive medicine, including during the 1918 influenza epidemic. They’re now being revived ^[12] in recognition of the importance of traditional relationships in delivering public health.

Some critical questions are now looming for Samoa. Having been criticised ^[13] for creating public doubt about the measles vaccine, will the government pursue another national immunisation program for Covid-19, and will the public accept it as a post-measles ‘lesson’?

Just how well the people of Samoa have accepted the lessons and consequences of both the measles epidemic and the Covid-19 pandemic will be tested in April 2021 when the government of Prime Minister Tuilaepa Sailele Malielegaoi goes to the polls.

This post is part of an ASPI research project on the vulnerability of Indo-Pacific island states ^[14] in the age of Covid-19 being undertaken with the support of the Embassy of Japan in Australia.