2019 Samoa measles outbreak
The 2019 Samoa measles outbreak began in September 2019. As of 6 January 2020, there were over 5,700 cases of measles and 83 deaths, out of a Samoan population of 200,874. Over three per cent of the population were infected. The cause of the outbreak was attributed to decreased vaccination rates, from 74% in 2017 to 31–34% in 2018, even though nearby islands had rates near 99%. A state of emergency was declared on 17 November, ordering the closure of all schools, keeping children under 17 away from public events, and vaccination became mandatory. On 2 December 2019, the government imposed a curfew and cancelled all Christmas celebrations and public gatherings. Families seeking MMR vaccination were asked by the government to display an item of red cloth in front of their homes so as to alert mobile medical teams traveling the island during the lockdown. Some added messages like "Help!" or "I want to live!". On 5 and 6 December, the government shut down everything to bring civil servants over to the vaccination campaign. This curfew was lifted on 7 December when the government estimated that the vaccination program had reached 90% of the population. On 14 December, the state of emergency was extended to 29 December. Samoan anti-vaccination activist Edwin Tamasese was arrested and charged with "incitement against a government order". Finally, as of 22 December 2019, an estimated 94% of the eligible population had been vaccinated. Background Measles first arrived in Samoa in 1893, carried by a steamer from New Zealand. By the end of 1893, over 1,000 people (of a total population of 34,500 at that time) had died from the disease. In the early part of 2019, measles has been spreading throughout the Pacific region, with outbreaks in Tonga, Fiji, the Philippines and New Zealand. In March 2019, the WHO and UN children's agency UNICEF warned the Pacific to take proactive measures and improve immunisation rates. 2019 outbreak In August 2019, an infected passenger on one of the more than 8,000 annual flights between New Zealand and Samoa probably brought the disease from Auckland to Upolu. A full outbreak began in October 2019 and continued for the next four months. As of 22 December, there were 79 deaths (0.4 per 1,000, based on a population of 200,874, a rate of 14.3 deaths per 1000 infected) and 5,520 cases (2.75% of the population) of measles in Samoa. 61 out of the first 70 deaths were aged four and under and all but seven were aged under 15. At least 20% of babies aged six to 11 months have contracted measles, and one in 150 babies have died. As of 20 December 2019, 94% of the population had been vaccinated. 95% is required to acquire herd immunity for measles. Measles is much more contagious compared to other infectious diseases such as polio, which only requires an 80% vaccination rate for the population to attain herd immunity. Vaccine hesitancy The outbreak has been attributed to a sharp drop in