Robert F Kennedy Jr. has been nominated as the US Secretary of Health, with confirmation before the US Senate scheduled for later this week or early next week.

His views and involvement with vaccine misinformation have sparked significant responses, including from the tiny Pacific nation of Samoa. The Director-General of Health for Samoa, Aiono Professor Dr Alec Ekeroma, and Samoa’s Prime Minister Fiame Naomi Mata’afa have challenged President John F. Kennedy Jr.’s assertions regarding blood samples sent overseas during the 2019 Samoa measles epidemic. This article explains why blood samples were not required, contrary to RFK Jr.’s assertions, and provides some lessons learned from Samoa’s 2019 measles epidemic.

It is widely known that the 2019 Samoa measles epidemic began when a visitor from New Zealand brought the measles virus to Samoa. In 2013, Samoa’s measles immunisation rate peaked at 92% for the first dose and 74% for the second dose, with a population immunisation rate of at least 95% considered essential for protection against the virus, according to the World Health Organisation. By 2018, immunisation rates had plummeted to 40% and 28%, respectively, following two infant fatalities caused by human error when a muscle relaxant was mistakenly used instead of water to dilute two doses of the measles vaccine.

This incident led to suspending the national immunisation programme while an investigation was conducted. Coupled with delays, mistrust, and anti-vaccination sentiments fuelled by antivaxxers, including JF Kennedy Jr., who visited Samoa, the country’s alarmingly low immunisation rates contributed to the measles epidemic the following year.  

The Medical Team examined the characteristics and spectrum of hospitalised adult measles cases at the Tupua Tamasese Meaole (TTM) Samoa National Hospital during the 2019 measles epidemic, though this work remained unpublished. After the epidemic overwhelmed Samoa’s health system, local doctors, who were overtaxed, returned to regular duties, working to catch up on significant backlogs and publishing the report was not urgent.

The pertinent features of the TTM Hospital Medical team report on the adult measles cases hospitalised during the epidemic indicate that the diagnoses of adult measles were on clinical grounds - probable cases meeting the clinical criteria with an epidemiological link.  Blood specimens and throat and nasopharyngeal swabs were not collected for measles virus testing or serology as they would not have contributed to patient management. This indicates that no blood tests were necessary to confirm the diagnosis of measles, consistent with the Director General’s statement that contradicts JF Kennedy Jr.’s claims regarding blood samples being sent overseas during the 2019 Samoa measles outbreak and that the reason for the 83 measles fatalities was unclear.  

The report indicated that age and low herd immunity were the main risk factors contributing to the high incidence of the 2019 Samoa measles outbreak among adults. The median age of the 103 adult measles cases admitted was 24. Of the five adult measles fatalities, all but one (18 years old) were older, with a median age of 39.5. All hospitalised adult measles patients were fit and healthy before contracting measles, and most had no other health problem. Measles can be severe in unimmunised individuals, though it is generally considered a benign viral childhood illness.  The vaccination status of the hospitalised adults with measles was unknown. It was difficult to determine whether the 95%, survival rate, of the 103 patients, was because the adult measles patients suffered modified measles because they had been vaccinated against measles but had waning or amnestic immunity, or if non-immunised were young, no other health issues with a competent immune system, fit and able to survive a severe course of measles, considering the older age profile of the fatal cases.

Lessons for the Future

Enforcing optimum vaccination coverage within targets is the cornerstone of prevention. Developing countries like Samoa must combat misinformation about vaccines to prevent future epidemics and ensure that immunisation programmes remain robust.   The 2019 measles epidemic is a powerful reminder of the necessity to maintain high vaccination rates, particularly among vulnerable populations, to prevent the devastating consequences of outbreaks.  

A Wake-up Call for Us

The zeitgeist of this period is characterised by misinformation from anti-vax influencers like JF Kennedy Jr., which, if left unchallenged, can become the norm. The danger of allowing this misinformation to evolve contributes to the growing dominance of metanarratives on social media. Good clinical practice standards are based on well-researched, evidence-based scientific narratives; however, the extent to which the external environment shapes these narratives and how quickly propaganda can replace well-grounded evidence can significantly influence listeners' mindsets. Samoa depends on reputable international agencies such as WHO, UNICEF, and others for their guidance and recommendations to prevent measles and address other health issues. Samoa must remain vigilant; otherwise, conspiracy narratives could take hold in the mainstream. This situation and fluctuating vaccination coverage highlight the events surrounding the 2019 Samoa measles epidemic.  

In the future, global health agencies, governments, and communities must work together to ensure that past mistakes are not repeated.

I wish to acknowledge the medical team at TTM Hospital for their work during the 2019 measles epidemic:   Drs. Le’avai F, Chadwick N, Pouono-Va’ai K, Puipui J, Neemia T, Potoi B, Le Mamea Fiu L, A/Prof Branley J, and Ioane-Cleverley L.