As Samoa struggles to get a grip on a lethal measles outbreak already claiming 42 lives, New Zealand experts predict the worst is yet to come. Health reporter Emma Russell explains.
More than 70 people - including toddlers and babies - are expected to die in Samoa's escalating measles epidemic, health experts predict.
In the next three weeks, it's likely 6500 people will be infected by the highly contagious disease - 3 per cent of the country's population.
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Scientists at the University of Auckland's Department of Engineering Science and Auckland Bioengineering Institute calculated the expected death trajectory, based on the number of reported cases and percentage of population currently immunised against the disease.
Immunologist and vaccine specialist Dr Helen Petousis-Harris said this was "absolutely devastating" and highlighted just how important it was for people in Samoa get vaccinated as soon as possible.
Auckland doctor Scott Wilson, who has been leading a medical team in Samoa for the last 10 days, told the Herald children were collapsing as soon as they walked through the hospital doors and required immediate resuscitation.
"We are seeing children literally deteriorating in a matter of hours. You'll see them, then go see another patient and come back and they are worse.
"You are watching the progression of the disease and it is just terrifying," Wilson said.
At least 3149 people have been infected with the deadly disease, as of yesterday afternoon.
In the last week the death toll has more than doubled from 20 people confirmed dead last Friday to 42 yesterday.
Of that, 38 have been children under the age of four - six were younger than five months old, 12 were between the age of six to 11 months and 20 were aged one to four years old.
The deadly disease has also taken the lives of three people between the age of 10 and 20, and one person in their 30s, figures released by the Government of Samoa showed.
Father-of-five Tu'ivale Luamanuvae buried his third child this week in the village of Lauli'i. He lost his one-year-old twins and two-year-old son after they all were infected with measles.
In the village of Toamua, another family lost their three-year-old boy who died from measles at the national hospital.
Official reports showed the deadly disease started appearing in Samoa, after arriving from New Zealand, in late August. On November 15 the Samoan Government declared a state of emergency. Five days later a mass vaccination began - and since then more than 45,000 people have been immunised.
Petousis-Harris said the outbreak couldn't have started with just one infected person arriving in Samoa, it would have had to have been a cluster of infected of people.
"The response has sadly been extremely delayed and for reasons unknown."
She said countries like Tonga and America had also seen measles being imported but it had not resulted in an outbreak because they had much higher vaccination rates and they moved quickly.
"As soon as cases appeared people were put into isolation and that's just a text book response but that didn't happen in Samoa and we don't know why."
Petousis-Harris said a distrust in the Samoan health system was one of the reasons the country had such a low vaccination rate.
The two toddlers, Lannacallystah Samuelu and Lameko Si'u, who died shortly after receiving MMR vaccinations in August last year likely escalated fear among the public about getting immunised, Petousis-Harris said.
She said after the toddler deaths the vaccination programme was halted in Samoa while an investigation into the deaths took place.
Though the findings were concluded within a matter of days and showed the MMR vaccine powder had been mixed with expired muscle relaxant anaesthetic instead of water, that information was not released to the public for several months.
"This meant there was a long delay before the vaccination programme started up again and fear around vaccinations quickly spread among the public," Petousis-Harris said.
She said in New Zealand muscle relaxant anaesthetic wouldn't even be in the same room as the MMR vaccine because it was far too dangerous.
Now, Dr Wilson said nearly every Samoan family was seeing the dreadful outcome of not being vaccinated and attitudes were starting to shift.
"People are coming into hospital wanting the vaccine which is really fantastic to see because we are trying to educate.
"They'll come in wanting the vaccine and then they actually have early signs of the disease - and they are really passionate about protecting their children," Wilson said.
On a more positive note, he has seen hundreds and hundreds of patients pumping through the facility who are doing well.
"We are walking into them at the supermarket and seeing them come back with their siblings and they are doing so much better."
The message Wilson wanted to share with New Zealanders was to be supportive of the vaccination programme.
"If you have relatives who aren't vaccinated encourage them to vaccinate, it is so successful and if people get it early it saves unnecessarily suffering."
"Also try to stay positive, send prayers and love because this isn't something that's going end soon - it will continue for some time yet."
Yesterday, Foreign Minister Winston Peters announced further support will be sent to Samoa to help control the outbreak.
This will include a third rotation of New Zealand's emergency medical assistance team (NZMAT), further nurse vaccinators, intensive care (ICU) specialists and Samoan-speaking medical professionals.
Peter said Samoan health workers had been grappling with the outbreak for a number of weeks.
"New Zealand is also looking to provide psychological support for health workers in Samoa, who have been confronted with some distressing cases in very demanding conditions, and communities that have been affected by the health crisis.
"This is a very difficult time for Samoa, and our sympathies are with everyone affected," Mr Peters said.
The spread of measles to Samoa:
August-September, 2019 - New Zealand's measles outbreak peaks.
August - Reports of measles in Samoa.
November 15 - Samoan Government declares a state of emergency for the measles outbreak.
November 20 - Mass vaccination launched - since then more than 45,000 people have been immunised.
November 29 - A total of 3149 measles cases reported, 42 resulting in death.