The year 2019 saw a totally preventable disease claim the lives of more than 140,000 people, mostly children and babies. It happened as unvaccinated children created a pathway for measles outbreaks globally. Some of the outbreaks are still continuing.
Samoan Emite Talaalevea lost her daughter. She says she never expected to see such grief.
"I was shocked, it was very hard to me to accept what happened,” she said.
Measles claimed the lives of some 81 people on the island, mostly children and infants. Robert Linkins, an expert on measles in the Global Immunization Division at the Centers for Disease Control and Prevention, said the deaths were completely preventable.
"Two shots of a vaccine could have saved those children's lives."
The vaccination rate in Samoa dropped to about 30% after two children died from a measles vaccine that was mistakenly mixed with a muscle relaxant. People wrongly attributed the deaths to the vaccine, stopped vaccinating their children, then measles exploded on the island.
Samoa has a population of 200,000. Some 5,600 people caught the virus. Linkins said because measles is so highly infectious, the disease spread rapidly.
"The hospitals and health clinics were overrun with very sick children, and there weren't enough health care workers and hospital beds to adequately deliver the services that they needed," Linkins said.
Medical teams went door-to-door with the vaccine. The goal was to get 95% of the population vaccinated. The Samoan government, Linkins said, turned to the CDC for help in stemming the epidemic.
"[The] CDC also was asked to do training of health care workers to ensure safe vaccine delivery, as well as to monitor the quality of the immunization campaign that took place," Linkins said.
In 2019, more 400,000 cases of measles were reported globally, with an additional 250,000 cases in the Democratic Republic of Congo alone, according to UNICEF.
In the first three months of 2019, the number of measles cases tripled over the same period of 2018. Dr. Kate O'Brien, an immunization expert with the World Health Organization, cites many reasons children are not getting vaccinated.
"The main reason for failure to vaccinate against measles is families, communities are not having access to the vaccine," O’Brien said.
Conflict and poor health systems in low income countries prevent families from vaccinating their children. But in rich countries, some parents are opting out of immunizations. The United States tops the list with 2.5 million children missing their first dose of the measles vaccine. Two doses are essential for immunization.
The CDC reported more than 1,200 cases of measles in 31 U.S. states by late December, the highest number in 25 years. Dr. Peter Hotez, a vaccinologist at Baylor College of Medicine in Texas, says the numbers are alarming.
"In the United States now, measles epidemics are becoming the new normal in this country, after we eliminated measles in 2000," Hotez said.
In 2019, four European countries — Britain, Albania, the Czech Republic and Greece — lost their measles eradication status, meaning measles is now considered endemic in these countries.
"In other words, we're backsliding," said Kate O'Brien with the WHO.
Samoa ended its state of emergency over its measles outbreak just days before 2019 ended. But the resurgence of measles is still a global health problem. Some parents are complacent about the vaccine. Others have come to fear it more than the deadly virus itself. Unless this changes, experts say, there will be more deaths, and more outbreaks in 2020.