Samoa is moving steadily toward achieving its vaccination coverage goal of 95-100% of the eligible population by 30 November 2021. As at 28 September 2021, 94.4% of its eligible population received their first dose and 52.4%their second dose. Samoa’s two-day national lockdown on 23 and 24 September gave a huge boost to these numbers, adding 12% to the number of first dose vaccinations and 10% to persons now fully vaccinated.
Achieving this milestone was important for many reasons. Samoans who received their first dose of vaccine during the lockdown can receive their second dose eight weeks later nearing the end of November 2021, when some of the vaccines in stock will expire. The Ministry of Health (MOH) is determined that these precious resources, so generously donated through the COVAX Facility, co-led by CEPI, Gavi the Vaccines Alliance and WHO, alongside key delivery partner UNICEF and the Governments of Australia and Japan, will not be wasted.
COVID-19 poses a serious risk to Samoans, given high rates of noncommunicable diseases (NCDs), which account for approximately 68% of premature deaths, and high costs to the health system. Samoa also has its eyes on the Delta variant of the coronavirus (SARS-CoV-2), which is currently spreading in some Pacific island countries. The Delta variant is twice as transmissible as the original strain of COVID-19 and affects even healthy and younger persons. As well, the ravages of the 1918 influenza are at the forefront of the minds of the Samoan government and people. In addition to key COVID-19 prevention and vaccination messaging, the reminder about this period in its history, which it is working hard to prevent from recurring, forms a key part of MOH’s discourse with the public. An estimated 90% of Samoans were infected by influenza and unable to work, and endured food shortages and starvation, while about 8,500 people, or 25% of its population, died, accounting for the greatest proportional mortality of any country or territory in the world. When the dust settled, many children were orphaned and the elderly lacked care as their caregivers had succumbed to influenza. Mindful of this history, stringent border and other control measures continue that have kept approximately 200,000 Samoans free of COVID-19 to date.
The lockdown, therefore, saw a ‘whole of country’ effort to increase vaccine coverage of Samoans who are at-risk for COVID-19. The effort was reminiscent of the two-day 2019 vaccination campaign lockdown to address the measles outbreak that was supported by 518 external emergency medical team members.
Having grown from the experience with measles, the MOH was able to mount the two-day COVID-19 vaccination campaign, which was delivered by 154 local teams comprised of a minimum of five members including two vaccinators, one data collection officer, and an accompanying police officer and driver. This amounted to more than 770 persons teaming up to vaccinate almost 22,0000 persons in 20 hours over a two-day period. The pay-out was worth it as this effort increased the overall number of vaccinated persons by 12 and 10% for first dose and second dose of the COVID-19 vaccine respectively.
Scores of other leaders supported the vaccination effort including government ministers, chief executive officers and assistant chief executive officers from various ministries, NGOs, village mayors, matais (chiefs) and women’s committees, church leaders and personnel from the World Health Organization (WHO), UNICEF and United Nations Development Programme (UNDP). They visited vaccination sites, communities, community and residential fales (homes and meeting venues) and halls, and district hospitals to encourage members of the public to get vaccinated. United in the Fa’a Samoa Spirit (the Samoan way) everyone used their resources and influence to plan and implement the lockdown. In the weeks prior to and during the lockdown, mayors, matais (chiefs) and women’s committees advocated with villagers to get vaccinated and checked the vaccination rates in their villages. In some villages fines were levied for not following village leadership directives to get vaccinated. On the vaccination days, ministries, police, fire and port health authorities used their vehicles to either bring persons to the central village fale (building for village meetings) to get vaccinated or bring vaccinators to the homes where red flags indicated requests for vaccination.
Samoa is not untouched by the infodemic that has accompanied the COVID-19 pandemic. Misinformation continues to pose challenges to the Ministry of Health’s efforts to close the gap to vaccinate approximately 7,330 of its eligible population with their first dose and 60,260 with their second dose by the end of November 2021. Media reports and social media monitoring conducted and reports from the field during the lockdown revealed that vaccine hesitancy is rooted in fear of dying from vaccination, misinformation about vaccine effectiveness and purported alternative remedies, religious beliefs, misperceptions and lack of understanding of rights and responsibility, and fear of complications such as blood-clots from the vaccine. However, there were reports of others being motivated to get vaccinated, even if delayed, including at the urging of family members overseas and at the prospect of being able to travel once the borders were reopened. While the lockdown was successful and received wide media coverage, the noticeable social and economic costs of the COVID-19 pandemic, including domestic violence, disruption and loss of income to self-employed persons and business, were also highlighted.
The Ministry of Health continues to strategize to close the gap to achieve its 95-100% full vaccination coverage goal by 30 November 2021 even as it is simultaneously rolling-out a number of new vaccines and planning a vaccination campaign for its 12–17-year-olds. Immediate key next steps include a rapid coverage assessment and analysis of the more than 1500 hotline calls received, and numerous social media posts and media monitoring reports amassed during the lock down to inform strategies to reach the unvaccinated.
Dr Baoping Yang, Officer-in-Charge, WHO Samoa Country Office visited communities, vaccination sites and supported the vaccination effort in general on both days of the lockdown with MOH teams and other government officials. He is very pleased with the increased vaccination coverage.
“The WHO stands with the government and people of Samoa and calls on everyone who is eligible to get vaccinated as soon as it is their turn,” he stated.
“I’d like to encourage everyone to get the facts on the vaccine to overcome concerns and misinformation and continue to “Do it all’: cover your coughs and sneezes; clean your hands regularly; avoid crowds, closed spaces, close contacts; and mask-up and get vaccinated”.
All Photos courtesy the Ministry of Health
Home vaccination visit appreciated. Foreground: Wheelchair-user resident vaccinated at home. Background: Vaccination team members consisting of two nurse vaccinators, data collection officer, police and driver.
Red flag in yard indicating residence where vaccination is welcomed.
Villagers waiting to be vaccinated at central fale in village.
Vaccinators assembled early morning awaiting instructions and preparing to go to the field.
WHO staff member supporting the MOH data entry teams to update vaccination statistics on the Tupaia IT system.
WHO and MOH partnering during lockdown. Dr Baoping (Officer-in-Charge, WHO Samoa ) and Leausa Dr Take Neseri (Director General, MOH, Samoa) discussing the vaccination roll-out on their way to the field.
WHO supporting the vaccination process, assisting with data collection, during the national two-day vaccination lockdown.