The Samoa Riddle

My friend and colleague John Day, MD noted in the comments that anonymous physician substacker Ah Khin Syed (“I Can Say It!”) wrote a very intriguing article about Samoa’s measles outbreak, postulating that it was actually due to a measles-coronavirus chimera that was created by Ralph Baric. What?!

I know nothing about that.

What I do know is that nobody dies of measles anymore in the US. The so-called measles outbreak that occurred in Samoa, a US territory that I once visited, whose capital is the delightfully named Pago-Pago, was bizarre. With US facilities on the island, no one should have died.

Only 3 American citizens have died with measles in the past 25 years (a teen who recently received a bone marrow transplant, an elderly male and an immunocompromised woman in her 50s who had no measles-like symptoms but was said to test positive for measles on autopsy). All were immunocompromised. Possibly one American died from measles between 1993 and 1999. Yet there have been thousands of cases of measles. As of December 19, there had been 284 cases of measles reported in the US for 2024.

Here are the US death rates and case rates for measles over time, from Our World in Data.

Since around 1993, there has been less than one death per 100 million people per year, according to this graph and according to my copy of CDC data.

The current population of American Samoa is 46,378. According to Ah Khin Syed’s table, there were 4,693 measles cases (over 10% of the population, most of whom were vaccinated) and 70 deaths (1.5% of cases, or 0.15% of the islanders). This is a very high rate of vaccine failure, and an unheard of death rate, especially where there is any medical care.

My point is that something very weird happened in Samoa, and Ah Khan Syed has an interesting theory for what that might have been. Whatever it was, it had little to do with Mr. Kennedy. Thanks to John Day, MD for the reference.