Outbreaks always present a problem for the antivaccine movement. After all, besides the misinformation that vaccines cause autism, autoimmune diseases, sudden infant death syndrome, and other complications that they don’t, the other key claims of the antivaccine movement include claims that herd immunity isn’t real, that vaccines don’t work, and that diseases were wiped out more by better sanitation and nutrition than by the vaccine. So when the vaccine uptake in a population falls well below herd immunity and, predictably, an outbreak results, antivaxxers like Sherri Tenpenny twist themselves in knots trying to deflect blame from themselves for the fear mongering that drives down vaccine uptake and to blame something—anything!—else for the outbreak. We are seeing just such a dynamic at work now regarding the measles outbreak in Samoa, which has already claimed 70 lives, ten more than the last time I wrote about this last week and the vast majority of them children under 4:

The good news is that Samoa has now vaccinated 91% of its population with the first dose of MMR.

I mentioned Tenpenny because the other day she posted an article on an antivaccine website entitled The Real Crisis in Samoa, which is a perfect illustration of just what I’m talking about. Basically, she’s trumpeting what has become an antivaccine talking point about the cause of the Samoa measles outbreak. Hilariously, since I first saw this article the other day, she’s added an correction in which she notes that in the first version of her article she had mistakenly stated that the outbreak was occurring in American Samoa, a territory of the United States, rather than in Samoa, an independent nation. I also can’t help but mock how she’s used the alphabet soup of her titles after her name to give herself an air of authority: ” Dr. Sherri Tenpenny, DO AOBNMM, ABIHM.” First, people who use both “Dr.” and “MD” or “DO” are begging to be mocked for their pretension, and mock them I will. Also, “ABIHM” denotes the American Board of Integrative and Holistic Medicine, a board certification by a “board” that basically no one outside of woo world recognizes. AOBNMM stands for American Osteopathic Board of Neuromusculoskeletal Medicine and denotes certification by that board for someone who has completed training in osteopathic manipulation. Basically, although I frequently point out that in the US DOs and MDs are generally equivalent and that the vast majority of DOs train in standard residencies, osteopathic manipulation is a throwback that all DOs learn during osteopathic medical school that is similar to chiropractic. The vast majority of DOs in the US don’t do it and soon forget it after they graduate from osteopathic medical school. That Tenpenny went above and beyond the basics taught in school tells you a lot about her.

Naturally, she begins with a conspiracy theory:

The speed at which the pro-vaccine forces are working to stomp out freedom of speech, freedom to learn, and freedom of choice is simply staggering. Hijacking the mainstream media and censoring all social media platforms to take complete control of the message shows how far they are willing to go to censure information not in lockstep with the Healthy People 2020 agenda. The plan is to vaccinate everyone, with few exceptions, and to eliminate even the difficult to obtain medical exemptions.

This is a frequent antivaccine claim, first that their speech is being unjustly “suppressed” and, second, that advocates for vaccines are so fanatical that we don’t recognize even medical exemptions to vaccine mandates and, fascist-like, want to force everyone to receive every vaccine. It’s a caricature and a lie, of course. No one—and I mean no one—proposes eliminating medical exemptions to vaccine mandates, as that would be bad for patients. The real story is that antivaccine activists like Tenpenny believe in “medical exemptions” not supported by science because science shows that the conditions cited by antivaxers do not increase the risk of adverse events from vaccination. I’m referring to family histories of autism, autoimmune diseases, and the like, all of which are frequently cited by antivaccine physicians like Sherri Tenpenny as “medical exemptions” to vaccine requirements. They’re not. Contraindications to vaccination are much, much fewer and more specific than antivaxers imagine, and these contraindications will still be accepted as justification for a medical exemption to vaccination. If your child is immunosuppressed, for instance, no one is proposing forcing your child to receive a live virus vaccine. No one. That’s still a hard and fast contraindication to vaccination.

Next up, Tenpenny lists a timeline starting with the deaths of two infants due to a screwup mixing up the MMR vaccine. Tenpenny puts it this way:

July 2018: Two infants died immediately after receiving the MMR vaccine Instead of examining the faulty vaccine or seeking to understand why the babies died, two nurses were blamed and charged with manslaughter

They were later sentenced to five years in jail for negligently preparing the vaccines, using a muscle relaxant instead of water to reconstitute the shots

After the incident, WHO and UNICEF estimated the Samoan vaccination rate for measles and overall immunization coverage fell from 74% to 31%

Funny, first she claims that Samoa didn’t bother to examine the vaccines that killed the two infants and instead just “blamed” the two nurses and charged them with manslaughter; then she cites the results of the investigation finding that the nurses had been criminally negligent for mixing the vaccines up with a vial of muscle relaxant instead of saline. I discussed this tragedy last week, and a details can be found in this timeline and news report of the trial of the two nurses. It’s also rather odd that, for apparently not investigating, the Samoan government suspended MMR vaccination for nine months after the incident. Why would it do that if it was absolutely certain that the vaccine was fine?

In any case, the rest of Tenpenny’s claim is based on a quote that’s gone viral on antivaccine social media. Here’s an example:

And here’s how Tenpenny put it:

June 2019: Robert Kennedy Jr. and Taylor Winterstein, the wife of an Australian rugby player, met in Samoa, just months before the outbreak begins

Robert Kennedy Jr. and Taylor Winterstein, the wife of an Australian rugby player, met in Samoa, just months before the outbreak begins by Oct 1: UNICEF had delivered 115,500 doses of measles vaccines and diluents

UNICEF had delivered 115,500 doses of measles vaccines and diluents Mid-Oct: First child reported to have died from measles

First child reported to have died from measles Nov 15: The Government of Samoa officially declares a state of emergency over measles

The Government of Samoa officially declares a state of emergency over measles Nov 26: A national Measles Vaccination Campaign begins, using mobile outreach vaccination teams and special vaccine booths

A national Measles Vaccination Campaign begins, using mobile outreach vaccination teams and special vaccine booths Nov 30: An additional 100,000 doses of MMR shipped from New Zealand.

An additional 100,000 doses of MMR shipped from New Zealand. Dec 1: Facilitated via social media, 200 packages of vitamins, probiotics, and superfoods are sent to Samoa. Individuals given “alternative” treatment of vitamin C and vitamin A recover.

Facilitated via social media, 200 packages of vitamins, probiotics, and superfoods are sent to Samoa. Individuals given “alternative” treatment of vitamin C and vitamin A recover. Dec 5-6: Door-to-Door vaccination begins. Every man, woman, and child was ordered to receive an MMR vaccination, regardless of previous infection or vaccination status. Only the police and mobile vaccination teams were allowed on public roads.

Door-to-Door vaccination begins. Every man, woman, and child was ordered to receive an MMR vaccination, regardless of previous infection or vaccination status. Only the police and mobile vaccination teams were allowed on public roads. Dec 5: The UN calls for more social media censorship to “protect the public.”

And:

According to ReliefWeb, UNICEF delivered a total of 115,500 doses of measles vaccines to Samoa since October 1, including the required diluent, syringes and safety boxes, as well as sufficient supplies of Vitamin A. Vaccinations started, with the first death from measles occurs on October 15. Within a month, hundreds of cases of measles were reported and the government declared an emergency on November 15, leading to mass vaccination of everyone, irrespective of age, vaccination status or previous recovery. And then, the government requested USD$10.7M from the UN to prevent “future outbreaks.”

You see the implied message: The measles outbreak started after the delivery of 115,500 doses of measles vaccine to Samoa. Although Tenpenny doesn’t come right out and say it, other antivaxxers (like the one on Twitter) are claiming that the measles vaccine is the cause of the outbreak. Of course, note that the UNICEF report dated November 28 stated that it had delivered 115,500 doses of MMR, along with stocks of vitamin A, to Samoa since October 1, not on October 1, as some antivaxxers are interpreting it.

In reality, the outbreak must have started sometime in September, as Dr. Vincent Iannelli explains:

On October 9, we got the first report of a measles case in Samoa and that it was related to a someone who visited from New Zealand for a conference at the end of August. But by the time of that first report, at least 86 people had already been tested for suspected measles! With that many cases already, it should be obvious that the measles outbreak in Samoa started in late September. That explains why UNICEF had begun to send measles vaccines and vitamin A to Samoa in early October.

None of this stops Tenpenny from JAQing off:

Now that everyone has been vaccinated, or revaccinated, including adults, another outbreak should not happen for at least the next ten or so years, right?

And why did they need 215,000 doses of measles vaccine when the entire population of the country is less than 198,000 and the population of Samoan children, aged 0 to 5 years (which would be given two doses of MMR) is only 22,555?

And why do they need all that money after-the-fact?

As Dr. Iannelli also explained, everyone not immune to measles will need two doses of measles vaccine, and Samoa didn’t approach 90% MMR coverage until this week, two months after that news report and over two months after the shipments of MMR vaccine and diluents began. As for all that money? It costs money to mount a huge vaccination program, as Samoa did.

Next come the conspiracy theories:

The book, Rules for Radicals: A Pragmatic Primer for Realistic Radicals written by Saul Alinsky, was published in 1971. The 10 rules he puts forth for ‘community activism’ have been used by many modern politicians to guide their socialist aspirations. Alinsky’s Rule #9 is “The threat is usually more terrifying than the thing itself.” Capitalizing on this rule in 2011, Obama’s chief of staff, Rahm Emanuel, expanded on this premise by saying, “First of all, what I said was, never allow a good crisis to go to waste when it’s an opportunity to do things that you had never considered, or that you didn’t think were possible.”

Could armies of vaccinators have been mobilized to innoculate an entire country over two days if were it not for instituting an overwhelming fear of measles?

That’s right. To Tenpenny, the mass vaccination program in Samoa is a socialist plot cooked up to capitalize on a measles outbreak that wasn’t caused by low vaccine uptake but by the vaccine and, of course, lack of vitamin A:

Given this information on vitamin A, was the UN lax in its global health agenda? Were Samoan children provided the twice-annual vitamin A supplement recommended by the WHO and UNICEF? Are the unvaccinated really the cause of the deaths within this outbreak, or was it the lack of vitamin A that lead to a crisis that has been capitalized on by the mainstream for the benefit of the pro-vaccine agenda? Could this travesty have been avoided by giving a pennies-a-day supplement over the last several years? Could the USD$10.7million flowing into Samoa be a form of blood money? I hope the answers to these questions – and many more – will be forthcoming over the next several months. I also hope that reports of vaccine-injured children – and adults – will not be the next epidemic arising from Samoa.

Of course, she notes that the World Health Organization reports that vitamin A improves a child’s chance of surviving by 12-24%, but the document cited makes it clear that that doesn’t just cover measles but the odds of a child living to adulthood. Let’s say, just for the sake of argument, that adequate vitamin A supplementation does decrease the risk of dying of measles by 24%. Given that it, contrary to what antivaxxers claim, vitamin A doesn’t prevent measles, that would result in roughly 17 fewer deaths and a case fatality rate still well over 1%, which is still horrific. That’s interpreting the WHO statistic as Tenpenny interpreted it (likely incorrectly) and also using the highest estimate for mortality reduction. No, “Dr.” Tenpenny, vitamin A would not have prevented the outbreak and would only have modestly decreased the number of deaths.

Tenpenny’s article is ridiculous enough, but it’s got nothing on an article by James Grundvig. In fairness, he discusses another outbreak that’s been far deadlier than the Samoa measles outbreak, namely the measles outbreak in Democratic Republic of Congo, which has killed roughly 5,000 people so far. His spin, however, is most despicable. After mentioning the deaths from a “generally mild viral infection” (No, Mr. Grundvig, measles is not a mild viral infection) and the mass vaccination program being undertaking in Congo, he continues:

This would be news if outbreaks of similar intensity occurred in first world countries, such as the United States or the European Union. But they don’t. Nor do they occur in a similar scale or severity. This means that hygiene, nutrition, refrigeration, and potable water—items many in the modern world take for granted—are the real delta between measles deaths in the Third World versus mild measles cases in the first, which come and go, and rarely result in fatalities. This has been a long-known and well-kept secret by the WHO, UNICEF, and medical institutions around the world even though it has never been discussed and certainly, it has not come forth in any scientific way.

What an ignoramus. It’s long been known that malnutrition is a major risk factor for death from measles. It isn’t a “well-kept secret,” and there’s plenty of scientific literature on the topic. Also note Grundvig’s bit of diversion, though. Measles is not spread by food. So refrigeration is irrelevant to preventing the spread of measles except in one way, namely keeping vaccines refrigerated. Potable water is critical to preventing the spread of waterborne illnesses like cholera, but less so when it comes to measles, which is spread primarily through they air by droplet. Hilariously, he cites an article by researchers from the United States Agency for International Development (USAID) that notes that the “lack of safe water, functional toilets, and handwashing facilities in healthcare settings pose significant risks to patients, healthcare workers, and surrounding communities,” adding that “those environmentalist researchers didn’t say vaccines were at the heart of disease reduction.”

Except:

Combating antimicrobial resistance requires a three-fold approach: first, improving infection prevention and control; second, conserving the effectiveness of existing and future antimicrobials; and third, engaging in research to optimize such approaches and to develop new antimicrobials, vaccines, treatment alternatives and rapid diagnostic tools (31).

Funny, but that sounds as though the researchers considered vaccines to be part of one of the three pillars of disease control to me. In any case, Grundvig repeats the antivax claim that it’s shedding from measles virus “muddying” the numbers from the outbreak, the implication that mass vaccination is accelerating the outbreak. (It’s not. Measles from measles vaccine virus shedding is incredibly rare, worthy of a case report when it happens.) Then he goes further down the rabbit hole and blames acetaminophen:

Now add a fourth dimension to the measles deaths equation: Treatment of the infection. Acetaminophen (aka Tylenol) and paracetamol are used to treat fever, but they both have side-effects. Acetaminophen side-effects include trouble passing urine, “swelling of face, throat, lips, and tongue” and “hives, severe itching, peeling or blistering skin.” In the latter three side-effects, could the skin hives, itches, and blistering from acetaminophen be mistaken for the measles?

He even includes a photo of a rash from acetaminophen and a rash to to measles. I must admit that I laughed out loud at the stupidity and ignorance of this claim, which merits three facepalms, at least.

Picard read what Grundvig wrote.

Seriously, though, it’s not too difficult to tell the difference between an allergic reaction to a medication and measles, the latter of which has a whole additional constellation of symptoms, including fever. None of this stops Grundvig from paddling even further up the river of antivaccine nonsense than Tenpenny did:

Could the bulk of the 5,000 measles deaths be a case of mistaken identity? Could one of the medications given to immune-depleted Congolese children produce measles-like infections, with the authorities checking the cause of death due to measles, and not the side-effects from the Ebola medication? This author firmly believes so.

That’s nice. There are authors who fervently believe that the world is flat, that the Holocaust is a hoax, that evolution doesn’t happen, and that ghosts exist. That doesn’t mean Mr. Grundvig’s opinion that thousands of cases of reaction to acetaminophen are being misdiagnosed as measles should be taken any more seriously than that of a flat earther on the shape of the planet. Hilarious in his scientific ignorance, Grundvig even tries to weaponize the recent finding that the measles virus produces immune amnesia, apparently conveniently forgetting that it takes a full-fledged measles infection to cause that long-lasting damage to the immune system and that it’s been shown that there are nonspecific beneficial effects of vaccinating against measles that go beyond just protecting against measles.

Antivaxxers are clearly desperate. It’s very well established that low vaccine uptake rates leave populations vulnerable to outbreaks, and it’s clear that antivaxxers are contributing to vaccine hesitancy through their fear mongering about vaccines. In Samoa, of course, we already know that Robert F. Kennedy, Jr. visited the country in June and that he wrote a letter to the Samoan Prime Minister in November in which he spouted all sorts of claims equally nonsensical to those of Grundvig and Tenpenny. We know that another high profile (in Samoa) antivaxxer was treating children with vitamins and discouraging parents from getting their children vaccinated or taking them to the hospital. So antivaxxers are throwing everything they can against the wall in terms of their bad science, pseudoscience, misinformation, and lies and seeing what sticks. That they’re now reduced to blaming acetaminophen for killing thousands of Congolese shows you just how low they’ve descended.

Finally, it is of course true that measles is much more lethal in Third World countries, where poverty and malnutrition are much more prevalent. That doesn’t mean measles is a “mild disease” here in the safety of our rich nations. Large percentages of those suffering from measles require hospitalization, and measles can still kill roughly 1-2 in a thousand due to neurologic or pulmonary. For survivors, subacute sclerosing panencephalitis (SSPE) is a horrible and fatal late complication of measles that typically manifests itself 7-10 years after infection. Antivaxxers want you to think that it’s only “those” people, mostly brown and impoverished, who die from measles, while for us wealthy white people it’s only a minor disease. They’re wrong. Poverty and malnutrition do make measles a lot worse, but it’s still not a minor disease, the contortions of logic and science antivaxxers go through to blame measles deaths in Samoa and Congo on anything but measles notwithstanding.