In Samoa, memory of the tragic measles outbreak in late 2019 has galvanized communities’ commitment to keep themselves safe from COVID-19, using traditional resources and a holistic approach.

In early 2020, health authorities in Samoa became aware that if the coronavirus arrived, health facilities and health workers could be overwhelmed. High rates of non-communicable diseases including cancer, diabetes and heart disease means that many people would be extremely vulnerable to the virus. It is a similar situation for several other Pacific countries and areas which, as of October 2020, had not had a single COVID-19 case: American Samoa, Cook Islands, Federated States of Micronesia, Marshall Islands, Nauru, Niue, Palau, Pitcairn Islands, Tokelau and Tuvalu.

Seeing that Samoa, a country of 195,000, needed to pull together as one, the Ministry of Health, the Ministry of Women, Community and Social Development, supported by the World Health Organization (WHO), through the Delivering as One UN initiative, developed a community engagement strategy to boost health beyond the pandemic. Key partners also included the Ministry of Agriculture and Fisheries, disability advocacy organization Nuanua O Le Alofa, suicide prevention organization Fa’ataua le Ola, the Samoa Red Cross Society, and the Adventist Development and Relief Agency International (ADRA).

WHO’s Representative for Samoa, Dr Rasul Baghirov, says the country’s holistic approach paid off. WHO supported the multi-sectoral approach to implement the strategy, trained health workers and engaged with matai (customary village leaders), district nurses already engaging with communities, and grass roots committees. Educational toolkits based on WHO messages on COVID-19 were adapted to the Samoan context and translated. They reinforced the practical steps everyone should take to keep safe, such as washing hands, covering sneezes and coughs, and physical distancing, and delivered hygiene kits.

Part of the impetus to protect the country from COVID-19 came from closely monitoring the epidemiological patterns of COVID-19 in the Pacific and the world. Samoa is still recovering from a tragic 2019 measles outbreak that claimed more than 80 mostly very young lives, as well as the loss of more than one-fifth of the population in the 1918 global influenza pandemic.

Samoa Red Cross Society Secretary General Namulau’ulu Tautala Mauala says, “The measles campaign set the scene for the COVID-19 work. It really encouraged our government and people to work together to ensure that COVID-19 doesn’t arrive to our shores. Without our experience with measles, COVID-19 might have already come to Samoa.”

Measles vaccination coverage in Samoa had fallen low but when young babies became sick and died, people took notice.

“The mass measles vaccination campaign that Red Cross was involved with was a very good thing in terms of limiting the spread. People recognised the success of vaccinations in protecting lives.”

They put their trust in science and the WHO, she says.

By December 2019, 95% of eligible people had been vaccinated against measles. Namulau’ulu Tautala Mauala hopes for a similar response to an eventual COVID-19 vaccination.

Dr. Baghirov says communities are motivated to put their new COVID-19 knowledge into action and refresh their usual hygiene promotion practices.

“When you go to a village, there will be a prayer, you will eat and be given water to wash your hands. You wash your hands after the food, not before.

“So, people are asking: what do we need to do now? When do we wash?”

Some communities face an even greater challenge. Water scarcity is a problem for people without sources of fresh water, such as on smaller islands like Apolima, or villagers whom had moved inland from coastlines following the 2009 tsunami.

WHO Health Systems Strengthening Technical Officer Dr Dyxon Hansell, who is Samoan, says the community outreach revived some old practices that are a living application of WHO guidance on hygiene in low-resource settings.

“It turns out that coconut husks – or cold ash from a fire – are excellent substitutes for soap. These are things that Samoans used traditionally to wash pots and pans. They peel off the husk to form a brush that looks almost like a steel-wool scouring pad.

“The idea is to maximise the use of local, available resources and people’s knowledge and expertise. Not every family has regular access to soap or hand sanitizer. But every family can collect coconut husks and keep their hands clean.”

Similarly, many families owned a simple open-sided house in the bush that they never used – but which could be a perfect location for someone with COVID-19 and needing to be in isolation.

Village visits took an inclusive approach that included the use of sign language to communicate hygiene messages, and making it easier for people with physical impairments to use hygiene facilities.

Eventually, more Samoans overseas will return and the country will open up for other visitors. By then, it is hoped that better awareness and health practices will ensure COVID-19 does not gain a foothold, says Dr Dyxon.

“Let’s work together to be ready and make sure everyone is safe. Look after your health and you’ll be better able to fight off the virus if you do get it.

“Even if COVID-19 never comes to Samoa, this is an opportunity to build up people’s health and strengthen their resilience.”