[Cited in "Antivaxxer Robert F. Kennedy, Jr. writes to Samoan Prime Minister Tuilaepa Aiono Sailele Malielegaoi about measles in the middle of an outbreak"]

I write with profound sadness to offer my condolences for the measles outbreak that has recently affected your country and taken the lives of precious Samoan children. These deaths are a personal tragedy for their bereaved families and for all the people of your tight-knit nation.

I was dismayed—but not surprised—to see media reports that linked the current measles outbreak to the so-called “anti-vaccine” movement. While we can expect pundits to engage in uninformed finger-pointing, Samoa’s public health officials must undertake the serious tasks of containing the infection and—equally importantly—to thoroughly understand its etiology. To safeguard public health during the current infection in and in the future, it is critical that the Samoan Health Ministry determine, scientifically, if the outbreak was caused by inadequate vaccine coverage or alternatively, by a defective vaccine.

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Media reports from Samoa suggest that the infection is targeting young infants who are not yet of age to receive the measles vaccine. If true, the culprit is most likely a vaccine that failed to produce antibodies in the vaccinated mothers sufficient to provide the infant with maternal immunity. Young infants contracting measles is a relatively new phenomena first recognized in the 1990’s. Prior to the development and widespread use of Merck’s measles, mumps and rubella (MMR) vaccine, mothers passed protection to their infants via passive immunity derived from the placenta and breast milk. In contrast, mothers vaccinated with a defective Merck vaccine provide inadequate passive immunity to their babies. Merck’s version of the MMR has created a crisis where infants under the age of one are now highly vulnerable to these infections. These young infants suffer a much higher morbidity and mortality compared to populations historically impacted by wild measles later in childhood.

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When it first introduced its measles vaccine in 1963, Merck promised that a single dose of its vaccine would provide lifetime immunity and maternal immunity equivalent to that provided by wild measles. Merck predicted that its vaccine would eradicate measles by 1967, so long as 55% of children were immunized. Leading scientists including the world’s preeminent bacteriologist, Sir Graham Wilson and Harvard Virologist John Enders, who first isolated measles, warned against introducing a vaccine unless it provided lasting life-long immunity, as Merck promised. Measles, they cautioned, would rebound with increased virulence and mortality as the vaccine shifted outbreaks away from children—biologically evolved to handle measles— to young infants with inadequate maternal immunity and senior citizens vulnerable to measles-induced pneumonia. Unfortunately, we are now seeing the global emergence of the exact pattern that scientists cautioned against.

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There is also the possibility that children who received the live measles virus during Samoa’s recent vaccination drive may have shed the virus and inadvertently infected vulnerable children. It is a regrettable possibility that these children are causalities of Merck’s vaccine. Alarmed CDC officials documented this emerging phenomenon during the measles outbreak in California in 2015. Federal epidemiological investigations found that at least 1/3 of Californian cases were vaccine strain. In fact, CDC identified 73 of the 194 measles virus sequences obtained across the entire United States in 2015 as vaccine strain A sequences. This means that those children contracted measles from vaccination or from someone who received the vaccine.

For obvious reasons, it is critical for Samoa’s public health officials to quickly determine if the Samoan children who recently died suffered measles from the Merck vaccine or from a mutant strain that evolved to evade the Merck vaccine. In each of those cases, Samoa’s public health officers would react with a very different strategy than if the lethal measles genotype was a wild strain that spread due to inadequate vaccine coverage.