It was a spasm of tragedy on a remote Pacific island that only a few months later was overshadowed by a global pandemic. But to Gov. Josh Green of Hawaii, the measles outbreak on neighboring Samoa that killed 83 people, mostly babies and children, was a preventable catastrophe wrought by the man President Trump now wants to steer American health policy.
In December of 2019 Dr. Green, an emergency medical physician and Hawaii’s Democratic lieutenant governor at the time, rounded up a medical team and thousands of vaccine doses and flew to Samoa to help. Last month he flew to Washington aiming to alert lawmakers from both parties about the role Robert F. Kennedy Jr., Mr. Trump’s nominee for health and human services secretary and a longtime vaccine skeptic, played in the Samoa outbreak.
Mr. Kennedy’s confirmation hearings are on Wednesday and Thursday before two Senate committees, which will then vote on whether his nomination advances to the full Senate.
Democrats are attempting to leverage Mr. Kennedy’s connection to the Samoa outbreak to build opposition to his nomination. Dr. Green recently appeared in an ad by a liberal advocacy group, 314 Action, saying, “R.F.K. Jr. had spread so much misinformation that the country stopped vaccinating, and that caused a tragic and fatal spread of the measles.”
In an interview on Monday, Dr. Green said that based on his conversations so far, if the full Senate vote was taken anonymously, “R.F.K. Jr. would be defeated 70-30 or worse.” At the same time, he said, “the political climate has everyone under great pressure to go with the president, or be labeled disloyal.”
A spokeswoman for Mr. Kennedy did not respond to requests for comment on Tuesday. In the past he has blamed Samoa’s measles outbreak on “an Indian-manufactured MMR vaccine,” referring to the measles, mumps and rubella vaccine.
Dr. Green, 54, arrived in Hawaii in 2000 as a young physician with the National Health Service Corps, and was often the only doctor serving small rural communities on Hawaii’s Big Island. After he was elected to the state legislature in 2012, he cared for patients on weekends. He was barred from outside employment after he was elected governor in 2022, but he says he volunteers as a “street medicine” practitioner offering health care to unsheltered veterans and other people in need.
Samoa’s outbreak had its roots in a tragic error. In 2018, nurses preparing MMR vaccines mixed the doses with a muscle relaxant instead of water. The tainted shots caused the deaths of two infants and ratcheted up parents’ fears about the safety of vaccines.
Vaccination skeptics often wrongly link childhood vaccines to autism, and after the incident Samoa’s prime minister, whose grandson happens to have autism, halted the island nation’s vaccination program.
As a result of the deaths and the ban, fewer than one-third of Samoa’s 1-year-olds received the MMR vaccine in 2018, down from as high as 90 percent in 2013, according to the World Health Organization. Infections began to surge.
Children’s Health Defense — a group led by Mr. Kennedy that in 2022 was banned for a time from Facebook and Instagram for what the platforms said was the spread of medical misinformation — posted news of the prime minister’s decision to stop the vaccine program on its website.
Both Mr. Kennedy and his friend Del Bigtree, who is also skeptical of vaccines, have large, international online followings, and they used the two babies’ deaths to underscore their message about the dangers of vaccines. Mr. Bigtree later served as communications chief for Mr. Kennedy’s presidential campaign.
As an American with a famous name and a powerful network that had amplified parents’ fears in Samoa, Mr. Kennedy “preyed on people that were vulnerable,” Dr. Green said.
In June of 2019, Mr. Kennedy and his wife, the actress Cheryl Hines, traveled to Samoa at the invitation of the prime minister, who treated the couple like visiting royalty. “My husband wants to move here,” a laughing Ms. Hines told reporters during the trip.
During the visit Mr. Kennedy posed for a photo with Edwin Tamasese, a coconut farmer whom he has called a “medical freedom hero.” Mr. Kennedy later wrote on the Children’s Health Defense website that the trip had been arranged by Mr. Tamasese, who was arrested months later for spreading vaccine misinformation and promoting ineffective measles treatments like vitamins and papaya leaf extract.
Mr. Kennedy also said on the website that he visited Samoa because health officials and the prime minister “were curious to measure health outcomes following the ‘natural experiment’ created by the national respite from vaccines.” Mr. Kennedy said he was offering them help in creating a tracking system.
He later denied that he had been in Samoa to push his views on vaccines. In a 2021 interview for “Shot in the Arm,” a documentary about vaccine hesitancy and the Covid-19 pandemic, Mr. Kennedy told the filmmaker, Scott Hamilton Kennedy, who is no relation, that “I didn’t go to Samoa, by the way, for anything to do with that issue.”)
Measles are highly contagious, and by late 2019, the number of new infections in Samoa was doubling each week. The first child died on Oct. 13. A month later, with 16 people dead from measles complications, the government declared a national emergency and made MMR shots mandatory. Four days after that, Mr. Kennedy sent a letter to Samoa’s prime minister urging the Samoan health ministry to “determine, scientifically, if the outbreak was caused by inadequate vaccine coverage or alternatively, by a defective vaccine.”
In early December, with over 3,700 new cases and more than 50 dead, Samoa’s communications minister said anti-vaccination conspiracy theorists were “slowing us down” in the effort to vaccinate people.
Dr. Green contacted Samoa’s health minister, Faimalotoa Kika Stowers. Could he bring a team on a vaccination mission? Ms. Stowers relayed his offer to the prime minister, who in the face of the growing death toll “offered to shut down the country” to help the Hawaii team work, Dr. Green recalled in an interview.
Within 48 hours Dr. Green secured volunteers, air travel from donors and 50,000 doses of vaccine from UNICEF.
His team landed in Samoa at 5:30 a.m. on Dec. 4 and with several hundred Samoan volunteers fanned into the countryside. Residents hung red flags or scraps of cloth outside their homes if they needed vaccine.
Dr. Green recalled visiting a home where a child had died so recently that her skin was still flushed with fever. “I felt the warmth leaving a child’s body after she died in a preventable measles outbreak,” he said.
Global public health experts have said several factors, including a slow government response and Samoans’ limited access to health care, contributed to the outbreak. But the World Health Organization has directly linked vaccine misinformation to the spread.
