The island nation of Samoa is in the midst of a truly devastating measles epidemic. Over 2,600 confirmed cases of the disease have been tallied, with hundreds of new cases being added by the day. A total of 33 people have died at last count, including dozens of children.

When disease begins to spread across an isolated population, the effects can be brutal. Many of the 200,000 people who call Samoa home are now scrambling to receive vaccinations, but it’s a recent anti-vaccination trend that may best explain how the outbreak happened in the first place.

In recent years, Samoa has suffered from a low vaccination rate. The government says that the deaths of two infants in 2018 may play a role in that. The children were said to have died shortly after receiving their measles vaccinations.

The standard measles vaccine is incredibly safe, and even in the rare instances where a child suffers side effects, they’re typically mild in nature. Two children dying as a result of being vaccinated would obviously be incredibly rare, and it was enough for the country to pause its own vaccine program.

Further investigation revealed that the vaccines hadn’t actually played a role in the tragic deaths and that another medication that was used incorrectly was the true cause. By the time the truth came out, parents were leery about vaccinating their children, and many chose not to do so. Of the 33 deaths from the current measles outbreak, all but four of them have been very young children.

The country declared a state of emergency and over 100,000 doses of the measles vaccine to Samoa. The government is working to administer them as rapidly as possible and is hopeful that the country has already seen the worst of the epidemic.