Acute rheumatic fever (ARF) and its sequelae rheumatic heart disease (RHD) is the most common cardiovascular disease in children and young adults and remains a major public health problem, especially in developing countries and Pacific countries. This article outlines the incidence and the prevalence of ARF and RHD in Samoa. It highlights the difficulties in the diagnosis of ARF using the currently internationally accepted diagnostic criteria given the limited laboratory facilities available in Samoa. The author explains the primary and secondary prevention of ARF and describes the rheumatic fever program in Samoa. Available data indicate that ARF and RHD are the cause of significant morbidity and mortality in Samoa, imposing large financial and social burdens on the government, patients and their families. The paper makes a case for urgently controlling and curbing ARF and RHD.