PNG and Fiji were both facing COVID catastrophes. Why has one vaccine rollout surged and the other stalled?

Hannah Peters/Getty Images

Ian Kemish, The University of QueenslandThings were looking very bad three months ago for both Papua New Guinea and Fiji. The two Pacific countries were each looking very vulnerable to the COVID Delta variant, albeit in different ways.

On July 10, PNG recorded its first official Delta case, and the nation’s health professionals were soon warning the combination of very low testing rates, high percentage of positive tests and an extremely slow vaccine rollout provided a “recipe for a major spread”.

Fiji was already in the thick of it at the time. After the deadly Delta strain entered the country via a quarantine breach in April, per capita infection rates became the highest in the world in the middle of the year.

Daily infections reached more than 1,800 in mid-July – a huge number for a country of only 900,000 people. The crisis caused 647 deaths.

Fast forward several months and PNG and Fiji are heading in opposite directions. More than 95% of eligible Fijians over the age of 18 have now received their first jab, and 80% are now fully vaccinated.

By contrast, PNG is in the grips of a major wave, with less than 1% of the total population fully vaccinated. PNG is trailing much of the world.

Why have two Pacific countries, which share Melanesian cultural connections, handled their vaccine rollouts so differently?

Not a matter of geography or vaccine supply

Fiji’s daily infection rate today is 4% of what it was at the peak, and it’s falling. Less than 50 new cases are currently being reported on average each day.

In PNG, the official infection rate is now averaging just under 300 new cases per day, but this drastically understates the reality of what is happening in the country.

Extremely low testing rates simply cannot be relied upon. The country’s own health data reportedly shows 2.6 million cases of flu- and pneumonia-like symptoms over the last year, and Port Moresby General Hospital is now reporting positive COVID testing rates of 60%. Like other hospitals across the country, it risks being overwhelmed by the virus.

Read more:
The Pacific went a year without COVID. Now, it’s all under threat

It’s not simply a vaccine supply issue. At this stage of the global crisis, PNG, like Fiji, has received substantial vaccine deliveries – principally from Australia, New Zealand and the COVAX vaccine delivery initiative.

In fact, thousands of PNG’s early deliveries went to waste because the health authorities were unable to use them. The PNG government has recently made the best of a bad situation by re-gifting 30,000 vials donated by New Zealand to Vietnam.

We can also set aside any suggestion Australia, as the major regional donor, is somehow favouring one country over the other.

The Australian government has put a high priority on providing vaccines to both countries in recent months. Its assistance has also extended to education and logistical efforts, along with targeted medical emergency teams and support for those with expertise and capacity on the ground.

Nor is it really a matter of distribution.

PNG’s geography does present some challenging physical barriers to distributing vaccines – its legendary mountainous terrain and the remoteness of many of its inhabitants are well known.

Read more:
Australia wants to send 1 million vaccine doses to PNG – but without reliable electricity, how will they be kept cold?

But companies from Digicel to South Pacific Brewery manage to penetrate the most inaccessible areas with their products despite these difficulties. And the authorities manage to deliver the vote across the nation every five years in what is one of the world’s most extraordinary democratic exercises.

With its own rugged terrain and dispersed populations across multiple islands, Fiji has also faced major physical impediments to its vaccine rollout.

The major difference: leadership and belief

We get closer to the problem when we think in terms of trust, understanding and belief.

Fijians have embraced the vaccination rollout almost as one, following the guidance of their medical authorities and falling in line with the firm “no jabs, no job” policy of its prime minister, former military commander Frank Bainimarama.

In PNG, the term “vaccine hesitancy” understates the problem. One survey earlier this year showed worrying low willingness to take the vaccine, and another survey of university students showed a mere 6% wanted it.

Vaccine patrols have received death threats in some areas, and any politician who speaks out in favour of vaccination risks a political backlash. Strong efforts are now being made to overcome this problem, with the health authorities preparing a fresh approach and iconic figures such as rugby star Mal Meninga supporting the publicity effort.

These dramatically contrasting pictures cannot be explained fully through differences in education standards, or the quality of medical advice and attention.
To be sure, Fiji leads PNG in these respects – Fiji has 99% literacy compared to just over 63% in PNG, according to the latest available figures. And while Fiji’s medical system has its challenges, the decline in PNG’s health services due to chronic lack of investment puts it in a very different category.

Read more:
Pacific nations grapple with COVID’s terrible toll and the desperate need for vaccines

In PNG, trust in leadership has flagged following decades of frustration with growing wealth inequality and concerns over governance and transparency.

Rather than trust official sources, people often look to Facebook and other social media for their information, and are thus vulnerable to the dangerous nonsense peddled by the anti-vaccination movement in the west.

I know how quickly Papua New Guineans tap into what’s happening in neighbouring Australia, too. They will have seen how the public debate here has dented confidence in the AstraZeneca brand – the mainstay of their own vaccine supply.

But perhaps most troubling of all is the sense that many Papua New Guineans have developed a fatalistic belief that COVID is just another health challenge to add to the litany of other serious problems facing the country, among them maternal mortality, malaria and tuberculosis.

It’s almost as if they believe this is all somehow PNG’s lot. But it doesn’t need to be.The Conversation

Ian Kemish, Former Ambassador and Adjunct Professor, School of Historical and Philosophical Inquiry, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Coronavirus Update: Global

‘A dam has been breached’: a COVID crisis on our doorstep shows how little we pay attention to PNG

Ian Kemish, The University of QueenslandUntil this week, it did not occur to most Australians to ask themselves how our nearest neighbours in Papua New Guinea were faring with coronavirus.

Our minds and screens have been full with what is happening at home and in countries like the United States and United Kingdom. In this and other ways, the current crisis on our doorstep highlights some perennial themes in the relationship between Australia and PNG.

Even for those who were paying attention, the apparently sudden spike in cases has come as a surprise. It had been difficult since the start of the pandemic to work out the real extent of COVID’s spread in PNG, given low testing rates and the inaccessibility of so much of the country.

But antibody analysis and testing of resource industry workforces employed by Australian and other international companies suggested that while the virus was present throughout the country, Papua New Guineans didn’t seem to be dying in the way that people in other countries were.

The apparently low rates of serious illness and death seemed to reflect the fact that three-quarters of the population is under the age of 35, and average life expectancy is only 64. Just a small proportion of the country’s inhabitants seemed to be in the main risk category — very elderly people.

But now it’s like a dam has been breached. Health facilities are close to being overwhelmed in Port Moresby, medical staff are being struck down and 50% of one batch of PNG swabs tested in Brisbane last week were positive.

Read more:
A catastrophe looms with PNG’s COVID crisis. Australia needs to respond urgently

Australians working in PNG

The crisis brings to mind a paradox in the Australia-PNG relationship. Despite our “blind spot” when it comes to our northern neighbour, there are thousands of Australians who have very strong PNG connections.

About 20,000 Australians call PNG home. They are heavily engaged in work there as teachers, miners, diplomats, aid workers and government advisers.

These people have known for some time how the pandemic has aggravated existing challenges in the country. It has strained the country’s fragile health system, put a squeeze on people’s incomes and encouraged a growing debt problem.

Read more:
Destitution on Australia’s hardening border with PNG – and the need for a better aid strategy

Many Australians, too, have been working on COVID’s front line there.

While the rest of us have been hunkered down safely behind closed borders, Australian women and men working in the resource industry have continued to come and go – doing quarantine at both ends, spending longer periods away from home and family.

They are managers and technical specialists, and they have been working with their PNG colleagues to implement world-class testing and treatment protocols in their mines and LNG production sites. This has helped keep thousands employed and some revenue flowing to the cash-strapped nation.

The Kokoda Foundation conducting COVID awareness training in PNG.
Author provided

The better companies have also been working “outside the gate” to help local authorities manage the impact of the pandemic on their communities and combat widespread misinformation about the disease and vaccinations that will come.

The tough new restrictions on travel between Australia and PNG are undoubtedly a prudent move, but this has left many Australian resource industry workers and others feeling stranded.

Resource companies operating in PNG, from Newcrest to Oilsearch, need to brief the Australian health authorities on the stringent protocols they are enacting for their workers when they are in PNG. These arrangements, they argue, make their employees a safer bet to travel for work than Australian citizens coming home from many other parts of the world.

Helping PNG is in both our interests

In the past week, mainstream Australian media have finally found a reason to draw broader national attention to what is happening next door.

Self-interest is an important motivator of public attention, and there is now legitimate concern about the disease spreading across the Torres Strait into northern Australia.

We don’t know how bad the problem is in PNG’s western province, less than four kilometres from Queensland’s northernmost islands. But we do know that several positive cases had led the Ok Tedi mine there to cease charter flights to Cairns well before the Australian government suspended travel from PNG yesterday.

We’ve seen a range of official responses from the Australian authorities over the past few days.

Queensland Premier Annastacia Palaszczuk has announced the vulnerable Torres Strait communities are being prioritised for vaccinations. Canberra has moved to bring forward its vaccination support to PNG, contributing 8,000 doses immediately to protect frontline workers and asking the European Union to divert one million of its AstraZeneca order to PNG.

Some will criticise all this as a knee-jerk response. But to be fair, it builds on a substantial existing program of Australian COVID-related support to PNG.

Read more:
China’s push into PNG has been surprisingly slow and ineffective. Why has Beijing found the going so tough?

And I know from my own time representing Australia as the high commissioner in PNG that the pace of assistance is often determined by the host government. PNG is a sovereign country, and they need to request help.

There are also those who will accuse Australia of acting purely in its own self-interest. Any such commentary reflects another basic and longstanding misunderstanding of how Australian and PNG interests intersect.

Our neighbour’s stability and prosperity is in our interests. Surely, there can be no better example of this than the current crisis: what is good for PNG is also good for Australia.

A better reflection of the self-interest at play is how most of us, in the general public, have only just realised there’s a problem.The Conversation

Ian Kemish, Former Ambassador and Adjunct Professor, School of Historical and Philosophical Inquiry, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia wants to send 1 million vaccine doses to PNG – but without reliable electricity, how will they be kept cold?

Ilya Gridneff/AAP

Tony Heynen, The University of Queensland; Paul Lant, The University of Queensland, and Vigya Sharma, The University of QueenslandAustralia’s nearest neighbour, Papua New Guinea, is battling an unfolding COVID crisis. The Morrison government is urgently deploying 8,000 vaccine doses to the nation’s health workers – but poor electricity access means there are serious questions over PNG’s broader vaccine roll-out.

Vaccine supplies must be stored at cold or ultra-cold temperatures along the supply chain. Importantly, when the vaccines reach hospitals and medical centres in PNG, stable electricity will be needed to power refrigerators to store the doses before they’re administered to patients.

Currently only about 13% of Papua New Guinea’s eight million people have reliable access to electricity. This is not an isolated problem. In 2019, about 770 million people globally lived in “energy poverty”, without access to electricity – and the problem has grown worse due to COVID.

Australia is working to provide one million doses for wider distribution in PNG. But the pandemic only truly ends when the vaccines are rolled out globally. Countries and communities without electricity access present a major barrier to this goal.

A PNG resident cooks over a fire
Just 13% of PNG’s population has reliable electricity access.

Energy poverty matters

Australia enjoys a relatively reliable electricity network, even in remote parts of the country. There are also systems in place to keep vaccines cold in the event of a power outage, such as backup power.

But around the world, even in our Pacific neighbourhood, energy poverty is widespread and persistent. And COVID-19 has created a vicious circle for these nations. The pandemic has forced governments to shift priorities, leading to less funding for electricity infrastructure. In some countries, progress in electricity access has reversed for the first time in many years.

The International Energy Agency (IEA) says this reversal is being worst felt in Sub-Saharan Africa.

There, 580 million people lack access to electricity – three quarters of the world’s total. The IEA estimates this number grew by 6% in 2020.

It cites Uganda, where public subsidies for an electricity access program have been put on hold, and South Africa where funds to expand rural electrification were redirected to health and welfare programs.

PNG wants 70% of the country connected to electricity by 2030. This will require large scale investment in new generation capacity, and transmission and distribution lines to connect people to the grid. But the nation has long suffered economic instability, and the pandemic has only added to this.

Making matters worse, the true extent and trajectory of COVID-19 may be uncertain in nations suffering energy poverty. For example, there is growing evidence of under-testing in Africa and under-reporting of cases and deaths in PNG.

Read more:
‘A dam has been breached’: a COVID crisis on our doorstep shows how little we pay attention to PNG

Medical staff gather around a table
The COVID threat in some developing nations is under-reported.
Farah Abdi Warsameh/AP

Vaccine refrigeration is key

As experts have noted, efforts to end the pandemic have largely focused on developing, testing and manufacturing an effective vaccine. Less attention has been paid to distributing it rapidly at scale.

There are exceptions. The Lancet has identified local deployment as one of four key dimensions for an effective global vaccination roll-out.

More than 390 million vaccine doses have already been administered, mostly in high- and middle-income countries with effective financial and planning resources.

But in countries where electricity access is poor, refrigeration of vaccines during transport and storage may prove very difficult. Some countries may not be able to vaccinate large parts of their population.

Country-level vaccine distribution – colour intensity indicates doses per capita.
WHO Coronavirus Dashboard

The Pfizer vaccine must be frozen at around -70℃. The AstraZeneca vaccine must be kept at between 2℃ and 8℃.

Ultra-cold supply chains were established for the deployment of the Ebola vaccine in Africa in 2013–14. However, the scale required for COVID is enormous, and would be prohibitively expensive.

As reported in the Lancet, as of 2018, 74 of 194 member states of the World Health Organisation had no adult vaccination program for any disease. Fewer than 11% of countries in Africa and South Asia reported having such a program. This was thought to be partly due to a lack of systems for storage and delivery.

Alarmingly, a recent study suggested more than 85 less-developed countries will not have widespread access to COVID vaccines until 2023.

Many are relying on the World Health Organisation’s COVAX initiative, which aims to secure six billion doses of vaccine for less developed countries. Similarly, the Quad regional grouping – Australia, the US, Japan, and India – recently pledged to boost vaccine production and distribution for Asian and Pacific island countries.

But without access to reliable electricity, the roll-out of these vaccines will be hampered. This is particularly an issue in countries with remote and dispersed populations. There, keeping the vaccine cold over the “last mile” of distribution and storage may prove impossible.

Read more:
How mRNA vaccines from Pfizer and Moderna work, why they’re a breakthrough and why they need to be kept so cold

Somalian woman receives vaccine dose
Many poor nations are relying on the World Health Organisation to access vaccines.
Farah Abdi Warsameh/AP

Energy access is key to ending the pandemic

Communities experiencing energy poverty, such as in PNG, face other setbacks when it comes to managing the pandemic. Those populations are more likely to use solid fuels, such as wood, for cooking. This leads to indoor air pollution which can cause severe respiratory illnesses and more severe COVID-19 symptoms.

Without electricity access, such communities are unlikely to provide appropriate COVID-19 health responses, leading to a higher burden of disease.

In PNG, an “Electrification Partnership”, of which Australia is a key partner, appears on track. For instance, at a virtual summit at the height of the pandemic last August, Australia committed to financing a large-scale solar plant in Morobe Province. It would be one of the largest solar plants in the Pacific.

But as immunisation emerges as the world’s primary weapon to combat COVID-19, much more work is needed to improve electricity access to those who desperately need it. Indeed, ending the global pandemic may demand it.

Read more:
A catastrophe looms with PNG’s COVID crisis. Australia needs to respond urgently

The Conversation

Tony Heynen, Program Coordinator, Sustainable Energy, The University of Queensland; Paul Lant, Professor of Chemical Engineering, The University of Queensland, and Vigya Sharma, Senior Research Fellow, Sustainable Minerals Institute, The University of Queensland

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Australia sends 8,000 vaccine doses to help Papua New Guinea’s pandemic crisis

Michelle Grattan, University of Canberra

The Morrison government is gifting 8,000 doses of COVID-19 vaccines to Papua New Guinea, and demanding AstraZeneca and European authorities urgently provide one million doses of Australia’s contracted supplies to help the country deal with its escalating pandemic crisis.

In an effort to prevent transmission of the virus to Australia, the government is also suspending passenger flights from PNG into Cairns from midnight for at least a fortnight.

Prime Minister Scott Morrison announced a raft of measures at a news conference on Wednesday morning, aimed at both supporting PNG and protecting Australians.

Charter flights from PNG are also being suspended (with limited exemptions for medevac and the like) and the passenger caps on flights from Port Moresby to Brisbane are being cut by a quarter.

Outbound travel exemptions for Australians to go to PNG will be suspended – except for critical workers – including for fly-in-fly-out workers. “You FI or you FO,” Morrison said. “If you’re there, you stay. If you’re here, you stay. We cannot risk more people going into those areas and then coming back to Australia.”

The government will boost the medical support it is providing to PNG. It will gift one million surgical masks, 200,000 P295 respirator masks, 100,000 gowns, 100,000 goggles, 100,000 pairs of gloves, 100,000 bottles of sanitiser, 20,000 face shields, and 200 non-invasive ventilators.

The 8,000 vaccine doses will be used for frontline health workers from next week.

Morrison said the doses Australia was seeking to assist this “developing country in desperate need of these vaccines” had been contracted for by Australia.

“We’ve paid for them and we want to see these vaccines come here so we can support our nearest neighbour, PNG, to deal with their urgent needs. And we’ll be seeking the support of the European Union and AstraZeneca to achieve that as soon as possible.”

A critical planning AUSMAT team of health specialists will be sent to PNG next week. They will work with PNG authorities on infection control, triage and emergency management, and public health measures. They will also prepare for further Australian assistance and deployment of a clinical team.

Vaccinations are particularly important for those in the Torres Strait Protected Zone, where people on both sides of the strait form one community. The Queensland government has already begun this rollout, and the federal government will work with the PNG government, as well as with Queensland.

Chief Medical Officer Paul Kelly said the PNG situation had changed very rapidly in the last couple of weeks and there was now “a major pandemic in the community”. He said mass testing had been done at the Ok Tedi Mine and almost half the results were positive. Australia has already suspended flights from the mine.

“They are finding the same when people are being admitted into hospital in Port Moresby – half of the women who are coming in due to pregnancy are positive.”

According to the latest numbers on Tuesday, there were 82 new cases in the previous 24 hours. This brought the total official number of cases to 2,351, including 26 deaths.

Morrison said of PNG: “They’re our family. They’re our neighbours. They’re our partners. They have always stood with us and we will always stand with them.”

PNG Prime Minister James Marape said this week his country was now “in the critical red stage” of COVID-19.

“We are possibly having an infection rate about one to three or four in our country.”

He said “the status of our public health system is that what we have in our country is not adequate to sustain a full-blown outbreak, that is of pandemic nature”.

Michelle Grattan, Professorial Fellow, University of Canberra

This article is republished from The Conversation under a Creative Commons license. Read the original article.