Pacific island nations can learn from the early roll-out of coronavirus vaccines in the north Pacific says the World Health Organisation’s Representative in the South Pacific.
The Pacific’s COVID response is on the agenda of today’s Pacific Islands Forum (PIF) leaders virtual retreat, along with the election of a new PIF Secretary General and action on climate change. A number of PIF members—including Marshall Islands, Federated States of Micronesia, Palau—are already vaccinating their citizens.
WHO’s Dr Corinne Capuano says while their initial projections were to see the vaccine rollout in the second half of this year in the South Pacific, there is a lot of work being done and it may be earlier, although it’s a complex issue. Forum members are talking to their development partners about vaccine procurement as COVAX is not expected to meet all vaccine requirements.
WHO Director General Dr Tedros Ghebreyesus recently said the world faces moral failure if it doesn’t ensure vaccine equity. “Rich countries are rolling out vaccines, while the world’s least-developed countries watch and wait,” he said, challenging world and health leaders to ensure that vaccination of health workers and older people is underway in all countries within the first 100 days of 2021.
It’s a message the next Chair of the Pacific Islands Forum, Fiji Prime Minister Voreqe Bainimarama reiterated when he opened the Pacific Island Forum’s reconstructed fale in Suva last week: “With vaccines rolling out across the developed world, we must not allow our region to be cast to the fate of “immunity inequality”. Our people must be kept protected. Our economies must keep pace with what may well be the most important economic recovery in a century. For that to happen, COVID-19 vaccines must become available to our citizens, not months or – God forbid – years after the developed nations, but alongside them. Because we know none of us is safe, until all of us are.”
Suva-based Dr Capuano says there are things to be learnt from vaccination campaigns already underway, including logistics such as cold chain management, and the importance of identifying priority recipients, that is, people most at risk of being exposed to the disease such as health care workers and people working at our borders.
She says dealing with any side effects will also be important; “making sure you have in place systems that are able to deal with any side effects. It is important that you can take care of any side effects after the vaccination and that you have a surveillance system in place so you can monitor what is happening after vaccination.
“The other element is that the vaccine that is currently used in the Pacific requires two doses of injections, so you also want to make sure that you provide full vaccination to people, so you have a registering system that is allowing you to ensure that if people that get the first dose, they get the second as well.”
Dr Capuano cautions that the vaccine is “not a magic bullet” and “non-pharmaceutical interventions”—handwashing, physical distancing and the wearing of masks—remain important, especially in places with community transmission.
She says Fiji and other Pacific nations have been “working very hard” to prepare for vaccine deployment, including messages to overcome the so-called vaccine hesitancy that has been seen in some other countries.
“As the campaign is rolling in other countries in the world, people also see what is going on and that this is the value of being vaccinated. So we see a lot of critical information coming from other parts of the world that can be useful for the Pacific.”
Dr Capuano made the comments at the recent signing of an agreement between the WHO, European Union, United Nations Food Programme and Pacific Community to strengthen the health sector across the Pacific. The European Union has repurposed US$24 million under the EU-Pacific Islands Forum Secretariat Financing Agreement to fund this work in Cook Islands, Kiribati, Fiji, the Republic of Marshall Island, the Federated States of Micronesia, Nauru, Niue, Palau, Papua New Guinea, Samoa, Solomon Islands, Tonga, Tuvalu and Vanuatu.
Opinion: From COVID-19 containment to suppression in the Western Pacific Region: 2020 Lessons for 2021
Compared to other parts of the world, the Western Pacific Region has been comparatively fortunate. Although the Region’s 37 countries and areas are home to more than a quarter of the world’s population, they have reported just 1% of globally confirmed cases to date. Most countries have avoided the so-called “red line”, or the point where critical care needs surpass health care capacity, large numbers of health care workers are infected, service quality declines, and deaths rapidly increase.
Of course, 2020 was a very difficult year – in particular, for healthcare workers, and for those who have lost loved ones and livelihoods. My thoughts are with the families of these people every day, and with the healthcare workers who have been working so hard over the past year. We all need to remain vigilant, in order to keep case numbers down, and health systems operating, and as far as possible, transmission of the virus in check.
As we embark on a new year, there are still many unknowns about COVID-19. However, it is still useful to reflect on some of the lessons that can be learned from our experiences and what we can take forward into 2021.
There are several reasons why the Western Pacific Region has fared relatively well, and important lessons that can be learned from countries in our Region's experience. Clearly, long term investment is critical. Countries in the Region have spent more than a decade preparing for events with pandemic potential, by strengthening their health systems in anticipation of an event like the COVID-19 pandemic.
Under the Asia Pacific Strategy for Emerging Diseases and Public Health Emergencies, or APSED, now in its third iteration, countries developed their response plans – and, crucially, the capacities and systems to implement them. Under this shared strategy, systems were set up – such as for contact tracing – which have proven to be critical in the COVID-19 response.
Countries that have successfully controlled COVID-19 had a very strong public health plan to manage positive cases. Most countries were able to scale up the right mix of public health interventions at the right time, to avoid health systems being totally overwhelmed.
China showed us early on that this virus could be suppressed, with strong public health interventions. Australia and New Zealand’s experience has reinforced this. We also saw in places such as the Republic of Korea, the importance of quickly scaling up testing – and linking this to the public health response.
In the Pacific, where there are some of the few remaining countries in the world yet to record a single case of COVID-19, countries and areas continue to prepare their health systems. Strong public health measures, proactive communications with their public, combined with border closures and stringent border quarantine measures, have slowed or stopped the spread of COVID-19. Fiji and New Caledonia, for example, which reported cases of COVID-19 in the community earlier in 2020, have now gone more than 240 days without reporting a case of COVID-19 outside of border quarantine.
From Japan, we learned the benefits of using a cluster-based approach. And of course, Japan also taught us about the renowned three C’s. I understand that now, even small children in Japan know about the three Cs: avoiding closed spaces, crowded places and close-contact settings.
There are many other important factors: for instance, good systems for multi-source surveillance have been crucial – to enable countries to monitor trends, assess risks, and adapt response strategies accordingly.
Communication from trusted sources including governments, healthcare workers and scientists has also been so important – for establishing and sustaining social norms around protective behaviours, and building community support for public health measures. We have been observing very effective communication in many countries including Viet Nam, Singapore and New Zealand. I have been impressed so many times with the communication of those countries. I have also observed in many countries, a strong community commitment to protecting the most vulnerable.
I am also very proud of the spirit of solidarity that characterized interactions between countries of our Region in 2020 – from technical exchanges on issues such as laboratory testing and clinical management, to working together in joint incident management teams, and commitments to support equitable access to COVID-19 vaccines. Countries in the Region really have come together, borne out of a recognition that no country is safe until every country is safe.
Of course, none of the things I have described are unique to the Western Pacific Region. But they came together in 2020 in a unique way – sparing us from the scale of devastation that we are currently sadly seeing in other parts of the world. But this is obviously no time to be complacent: the pandemic is far from over, and how COVID-19 evolves in 2021 depends on all of us: our individual and collective actions will determine the course that the pandemic takes next.
As the holiday period draws to a close and we begin this new year, I encourage everyone in COVID- contained countries across our Region, those who are able to be together with their families and communities in-person, to discuss what they can do to be ready to apply the public health measures that we see working elsewhere in our Region, as and when they are needed.
Dr Takeshi Kasai, WHO Regional Director for the Western Pacific
Fiji’s Permanent Representative to the United Nations says the COVID-19 pandemic is a wake-up call for the Pacific on the need for regional cooperation.
“If the world ever needed confirmation of why multilateralism is important, this is it,” says Ambassador Dr Satyendra Prasad. “This pandemic has inflamed the whole of the world in a few months, and not a distant corner… is immune from it.”
Ambassador Prasad says the world needs to work together to develop, test and distribute vaccines, and produce and supply ventilators, medical equipment and information and knowledge.
“That is a confirmation of why we need multilateral agencies such as the WHO, such as the UN to share perspectives and understanding on how we deal with the pandemic.
“In the Pacific it's also a reminder, a wake up call to us that we need to co-operate as all of the cases of course are imported. But from Fiji of course it can spread to Tuvalu, from the North Pacific it can potentially spread into Melanesia because of shipping lines and because of flight patterns etc. So amongst ourselves as a Pacific island group of countries, we need to co-operate."
In response to criticism of the WHO’s handling of the pandemic from the United States government and other quarters, Ambassador Prasad says the focus of the world now should be on containing and crushing COVID 19, and the time for reflection will come.
“We understand that in the international system there are frustrations and there's anger and there's the divergence of views and there's competition as there always has been, but in a very forceful and powerful way this [pandemic] has reminded ... the smallest and the largest countries in the world of the value and the intrinsic importance of working together cooperatively and collaboratively and seeking a solution to what is truly a global problem.”
“This whole system is trying it's best in unfortunately very difficult circumstances,” he says.
“When we have come past this, there will be a time for the international system to look at what worked well and what did not work well, and learn the right lessons and apply it, ensuring the systems are much better and stronger by the time the next pandemic comes, but today is not that day.”
The Pacific’s response to the COVID-19 outbreak is likely to lead to increased scrutiny of health budgets and investments in our region.
However first there are the very pressing questions of how to scale up response in individual countries and territories, best leverage regional expertise and cooperation, maintain public health messaging that is relevant to Pacific communities, and prepare for second and subsequent waves of infection.
When Islands Business first interviewed Sunia Soakai, the Deputy Director, Public Health Division, at the Pacific Community, only five countries had COVID-19 testing capabilities: Fiji, French Polynesia, New Caledonia, Guam and Papua New Guinea. Since then other Pacific locations have come online. Palau has begun random testing with equipment donated by Taiwan. American Samoa is doing limited local testing, while still sending samples to Hawaii. The Northern Marianas has taken delivery of kits from a South Korean manufacturer, and its government aims to test every resident.
The most efficient way of facilitating local testing in our region, says Soakai, is to use custom-made cartridges in machines already in place for TB testing. The joint Incident Management Team of which SPC is a member (see p13) has placed orders for the cartridges and the consumables that go with them.
“No firm date has been set by the manufacturer [for delivery]” Soakai says, “but given that the Pacific is a region that has limited capacity, WHO and UNICEF have provided their support and the manufacturer has agreed to provide priority for the Pacific.”