Cook Islands + 10 more

As COVID-19 gains a foothold in the Pacific, countries, WHO and partners work together to save lives

At the end of 2021, the Pacific was home to some of the last countries in the world to remain entirely COVID-free. However, several Pacific island countries and areas (PICs) are now facing their first community transmission, while the few remaining COVID-free PICs are reinforcing their preparedness.

Yet as WHO’s Representative to the South Pacific, Dr Mark Jacobs, says, they are not alone in these efforts: “The World Health Organization (WHO) and partners have been working together to support Pacific island countries and areas (PICs) to ready themselves to respond to the virus since the pandemic began. Together, PICs and partners are building on many years of joint efforts to boost emergency preparedness – two specifically focused on preparing for the pandemic – to save lives and protect people’s health from COVID-19.”

Responding to first cases and community transmission of COVID-19

The turn of the new year saw a spate of PICs detecting their first cases outside of quarantine and in the broader community. The Cook Islands, Kiribati, Solomon Islands and Tonga have all recently detected their first community transmission of the virus.

WHO has been providing detailed technical advice tailored to each of these countries, but the general approach has been explained by Dr Jacobs as follows, “Test widely, detect early and respond rapidly. Go hard in the early days and attempt to stop the virus but also ensure that health services are ready to provide life-saving care in the face of rapidly rising numbers of COVID patients.”

For example, Tonga’s routine testing of frontline workers meant that they were able to detect the virus early, giving them an opportunity to put response measures in place before case numbers could take off. A short and focused lockdown is now being used by health authorities as an opportunity to slow transmission and hunt down the virus. At the same time, knowing that they are facing the highly transmissible Omicron variant, the country is getting ready for the next phase in the response, if needed. For example, they are activating their plans for the care of COVID-19 patients and using data to inform real-time decision making, alongside the ongoing response to the recent volcanic eruption and tsunami.

In Tonga, like in the other PICs confronting COVID-19 for the first time, WHO is lending a hand. In addition to providing technical advice, 10,000kg of medical equipment, PPE, laboratory supplies, medicines and other items have been sent to Tonga by WHO and pre-positioned in the country to facilitate the rapid response to COVID-19 cases. WHO has worked with the Ministry of Health for several years to establish and train the Tongan Emergency Medical Assistance Team (TEMAT), which recently deployed to provide medical care in the aftermath of the Hunga Tonga-Hunga Ha’apai volcanic eruption. TEMAT could also be used to support COVID-19 response, particularly establishing intermediate care facilities, or supporting outer island response.

Since early 2020, WHO has also led partner coordination through the Pacific COVID-19 Joint Incident Management Team (JIMT), providing PICs with a range of preparedness and response support. The JIMT brings together partners including Australia, New Zealand, the Pacific Community ,UNICEF, the Asian Development Bank, European Union, International Committee of the Red Cross, International Organization for Migration, Pacific Island Health Officers’ Association (PIHOA), Pacific Islands Forum, United Nations (UN), United Nations Development Programme (UNDP), United Nations Population Fund (UNFPA), United Kingdom, United States, World Food Programme and the World Bank. Together, JIMT partners have provided almost US$30 million worth of personal protective equipment, medical equipment, medicines and other supplies to support COVID-19 preparedness and response in the Pacific.

Preparing for transmission in the last COVID-free countries and areas

As the world enters the third year of the pandemic, there are still some PICs which remain entirely COVID-free: The Federated States of Micronesia, Nauru, Niue, Pitcairn Islands, Tokelau and Tuvalu. However, as the recent cases elsewhere in the Pacific and several near misses have shown, it is only a matter of time until they too will come up against the virus.

These countries and areas are now reinforcing preparedness measures based on lessons identified from the pandemic response in neighbouring countries in the Pacific and the broader region (see “six lessons from the response to COVID-19 in the Pacific and beyond”).

In this, they also have support from WHO and partners. For example, the European Union and the United Kingdom have been working closely with WHO to support health systems to test and treat COVID-19 patients. Australia, New Zealand and the United States have been working with WHO to support PICs to establish their own national emergency medical teams. WHO is also working with Japan to scale up access to medical care in remote outer islands of Micronesian PICs.

And, of course, there has been extensive support for the rollout of COVID-19 vaccines. More than 1.2 million doses of COVID-19 vaccines have been provided to Pacific island countries via the COVAX facility to date with other partners providing additional doses bilaterally. By the end of 2021, ten PICs had successfully double-vaccinated more than 80% of their eligible populations.

“This is no small feat in nations which are often dispersed over many far-flung islands. It is the result of hundreds of hours spent by dedicated health workers travelling by boat and on foot to reach the hardest-to-reach villages and communities,” continued Dr Jacobs. “Whenever the virus arrives on their shores, these high vaccination rates will help to prevent severe illness and keep death rates low.”

Looking towards the future

At the same time that WHO is supporting PICs to respond to the pandemic, the Organization is strengthening local capacities that will also serve countries long after the pandemic is over, such as emergency medical teams that can respond to COVID-19 but also the next climate-fuelled disaster, or laboratories that can test for SARS-COV-2, but also for measles, dengue or tuberculosis.

“Whether COVID-free, facing first cases or battling a third or fourth wave, WHO and partners are there supporting countries and areas across the Pacific to respond accordingly and get ready for what may come next,” continues Dr Jacobs. “We will stand by you now during the pandemic and we will continue to stand by you long into the future.”

Six lessons from the response to COVID-19 in the Pacific and beyond

  • Border controls and vaccination are important, but not enough on their own – Every country will eventually have to face COVID-19. Some Pacific island countries have experienced quarantine leaks and there have been several close calls related to potential maritime importations (i.e. with COVID-19 arriving on Pacific shores via ship). In addition, tight border closures cannot continue forever. Other preparedness and response measures must therefore continue, including community testing for COVID-19 (e.g. in frontline workers and patients with influenza-like illness).

  • Epidemiological data collection, contact tracing and testing should be strengthened – When case numbers rise, paper-based data collection systems, contract tracing and testing capacity can be very quickly overwhelmed. Digital systems can be used to manage data, non-health staff (e.g. police and teachers) can be used to support contract tracing, and testing can be prioritized.

  • Systems for the isolation, management and treatment of COVID-19 patients need to be carefully reviewed to avoid hospitals becoming overwhelmed and ensure that people seek care at the right place at the right time.

  • The whole of government needs to cooperate on the response – Coming up with a set of ‘alert levels’ can be helpful in achieving joint understanding of what response measures will be put in place at different stages of transmission. Similarly, the highest levels of government are likely to be involved in making pandemic-related announcements and so should be supported to communicate in line with the principles of health risk communication.

  • Plan for the hardest to reach, as the virus will eventually reach every corner – Vulnerable or marginalized communities are often disproportionately affected by the pandemic. Countries and partners need to plan for those who are geographically remote (e.g. outer islands or isolated mountain villages), those who are less able to adhere to response measures (e.g. living close to others, reliant on daily wages) and those who may not understand, trust or be reached by mainstream media (e.g. because of language or literacy).

  • Strong health systems fare better during emergencies – The health capacities that are best positioned to save lives during emergencies are the capacities that have already been established and practised before an emergency starts (e.g. infection prevention and control, quality clinical care, disease surveillance, laboratories, emergency medical teams, community engagement networks etc). Investments in health system strengthening during peacetime are therefore helping to advance universal health coverage and increasing resilience to health emergencies, including pandemics.