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COVID-19 crisis in PNG amid vaccine rollout concerns in Australia

Aid agencies are urging Australia to step up its responses to the COVID-19 crisis in Papua New Guinea, warning that the pandemic poses grave threats to PNG and its neighbours, as per warnings dating back to March last year.


 Marie McInerney writes:

Australia has announced emergency COVID-19 support for Papua New Guinea (PNG) in response to fears of a “looming catastrophe” that could devastate the nation and its healthcare system and that also threatens communities in the Torres Strait and Far North Queensland.

Amid dire warnings from PNG and Australian health experts, Prime Minister Scott Morrison announced today that Australia would urgently supply 8,000 AstraZeneca COVID-19 vaccines from Australia’s stock to start vaccinating PNG’s essential health workforce.

The Australian Government will also ask AstraZeneca and European authorities for one million doses of Australia’s contracted supplies to gift to PNG, and work with the PNG and Queensland Governments to “address health security on both sides of the Torres Strait” including to roll out vaccines to the “Treaty Villages” in the Protected Zone.

“By helping Papua New Guinea, we are not only helping our Pacific family, we are keeping our nation and our people safe,” Morrison said, amid criticism from Opposition foreign affairs spokeswoman Penny Wong that Australia’s response to date in the emerging disaster in PNG had been “tardy and uncertain”.

Warnings last year

The crisis should not have come as a surprise, with warnings as early as March 2020 that PNG’s health system was already stretched to the limit dealing with serious endemic health problems including malaria, tuberculosis and diabetes and that an outbreak of COVID-19 in Port Moresby and other large centres would be “an absolute catastrophe”.

The World Health Organization sounded the alarm on the current outbreak nearly two weeks ago, fearing that mass gatherings to commemorate the country’s founding prime minister, Grand Chief Sir Michael Somare, threatened to “accelerate already rising cases of COVID-19”.

Among other early measures announced today, Australia will deploy a critical planning AUSMAT team to PNG next week, supply 200,000 facemasks, other personal protective equipment (PPE) and hospital tent facilities and support the setting up of isolation facilities in Port Moresby.

Concerned about the risks to North Queensland, Morrison also announced flights between Port Moresby and Cairns would be suspended for a fortnight to start with, and passenger capacity on flights between Port Moresby and Brisbane cut by 25 percent.

While freight flights will continue, in order to maintain emergency supplies and essential services, charter flights were also suspended, including to the Ok Tedi mine, where Morrison said there had been a “high incidence” of positive COVID-19 cases.

Cairns Hospital in Far North Queensland last week declared a “code yellow” emergency, following the arrival of six COVID-19 patients who were PNG fly-in fly-out mine workers from Cairns.

“We cannot risk more people going into those areas and then coming back to Australia,” Morrison said, confirming that 32 COVID-19 cases from PNG have been identified in Queensland over the past two days.

On Monday Queensland Premier Annastacia Palaszczuk told media that one batch of 500 samples processed by Queensland pathology services had returned a massive 250 positive results —”quite extraordinary and quite concerning when it’s right on our doorstep”.

Risk of humanitarian disaster

Health experts have warned that an out-of-control COVID-19 epidemic in PNG would be “a humanitarian and economic disaster” for the country itself and a “grave threat” to the health of the region, with shared borders to Solomon Islands and Indonesia, and a “porous” sea border with Torres Strait Island communities.

Torres Strait Regional Council Mayor Philemon Mosby told ABC radio today that it could be “catastrophic” for local communities if the emergency wasn’t handled properly; however, others are hopeful the crisis can be averted, including National Aboriginal Community Controlled Health Organisation (NACCHO) CEO Pat Turner.

“Our people are very much aware in the Torres Strait about the dangers of COVID and they’ll be taking every precaution,” Turner told ABC TV’s The Drum, saying she had “every confidence that Queensland Health will be able to manage this and control the movement of people, with the cooperation of the Torres Strait Island leadership”.

NACCHO CEO Pat Turner on ABC TV’s The Drum

Others told Croakey there are hopes in the region that the West Fly region of PNG, closest to Torres Strait Island communities, may be relatively protected from COVID-19 because it is very remote. The downside of this is they have very limited health services so if there are cases, it might take a while to recognise them and treatments also will be limited.

Médecins Sans Frontières Australia said PNG and other Pacific nations could have received its doses of the vaccine earlier, and have a rollout already underway, if Australia and other countries had not blocked an intellectual property waiver related to COVID-19 vaccines.

It said Australia also needed to take responsibility for six refugees formerly held at the Manus detention centre, but stranded in PNG, who are reported to have tested positive for COVID-19.

More help needed

Aid organisations welcomed the Federal Government’s package of support for Papua New Guinea, but warned much more was needed on the ground amid high stakes.

“PNG’s health system is not equipped to respond to a major outbreak such as this, and many lives are at stake,” said Lyn Morgain, CEO of Oxfam Australia.

“The country urgently needs more vaccines and, critically, the resources required to roll out a vaccine program into remote parts of the country, to get this outbreak under control and to keep the people of Papua New Guinea safe,” she said.

Morgain said the Government’s support package recognised that “our health and safety and that of our neighbours is interconnected, and that we’re not safe until everybody is safe”, and that supporting developing nations with fewer resources is also the right thing to do.

“That’s why it’s important that Australia does all it can – including supporting proposals to waive patents on vaccines – to allow the quickest vaccine rollout possible in all developing countries,” she said.

Oxfam’s call for more PNG support  was echoed by ChildFund Australia, which warned that PNG’s healthcare system, which struggled at the best of times to manage the spread of infectious diseases like tuberculosis and measles, was “at risk of collapse”.

“We have serious concerns that PNG’s healthcare system will not be able to sustain the additional pressure of a major COVID-19 outbreak,” said CEO Margaret Sheehan.

“Getting the vaccines into PNG for healthcare staff is one hurdle – the other challenge will be the logistical rollout of the vaccine among the general population,” she said, noting that some communities are accessible only by foot so a full vaccination rollout will take “many months”.

Penny Wong said the unfolding situation in PNG was deeply serious and “a clear and present danger not only to the people of Papua New Guinea, but also to Australia”.

“We all know this is a porous border, we all know how close we are to PNG and we’ve seen this highly risky situation unfolding for some time now,” she said.

Vaccine rollout “chaos”

The PNG crisis came as critics described Australia’s slow domestic rollout of COVID-19 vaccinations as a “shemozzle”, ahead of the beginning of the Phase 1b rollout of vaccines through general practices.

Peak medical groups today criticised the Federal Government for allowing “unrealistic expectations” to build after GPs were “inundated” by people wanting to book their vaccinations while GPs were still uncertain how many doses they would get.

The Government had not done enough to communicate with patients about the rollout process, according to Royal Australian College of General Practitioners (RACGP) President, Dr Karen Price.

GPs’ phones were ringing off the hook at practices named in some newspapers, while GPs were yet to be sure how many doses they would get and when, and as the Federal Health Department website struggled to keep up.

Grattan Institute Health Program Director Professor Stephen Duckett said the Federal Government had not anticipated the size of the logistic exercise, and had “put its eggs in the GP and pharmacy basket”.

To meet its targets, it would need to fully engage with and fund the states to roll out mass vaccinations in halls across Australia, he told ABC TV’s The Drum.


United States action

By contrast, in the United States, the Biden Administration announced on 11 March that it would double the number of federally-run mass vaccination centres, including the use of mobile units to travel into local communities to provide vaccines directly in underserved populations.

As well, the vaccine can now be given in the US by dentists, advanced and intermediate emergency medical technicians, midwives, optometrists, paramedics, physician assistants, podiatrists, respiratory therapists, and veterinarians, as well as medical students, nursing students, and other healthcare students.

Opposition health spokesman Mark Butler told media today’s “chaos in the online booking system” was not good enough, and that systems should have been tested and finalised weeks ago. “Instead, all older Australians and GPs are seeing out there today is chaos and confusion,” he said.

According to Curtin University researchers, preliminary research suggests Australia needs to be administering 200,000 vaccines per day to hit the October deadline for all adults to be vaccinated, but the ABC reported just 159,294 people in total had been vaccinated as of March 12.

“Almost a month into the rollout, the total number of vaccinated Australians is fewer than the number we’ll need to vaccinate each and every day,” wrote Elizabeth Jackson and Sharyn Curran at The Conversation.

“It’s fair to say we’ve not exactly hit the ground running,” they said, though adding Australia is likely to catch up and that there are “risks in accelerating and pressuring the supply chain purely to hit an arbitrary deadline”.

Meanwhile, questions are being raised about the safety of AstraZeneca’s COVID-19 vaccine, with more than a dozen European Union countries having suspended its use as the WHO committee of experts is reviewing cases of bleeding, blood clots and low platelet counts in people vaccinated, but says there is no proven link.

Australian vaccine safety experts say it is important to investigate these safety concerns thoroughly but urged “extreme caution” in suspending rollouts, “because once a vaccine rollout is paused, it can sometimes dent vaccine confidence so much that it struggles to recover, as seen in Japan with the Human Papillomavirus vaccine”.

ABC health broadcaster Dr Norman Swan tweeted this thread, which he said seemed to explain why Germany had paused its AstraZeneca rollout. “It’s more than low platelets associated with clots. The issue is not whether the rate is below the usual for thromboembolism but whether rare unusual events are occurring and where and why,” he said.

Australia’s Chief Medical Officer Professor Paul Kelly said today that he has “no concern about the AstraZeneca and specifically the blood clot issue that’s emerged in Europe,” saying his position had been echoed by the European Medical Agency, the WHO, the United Kingdom regulator and the Therapeutic Goods Administration here.

“Things will happen because they happen, it doesn’t mean that they’re related to the vaccine,” he said, telling the Prime Minister’s media conference that while there is concern about vaccine hesitancy in PNG as well as in Australia, uptake in the Torres Strait was strong: “they understand the threat so they are getting vaccinated”.

PNG emergency

Burnett Institute Director and CEO Brendan Crabb and colleague Professor Leanne Robinson this week warned that while Papua New Guinea had avoided many COVID-19 cases through much of the past year, “that situation has changed dramatically over the past fortnight” and a crisis was “now unfolding with alarming speed”.

Low testing rates in PNG are “critically low”, with just 55,000 taken from the nine million PNG population, which means there is no precise picture of the scale of the crisis, but the reported numbers are “highly concerning”, they wrote at The Conversation.

In the first week of March, they said 17 percent of all people who were tested throughout the country  had COVID-19, with over 350 newly confirmed cases. This was the highest number of cases in a single week in PNG since the start of the pandemic, with more than half of PNG’s 22 provinces reporting new COVID-19 cases in that week.

“There are other indicators of a potential large scale outbreak, such as reports of increased cases among health-care workers. What’s more, the total number of documented COVID-19 deaths in PNG has nearly doubled in the past fortnight alone,” they said.

The risks on the ground for patients and staff were spelled out graphically in an article for Guardian Australia by Professor Glen Mola, head of Obstetrics and Gynaecology at Port Moresby General Hospital, who said that since mid-February, the rise in COVID-19 cases in PNG “has been exponential”.

Mola wrote that about 20 percent of women presenting in labour at the hospital had COVID-19 symptoms and about one-third of those — four to five women a day — were testing positive, putting staff at risk, with about 10 nurses and doctors becoming infected each week and having to stay away from work.

He was worried the hospital will “reach a point in the near future where we will have insufficient staff to keep the doors open”.

“If we get to this point, what will happen to the more than 50 women who present for pregnancy care every day? Some may make it home again with their severe pre-eclampsia or life-threatening bleeding or to give birth, while others may end up dying in the hospital car park,” he warned.

The Burnett Institute also warned that the people of PNG now face “dual health emergencies: death and disease from COVID-19 itself, and a likely increase in existing major diseases barely held in check by the nation’s already stretched health system”.

“These indirect effects, such as potential rises in malaria, tuberculosis, HIV, cervical cancer, vaccine-preventable diseases and poor maternal and newborn health, are likely to be even worse than the direct impact of COVID-19,” Crabb and Robinson said.

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