Some Pacific Islands are seeing their first cases of COVID-19 this year – two years after the rest of the world. Global health journalist Meera Senthilingam investigates what 2022 will mean for them.
Meera Senthilingam writes:
Until a few weeks ago, the Cook Islands was one of few places on earth yet to report a single case of COVID-19. Like many of the Pacific Islands, it had remained COVID-free for more than two years due to its geographical isolation, small populations and closed borders, but it was only a matter of time before the virus arrived on its shores – and experts believes this is the case for all the islands that are yet to face COVID-19.
“It will likely reach every corner of every country at some stage,” said Sean Casey, COVID-19 Incident Manager for the World Health Organization’s Western Pacific Regional Office (WPRO).
Even for those with continued border closures in place, Casey explains that repatriation flights, ships coming into ports and fisherman interacting with other boats mean they need to prepare for that scenario. “We have been saying for a good while now that every country needs to be prepared,” he told Croakey.
For the Cook Islands, the moment came in mid-February, less than a month after the nation opened up its borders.
The start of the month, February 8, saw the first scare, when someone who had visited Rarotonga, the largest of the state’s 15 islands, tested positive for COVID-19 on arrival back in Aotearoa/New Zealand. Prime Minister Mark Brown warned of the potential for “silent transmission” as the person had travelled across many islands.
But it was February 13 that the first case tested positive on island soil, again someone visiting from Aotearoa/New Zealand, but community transmission had not yet established. The person had travelled to the Cook Islands with two others who tested positive soon after, bringing the total up to three and prompting a rapid response across the population.
A fourth case was then identified on February 17, in a traveller who had arrived from Aotearoa/New Zealand two days prior and soon after, community transmission on some of the islands began.
“We are prepared for this situation as best we can,” Prime Minister Brown said in a video posted on Facebook, following the confirmation of the second and third cases. As of 1 March there have been 53 cases, the first four now out of isolation, and in his latest address on 28 February, Prime Minister Brown confirmed none have required hospital treatment.
More than 2,000 people have been tested since the first cases were reported and travel to outer islands has been suspended as needed. COVID-19 booster vaccines are also being promoted to top up the already high vaccine coverage in the population.
The Cook Islands has among the highest coverage in the world, with 97 percent of eligible people having had two doses of a COVID-19 vaccine. As of 1 March, 71% had also had a third booster dose. Vaccines also started rolling out in 5 to 11-year-olds earlier this month and have already reached 75 percent coverage with a single dose – earlier and faster than many countries, including the UK.
“Our high vaccination rate provides us with the best possible protection form Covid-19,” Brown said in his 28 February address, but called on restrictions around masks and physical distancing to be followed to reduce transmission in the community and protect more vulnerable members of the population.
Focus on vaccine rollout
WHO’s Casey said the Cook Islands has benefitted from the fact authorities were able to spend a lot of time on vaccine rollout last year without having to respond to coronavirus at the same time.
As Prime Minister Brown pointed out, it’s hoped this immunity will limit the damage coronavirus does among the population, because in locations like these, it is disease severity and the need for hospitalisation that will not only push health systems to breaking point, but put residents at risk due to the vast geography of the territory’s 15 islands.
“If there is a severe case or critical case in one of the outer islands, there are logistical challenges to getting that person to the highest level of care in the country,” said Casey.
These concerns are why authorities in the Cook Islands have spent the last two years, while mostly closed to international travel, on preparation. This has not only meant vaccinating the population but also communicating to the public to increase awareness of COVID-19. Health facilities have also been preparing, Casey explained.
The Prime Minister’s office said “we have expected this virus, we have prepared for it, and we are ready to fight it,” in a statement last month.
Cases soaring on other islands
The Cook Islands are one of a handful of Pacific Islands countries and territories to have seen cases of COVID-19 occurring in the community for the first time this year.
The Solomon Islands, Palau, Kiribati and Tonga also faced the arrival and spread of COVID-19 in January and all but Tonga saw explosions in cases, with 7,049, 3,781, 2,914 and 355 cases, reported respectively, as of 1 March, according to WHO data. The islands are reporting a mix of both the delta and Omicron variant, according to WHO’s epidemiological record.
Palau was heralded for having the highest COVID-19 vaccination rate in the world last year. Its population of just 18,000 has 98 percent coverage for two doses of vaccine and now 60 percent covered with a booster dose, while Tonga’s much larger population is still lower at 65 percent. Deaths in both countries have so far stayed low, with zero to date in Tonga and six in Palau, but health services are stretched. In Palau in particular, the high number of cases in such a small and spread out population – the archipelago consists of 340 islands – means resources simply cannot cope.
In Tonga, routine testing in frontline workers meant earlier detection and response, which has helped keep case numbers low, according to the WHO Western Pacific Regional Office (WPRO) and numbers have since relatively stayed low.
But Kiribati and the Solomon Islands have a different situation in play as COVID arrived with a bang. Kiribati had stayed COVID-free until mid-January, when two-thirds of passengers on the first international flight to arrive in ten months tested positive for COVID-19. Community transmission promptly followed, leading to a strict lockdown.
The Solomon Islands saw their first case in mid-January and reported 100 more within one day, rising exponentially thereafter – including among healthcare staff. Frontline health workers at the National Referral hospital have since raised the alarm that the country’s health system is on the brink of collapse, telling the Guardian that people are dying on the floor due to a lack of hospital beds – a claim dismissed by Health and Medical Services Minister Dr Culwick Togamana who said improvement have been made in recent weeks, in response.
Vaccine coverage is also a concern, with rates currently just 41 percent in Kiribati and just 13 percent in the Solomon Islands, as of 1 March, though Casey says numbers in Kiribati are higher than reported. The low rates reflect hesitancy fuelled by misinformation and rumours, alongside the logistical challenges of getting vaccines to remote island communities.
Kiribati’s ocean territory is the same size as India and the territory has just one plane nationally that can travel to those islands and deliver equipment, Casey explains. “Populations are scattered over huge distances, so there are extremely challenging logistics there.”
The Solomon Islands also faced civil unrest in November following an attempted coup.
Casey believes risk perception is a factor, with COVID having not been a reality for people until now. With no COVID cases, there is “low risk perception, a lower sense of urgency, which changes when you end up in a transmission scenario and deaths reported on a daily basis,” said Casey.
Exemplifying this is a rise in demand for COVID-19 vaccines on the Solomon Islands, as observed by Casey and his teams at WHO Western Pacific Region. “We have seen a significant increase in demand in the last couple of weeks,” he said. Indeed, teams had to suspend some sites because of overcrowding and the risk of coronavirus spreading.
An additional barrier stemming from the geography, with people living across hundreds of islands, is that connectivity and communication issues make it difficult to address and overcome myths and misinformation around COVID-19. “There are lots of languages, populations are spread out over hundreds of islands, and it is a low resource setting,” he said.
Fragile health systems
The International Federation of the Red Cross (IFRC) said in a recent statement that “ramping up vaccinations is critical” in the Solomon Islands, given COVID-19 is “overloading the country’s fragile health system.”
The Solomon Islands has reported 99 deaths as of 1 March, and according to the IFRC, one in two people had COVID-19 symptoms last month, causing testing facilities to be overwhelmed. Many more people likely to have the virus than official figures show. More health workers are also becoming infected, the IFRC said.
“COVID-19 is spreading faster than the wind from our cities and towns to the most remote communities. Testing and health services are overloaded, and this dangerous virus is running rampant in villages where people are yet to be given a first dose of the vaccine,” said Clement Manuri, Secretary General of Solomon Islands Red Cross Society.
In many Pacific Island countries, healthcare systems lack resources, equipment and infrastructure, compounded by the remote environment, according to IFRC. These islands also face natural disasters regularly – cyclones, floods, tsunamis, volcanoes – which need responding to as well as outbreaks, as happened with the volcanic eruption in Tonga in December and Cyclone Cody in Fiji in January.
Anything that can be done to prevent the need for people to turn to healthcare facilities is therefore extremely crucial, and more so here than many regions of the world.
Katie Greenwood, Pacific Head of Delegation at the IFRC highlighted the consequences of low vaccination rates.
“Solomon Islands and other countries in the Pacific are facing their first wave of COVID-19 and it’s clear that vaccinations help protect people from severe illness, hospitalisation and death, particularly in countries with fragile health systems,” she said, adding that outbreaks in Fiji and Papua New Guinea (PNG) have shown “how this ruthless virus overwhelms hospitals and health systems.”
Fiii has reported more than 63,000 COVID-19 cases and 834 deaths to date, while PNG has reported more than 41,000 cases and over 630 deaths. Experts across the region are concerned repeat scenarios will happen across the Pacific Island communities as they face either first cases or new waves of COVID-19. Six Pacific island nations are yet to report a case of Covid-19.
Casey told Croakey that some countries have been repatriating hundreds and hundreds of people at a time, meaning there will be cases, even with quarantine and testing in place. “We say to the countries, this could happen imminently, so you need to prepare,” he said.
What lies ahead
The Pacific Islands were able to firmly shut themselves off from the rest of world – and each other – and have watched how the pandemic has unfolded elsewhere, to inform their preparations. But their economies need international – and national – exchanges to survive.
Lockdowns and continued border closures are not viable for a region that relies heavily on tourism for income. According to a report by the Pacific Private Sector Development Initiative, tourism provides more than 20 percent of the gross domestic product (GDP) in six Pacific Islands, including the Cook Islands where the figure was 66 percent. In 2019, tourists outnumbered the local population in Kiribati 11:1.
The government of the Solomon Islands is already reviewing COVID-19 restrictions with a view to relaxing them. Prime Minister Manasseh Sogavare said in a nationwide address in February that COVID-19 was challenging the country’s economy, with measures such as the countrywide lockdowns “not sustainable, especially in a small economy like ours.”
Sogovare added that the primary objective now was to “manage the community transmission of COVID-19, while protecting those at risk and those who are vulnerable to community transmission, while sustaining the economic livelihoods of our citizens”. Though the Health and Medical Services Minister continues to stress the need for the public to stay vigilant in practicing Covid-19 safety measures.
But this will inevitably highlight certain vulnerabilities in the population.
Not all the islands have had equal access to resources such as vaccines during this time, leaving some, like the Cook Islands, in better situations than others, like the Solomon Islands following the challenges around logistics, delivery and hesitancy.
Many Pacific Island communities also have among the highest rates of obesity and diabetes in the world, which we know increases a person’s vulnerability to severe disease from Covid-19. Kiribati and Palau have around one in five people living with diabetes and their healthcare facilities will not be able to cope with many severe cases.
And with other parts of the world relaxing restrictions – and people from those regions visiting the islands on holiday – will the Pacific Island populations be able to maintain them for long?
Casey believes the preparations made in the last two years will prove to be valuable as the year plays out.
“Fiji had a large Delta wave last year and has reopened and is now transitioning to trying to live safely with COVID-19,” said Casey. “We’ll probably see more evolution in that direction in the months ahead across the Pacific.”
Meera Senthilingam is a global health journalist based in London and an editor at Croakey
• Croakey acknowledges and thanks donors to our public interest journalism funding pool for supporting this article.
Previously at Croakey by Meera Senthilingam
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