CANBERRA — The Pacific Island countries have not yet seen coronavirus cases, but the vulnerability of the region to infectious diseases — highlighted recently with a measles outbreak — means country plans and responses are being implemented to prevent the virus from being imported and to deliver a rapid response if it is.
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Travel restrictions have already been implemented by a number of Pacific countries, not just from China but countries that are deemed high risk as well. The World Health Organization, Australian and New Zealand governments, and the Pacific Community — or SPC — are among the players supporting countries in the region with their needs for preparations.
“Considering the challenges faced by the Pacific such as vast distances, dispersed and isolated islands and populations, and limited resources, even a small number of cases could quickly cause significant strain on health systems.”— Dr. Corinne Capuano, director of Pacific technical support, WHO
New Zealand recorded its first case on Friday, putting Pacific Island nations at a greater risk. Concerns also exist that lack of robustness in health systems, an unprepared health workforce and the composition of demographics may still be against the region if COVID-19 is detected.
“Coronavirus may not come to the Pacific [island nations], but something will,” Meru Sheel, a research fellow with the National Centre for Epidemiology and Population Health, told Devex. “Facilitating preparedness and surveillance is critical. But [health] workforce retention, a trained workforce and an increased capacity of this workforce is also critical so we are not just reacting to outbreaks when they happen.”
The state of play in regional assistance
WHO in the Pacific is coordinating with humanitarian and development partners in a multiagency incident management team, and is being led by the Division of Pacific Technical Support in Suva, Fiji. Australia, New Zealand, and SPC are among the key regional players, with their role to support and guide Pacific Island countries in preparedness, surveillance, and response activities.
“WHO in the Pacific is pulling in resources with different areas of expertise, repurposing many of our staff in order to provide timely support,” said Dr. Corinne Capuano, WHO director of Pacific technical support.
“We are working with governments and partners around the clock, making sure that our preparedness and response plan is strategic, well-coordinated, and timely.”
There is a range of other activities supporting preparedness — including weekly preparedness meetings for U.S.-affiliated Pacific Islands, regular Fiji task force meetings, and individual country preparedness planning.
Regional donors including Australia and New Zealand are supplying a range of assistance to help prepare.
Personal protective and medical equipment that is needed for health care facilities is provided on the requests of countries. This includes masks, goggles, gowns, and sanitizers. Technical assistance is also being provided in areas such as national coronavirus response planning, infection prevention and control, and risk communication.
Those countries are also supporting WHO in its implementation of a six-month Pacific Action Plan for 2019 Novel Coronavirus (COVID-19) Preparedness and Response, which includes providing countries with enough supplies to support 50 to 100 cases — either suspected or confirmed.
Services in the region are being used to support testing for COVID-19, including surveillance and laboratory assistance from the Public Health Division of SPC based in Fiji, as well as services of the Victorian Infectious Diseases Reference Laboratory based in Australia, which has already been utilized to test samples of suspected cases — all of which have returned negative results. SPC is also supporting surveillance through the sharing of epidemic intelligence and mapping.
In the event of an actual outbreak in the region, it is expected that Pacific countries will request support from foreign emergency medical teams such as the Australian Medical Assistance Teams. These teams could be deployed in various ways, ranging from small teams of public health personnel to large teams of clinical personnel with an associated field hospital capacity.
Coronavirus by region:
As part of its development assistance program, the Australian government is leveraging expertise within the Indo-Pacific Centre for Health Security. A range of activities from the center, either underway or understood to be starting in the coming weeks, are directly relevant for regional COVID-19 preparedness.
These activities will support governments in the region with infection prevention and control, laboratory strengthening, outbreak response, and surveillance, and will be adapted to directly focus on the challenges of COVID-19. The center will also be putting Australians into key positions within WHO’s Suva office and its Western Pacific Regional office to deliver better coordination between bilateral and multilateral assistance in the region.
Preparations prior to the December emergence of COVID-19 in China has put many Pacific nations on a path of strengthened surveillance systems to infectious diseases more broadly.
Melanie Bannister-Tyrrell, a senior consultant with Ausvet and an author of “The State of Health Security in the Indo-Pacific Region” report, told Devex that several countries have made significant progress toward implementing core public health capacities to improve preparedness.
“The Federated States of Micronesia has completed a voluntary joint external evaluation of their preparedness for public health emergencies,” she said. “This showed a number of key strengths, especially the quality of the surveillance system, and laboratory capacity to detect emerging infectious diseases such as COVID-19.”
Papua New Guinea, since 2013, has had a field epidemiology training program providing training in outbreak response to officers embedded in the health system with other training programs either starting up or underway in other Pacific countries. And some Pacific countries have experience in implementing early warning and response systems for outbreaks and other health emergencies which can be rapidly implemented and greatly increase access to crucial data during an outbreak.
Innovative approaches to health, Bannister-Tyrrell said, are also supporting Pacific countries to improve their capacity to prevent, detect, and respond to public health emergencies.
“As an example, Tupaia is a Pacific regional project to combine data sources and map laboratory diagnostic capacity, medical supplies, and outbreaks throughout the Pacific,” she said. “These initiatives have been initiated and scaled up in the past few years, which shows the importance of investing in public health prior to an event such as COVID-19.”
Health system gaps
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While health systems to detect outbreaks are improving, there are still many gaps. The Pacific is a region with diverse challenges related to population, economics, geography, and health. While the region as a whole is preparing, strategies need to be tailored to the needs — and gaps — of specific countries.
“In the Pacific, currently, health system capacities are at various stages in their preparedness efforts to respond to a large scale outbreak,” Capuano told Devex. “However, considering the challenges faced by the Pacific such as vast distances, dispersed and isolated islands and populations, and limited resources, even a small number of cases could quickly cause significant strain on health systems, both in terms of responding and implementing the public health measures necessary to contain spread.”
“It is now the time to enhance surveillance systems to ensure they can identify cases as early as possible. And at the same time it is important to really strengthen the health workforce and implement strong prevention measures.”— Meru Sheel, research fellow, National Centre for Epidemiology and Population Health
WHO is “working intensively” with Pacific governments to fill the gaps in preparedness and response, Capuano said. But this gap may not be possible to fill in the region, Dr. Sanjaya Senanayake, an infectious diseases specialist at the Australian National University, told Devex.
“Countries with a less well-resourced system may struggle to deal with COVID-19,” he said, explaining that the infectious nature of the virus, incubation period, and ability to be transmitted while a patient has no apparent symptoms creates challenges for detection. “Without having the details at my fingertips, I would imagine that this includes some of our Pacific island neighbors.”
For Sheel, concerns were also raised about the strain health facilities and workforce may be under after responding to the recent measles outbreak.
“Fatigue in the system is really high,” she said. “It is a cycle that shows us these health systems are vulnerable — not just from infrastructure point of view but the fatigue of the workforce which, in these settings, is limited.”
Supporting the workforce, Sheel said, was vital in ensuring they were ready for another potential outbreak — and adequately trained for COVID-19.
“We know that the earlier we detect cases, the better we are at controlling an outbreak,” she said. “It is now the time to enhance surveillance systems to ensure they can identify cases as early as possible. And at the same time it is important to really strengthen the health workforce and implement strong prevention measures. That needs to be done now.”
Bannister-Tyrrell said training should focus on the implement effective infection prevention and control in health care facilities with clear protocols established for suspected case management.
“This includes hotlines for potential cases to contact in the first instance and establishing facilities and procedures so that suspected cases can be tested and treated without posing a risk of infection to other patients, health care workers or the general public,” she said.
In responding to potential cases of COVID-19, population dynamics will play a make or break role for disease control in the Pacific. With measles, Sheel explained that the movement of population, high-density settings, and communities where 20 people can live in one household helped build the infection tally.
“Measles was able to spread quickly because of this issue,” she said.
Ensuring surveillance systems respond quickly is vital to prevent outbreaks and communicating effectively with populations throughout the region is essential. This includes the basics of investing in education on hygiene — an area Karen Page, the public health in emergencies delegate for the Red Cross in Suva, is focused on supporting in partnership with WHO and UNICEF.
“To reduce the risk, we can’t say often enough that the best protection is washing your hands,” she told Devex.
“Social distances, coughing properly, avoiding people are all important practices. But it is very hard to change ingrained habits for all of us.”
Putting the challenge back to communities to be responsible for their own health is a message WHO is also communicating broadly in the region.
“In addition to measures that governments are already taking, it is also important to emphasize that we all share a collective responsibility to act to protect ourselves, our communities, and the most vulnerable among us,” Capuano said.