As the COVID-19 crisis besieging Papua New Guinea (PNG) escalates, the nation’s healthcare system is over-burdened and under-resourced. Hospitals are overflowing and there are makeshift clinics set up in an aquatic centre and a sports ground in the nation’s capital, Port Moresby.
As of 30 March, PNG has reported 5,620 active cases and 56 deaths, but these figures are considered conservative because testing rates around the country remain low.
Just under a week ago, Queensland Heath announced that the strain of COVID-19 found in returned travellers from PNG was a new lineage, labelled B.1.466.2. Currently, it’s believed to be less contagious than both the so-called UK and South African strains; Queensland Health has said it’s not a “problem line.”
But the emergence of a new strain raises alarm bells about the rate the disease is spreading through the country, and the risk it poses.
A fragile healthcare system
“Our colleagues in Papua New Guinea are tired, they are working under extremely challenging circumstances to provide the best possible care that they can,” says Dr Rob Mitchell, an emergency physician and PhD candidate at Monash University, whose emergency triage system is currently being implemented in the country.
But Mitchell says PNG’s healthcare workers are hampered by a struggling system, where the workforce amounts to 0.7 doctors per 10,000 people. By contrast, Australia has about 38 doctors per 10,000 people.
“PNG has a very fragile, under-resourced healthcare system,” says Mitchell. “Many patients have difficulty accessing healthcare at the best of times, and the current outbreak has added significant stress.”
Mitchell attributes the system’s current crisis to a small, stretched workforce and a lack of resources – including critical supplies of oxygen and non-invasive ventilators.
The COVID surge also raises fears about overspill into neighbouring Pacific nations, says Mitchell. “The big risk is the very porous PNG-Solomon Islands border.
“Solomon Islands is getting or has recently got 30,000 vaccinations, but the pandemic could spill into Solomons and [further] on to the Pacific.”
Vaccines critical to stem crisis and prevent mutations
In response to the crisis, Australian Prime Minister Scott Morrison sent 8,0000 vaccine doses to PNG, which landed on 23 March and are due to be administered in coming days. But there are questions about whether 8,000 shots is enough to scratch the surface of the crisis, and whether the nation’s unreliable electricity will threaten the refrigeration required to keep the AstraZeneca vaccine functional.
“Obviously, 8,000 vaccines is a very limited number in a country of approximately 8 million people, so I’m really hoping that the Australian government can further step up its support to make sure that in the first instance all essential health workers in Papua New Guinea can be vaccinated,” says Mitchell.
“There are significant numbers of health-care workers who are being infected with COVID-19, and because there are so few health workers in Papua New Guinea, that really threatens the sustainability of the health system.”
PNG has yet to benefit from COVAX, the international initiative to provide equitable access to COVID-19 vaccines. The promised 228,000 COVAX-funded doses, originally set to arrive in the nation next month, are potentially delayed as India halts its vaccine exports.
Despite these setbacks, the emergent crisis highlights the importance of the initiative: COVAX is both an ethical and a practical venture, because the unequal distribution of vaccines to wealthy countries allows mutant strains to spread and thrive in poorer nations, risking millions of lives and threatening the coordinated global fight against the virus.
Says Mitchell: “The best thing that Australia can do to stop the emergence of mutant strains is to help suppress the virus. If there is unmitigated community transmission of the virus that creates an environment where mutant strains can emerge.”
The Department of Foreign Affairs and Trade was contacted for comment about Australian vaccines going to PNG, but had not responded at time of publication.
PNG’s pandemic history
PNG has historically managed to avoid the worst ravages of recent pandemics, including H1N1 (‘swine flu’), which infected more than 37,000 Australians and only one PNG local. Despite this, epidemiologists have long identified PNG as an area of concern due to limited resources, remote populations, and greater contact between individuals.
The country is also uniquely vulnerable because of lack of access to sanitation, and hygiene issues.