The rise of COVID-19 in Papua New Guinea

Papua New Guinea has been somewhat sheltered from the COVID-19 pandemic, with relatively low numbers throughout 2020. Since late February, however, the country has experienced a spike in new cases.

Currently, there are over 2000 reported cases, but this is likely to continue to rise without interventions. Critically, this is not necessarily the true burden of cases, because high rates of testing in PNG are difficult to achieve due to limited access to or uptake of testing.

This wave poses a great threat to the country because medical resources are already stretched. Front-line medical workers who are at high risk of contracting COVID-19 are critical, so require vaccinations as quickly as possible.

Australian Prime minister Scott Morrison has pledged to send 8,000 AstraZeneca COVID-19 vaccines to PNG, and has urged AstraZeneca and European authorities to provide another 1 million, that were originally contracted to Australia, directly to PNG. However, compared to the total estimated population of 9 million, this is nowhere near enough.

Swift action is essential for managing pandemics, but decisions are also weighed against medical capacity, culture and resource availability. Lockdowns in Australia will likely play out completely differently to PNG, because there are key differences between access to basic resources and social attitudes.

In PNG, livelihood insecurity complicates strict lockdown laws because access to income, food and safe drinking water is often only possible from outside the home. For example, only 43% of the population can access safe drinking water within a 30-minute return trip from their home and food insecurity requires similar travel.

Beyond these challenges, large numbers of COVID-19 infections can also lead to mutations in the virus that affect how quickly it spreads or how deadly it could be. Without adequate management in resources, the emergence of these novel mutations could affect how effective vaccines are, too.

“We need to ensure, globally, that we don’t leave countries behind that we have an equitable distribution of vaccines,” says Leanne Robinson, a vector-borne diseases researcher who spent 10 years in PNG.

COSMOS Magazine spoke to Professor Robinson, Program Director of Health Security and Group Leader and Vector-Borne Diseases & Tropical Public Health at the Burnet Institute, to discuss the situation.

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Interview Transcript

Deborah Devis 

Hi, and welcome to Cosmos Insights, a Cosmos Briefing Bonus, where we interview experts around key issues in science. I’m Dr. Deborah Devis and today I’m talking to Professor Leanne Robinson, program director of health security and group leader of vector borne diseases and tropical public health at the Burnet Institute. So hello, Leanne. It’s lovely to have you here.

Leanne Robinson 

Hi, Deborah. It’s nice to join you.

Deborah Devis 

Thank you. So a little context, for those of you who are listening, Papua New Guinea has not been having very many COVID cases for the last little while they had a small spike a little bit last year. But since February, I’ve had quite a few new cases. So I think currently, and this is in currently in mid March, we’re at about 1500 cases.

So for a country that was experiencing relatively low COVID cases, and it was seemingly under control, this spike that’s happened in February makes it seem like it got serious quite fast.

So Leanne, what is the situation in PNG right now?

And was it ever truly under control when it came to COVID?

Leanne Robinson 

Yeah, look, there’s certainly been a very rapid escalation in the number of new cases in the past fortnight. And in fact, now it’s well over 2000 total cases that have been documented in PNG, with more than 450 cases in a single week, last week, and even more than 300 cases on Sunday alone.

And as you say, I guess, you know, these numbers also need to be taken in the context of what is still an overall low rate of testing in in Papua New Guinea. And so knowing what we know about COVID-19, and the constraints of the healthcare system in PNG, this obviously has very many people extremely worried in terms of why the increase now, you know, I think it’s very difficult to say, based on the available data.

Certainly last year, PNG implemented a strong response early on in the pandemic and early cases really didn’t spark the chains of transmission and explosion of cases that we saw in other settings.

And I guess the lack of some risk factors that exacerbated first and second waves in many other settings, such as cities with really concentrated population density and higher rates of, of indoor social mixing, especially in the winter, they kind of appeared as though they might work in PNG’s favour.

And it’s also really well documented that only 20% or less of infected people give rise to 80% of ongoing infections.

So it’s very possible that some of those spikes we saw in PNG, you know, in August and September of last year, that they did die out, actually. And what we’re seeing is is a new sort of surge and spike.

It’s also possible that there was continued low level transmission, especially in Port Moresby, where there has sort of been a steady number of new cases are over the period, but possibly also in other areas that went undetected with the limited testing that would that was able to be in place.

Deborah Devis 

What was some of the reasons for that limited testing?

Leanne Robinson 

So I think combination of factors are in PNG.

People are incredibly resilient and so people don’t rush off to a health facility when they’re suffering from a mild or even a moderate illness. So people presenting for testing has definitely been part of the problem.

And then being able to ensure that PNG’s health system was equipped to be able to conduct comprehensive and rapid testing, you know, right across the country has certainly been a challenge and something that all of the PNG organizations involved have been working really hard on over the past 12 months with a lot of support from the Australian Government in terms of ramping up that capacity for testing.

So, both of those things contribute to a low overall rate of testing.

I think it’s also notable that the period of increased travel and social mixing over Christmas over December and the new year period, traditionally a time in PNG when people travel extensively, you know, from large urban centers, like Port Moresby and lay home to see their family to go to the village.

You know, this could have contributed to some seeding of infections throughout the country.

There are also widespread reports really of a fairly relaxed attitude to the threat of COVID-19 in PNG. I think last year, when these escalations were occurring in other parts of the world PNG didn’t suffer from, from these escalations. And I think that that contributed to people feeling quite safe. That this is not something that was going to impact us and actually, you know, we’re okay.

And so you know, the uptake of non-pharmaceutical interventions, or as it’s called in top person in PNG, the nuclear person rules around social distancing and wearing of mass probably have not been really able to be implemented, to the extent that that could have potentially reduced some of the transmission we’re seeing now.

Deborah Devis 

Yeah, absolutely. And even being in a country like Australia, where we were relatively sheltered compared to the rest of the world, and PNG having an even less seeing even less impact, it makes a lot of sense where we can see that happening.

But beyond the social attitude, what are the public health resources like in PNG?

Leanne Robinson 

Look, they’re incredibly stretched.

And, you know, I think it’s really important for people to understand that the majority of Papua New Guinea’s estimated 9 million people live in rural areas of the country where access to health care is very limited. And we’re talking about, you know, health facilities that might be staffed by just two or three or four people.

And if some of those staff start to get sick themselves from COVID, their health facility closes, leaving a community with without access to basic health care.

 And also, right across the country, you know, there are substantial challenges with transportation and logistics, and by extension, food security.

And so when you combine that with you know, a high average number of people living in a household, and that inability to therefore effectively social distance or isolate, if you are sick, you know, crowded situations, on transport on private motor vehicles, you know, that that are really relied upon to to get around, then, you know, the need to go to food markets to in order to be able to live, it’s very difficult for people to just, you know, lock down in in the PNG situation.

And so, all of this really, also combined, I think last year, to mean that lock downs were an incredibly blunt instrument in a setting like PNG, and cause substantial hardship, you know, just through that inability to actually go about what’s needed for one’s daily life.

So, I think all of that, you know, has also probably contributed to now the the decision around lockdowns also being an incredibly difficult one for the COVID-19 control and the PNG government.

Deborah Devis 

Of course, so if those healthcare resources are already stretched, plus, adding on to that the sheer food insecurity and lack of security and other places that come from having a lockdown, what can happen?

What can happen immediately?

What are those next steps for PNG?

Leanne Robinson 

Oh, look, I mean, immediate escalation in the response is needed. And I think we’re seeing that now.

You know, we’ve seen the Prime Minister James Morape, give several press conferences now about changes in restrictions and new rules coming into effect.

We’ve also seen the announcement this morning from the Australian Government, that there will be 8000 doses of the AstraZeneca vaccine provided immediately, as soon as next week in order to vaccinate all of pain days critical frontline health workers.

I think these things will help, but there’s also needs to be, you know, great leadership on how serious a threat COVID-19 is in PNG, that it is a disease and also that it is in terms of its impact on the on the health system, you know.

Those 8000 doses also, you know, they’re not going to implement themselves, like, there obviously needs to be a lot of support around the vaccine strategy.

And PNG is prepared for that, you know, a there’s a vaccine technical working group and there’s been work around vaccine readiness plans and community awareness. But this now has to be rolled out at a speed and scale that was not really what was being, you know, planned for just a month ago.

So I think increased support for that community awareness for faith based non-government organizations which play a very important role in PNG in public health awareness that will be needed in order to ensure community trust in the public health program and the vaccine rollout in PNG.

Obviously, in the, in the short medium or even longer term, you know, there’s also a huge need for continued sustained support, to strengthen health services, to be able to support what is a small health workforce, you know, with the challenges that lie ahead.

Deborah Devis 

So it’s really great to hear that countries are trying to help each other when one has more resources than the other. But 8000 doesn’t sound like a lot compared to a population of 9 million.

So, how far will that go?

Leanne Robinson 

Well, exactly. I mean, we are so far only talking about those 8000 doses for critical frontline health workers.

So, it won’t go any further than that and I think that’s, that’s now where, you know, the work starts, because what about their families? What about all of the essential support services that are going to be needed to deliver an effective vaccine program, you know, these people will require protection as well.

Deborah Devis 

Wonderful. So PNG will have been looking after and managing other sorts of diseases as well.

How do you think that this particular situation well, managing COVID, could affect the management of other diseases like malaria?

Leanne Robinson 

Yeah, look, I mean, it’s absolutely going to have an impact with rapidly increasing numbers of healthcare workers.

We’re seeing the reports out of, you know, Port Moresby General and that will be reflected around the country in terms of, of health care workers becoming sick, sick with COVID.

There’s just a very real fear that the already stretched and fatigued health system won’t be able to withstand the additional pressure of an escalating number of COVID cases. We’re already hearing reports of health workers unable to go to work, or else too afraid to go to work, for fear of catching COVID [and] of bringing it home to their to their families.

So, I think there is very real potential for the recent gains, hard won gains, in HIV, TB and malaria control to be lost unless we can protect those frontline health workers, those critical essential staff, that are doing bednet distributions as part of their normal job on a normal phased rollout, programming PNG. If we can’t protect them, then those essential tools won’t be delivered, and we will suffer setbacks.

Deborah Devis

Yeah, absolutely.

And for a population that, like you said, uses a lot of public transport and can be tightly packed at those times.

You and your fellow Burnet colleague, Professor Brendon Crabb have written about your concerns that some Asia Pacific places have the potential to be breeding grounds for mutant COVID strains.

Can you explain why this might happen?

Leanne Robinson 

Yeah, I mean, increased viral transmission, anywhere, so not just in PNG, but in any country, in our region, or in the world, you know, it just creates this greater opportunity for the emergence of SARS-CoV-2 variants.

This is normal, viruses mutate, and they usually do that under pressure. So you know that some of the current variants of concern are more transmissible.

But it’s possible that as vaccination programs continue to be rolled out, that there may also be new variants of concern that evade immunity. And this is a very real concern and a threat to the global vaccine program and the regional vaccine program.

Deborah Devis 

Is it preventable at all?

Leanne Robinson 

It is preventable by responding as quickly as possible to reduce transmission, and so fewer new infections mean less viral replication, which in turn lowers the risk of new variants.

So the situation can only really be achieved by that combination of non-pharmaceutical interventions and scale up of vaccines.

So, you know, we need to ensure, globally, that we don’t leave countries behind that we have an equitable distribution of vaccines.

We also need to make sure that we’re strengthening surveillance for variants of concern. So we know when they are arising.

And globally, as our capabilities to produce COVID-19 vaccines reactively and adapt them to emerging strains needs to be to be fortified.

Deborah Devis 

Yeah, absolutely. I think that’s fascinating hearing about the importance of how quickly we need to have a response, how we need to understand the culture of where we’re working in order to actually make effective responses to that and also looking after each other when it comes to distribution of vaccines as well as sharing this information.

So thank you so much. It’s been really wonderful talking to you. And this has been a Cosmos Briefing Insight. If you want to know anything more about the situation in PNG or anything COVID-19 related or far beyond that into the science sphere, please visit us at Cosmosmagazine.com. Thank you.

Leanne Robinson 

Thank you very much.