The consequences for Papua New Guinea and Australia of low covid vaccine acceptance in PNG

Looking at the development assistance allocation for Papua New Guinea in last week's federal budget the standout is the focus on the Covid-19 pandemic, and especially vaccinating the 8.5 million people of our closest neighbour.

Clearly the Australian Government believes that mass vaccination is the best, if not only, solution to the escalating Covid-19 crisis in Papua New Guinea.

That is the policy being pursued here in Australia, as are all developed countries, and some developing countries.

Sadly, the hope that mass vaccination will contain the pandemic in Papua New Guinea seems to me to be defying reality – and is in need of urgent and total revision!

Before I write my opinions on Papua New Guinea I often consult my many PNG contacts in politics, business, the NGO sector and wider community.

I sometimes wonder whether DFAT and our High Commission in PNG do the same?

There have in recent weeks been any number of reports from medical practitioners and health workers in PNG expressing grave concern at the extraordinarily low "acceptance rate" of vaccination among health workers, let alone the wider population.

Various sources have confirmed that as many as half the nation's front line health workers have either rejected or are reluctant to take the vaccine which is on offer.

So I decided to ask a couple of my business contacts what the attitude of their workers, and especially national workers, toward being vaccinated.

The response was absolutely alarming! In the case of one employer in the transport sector all ten Australian workers agreed to be vaccinated. Of the 180 Papua New Guinean workers just THREE agreed to be vaccinated! And that was after the employer told them continued employment might be dependent on being vaccinated.

The second employer is a major player in the hospitality sector. Of his 150 Papua New Guinean workers all but THREE declined to be vaccinated!

These statistics don't lie or mislead. They reflect the real world in our nearest neighbour.

All the contacts I consulted agreed that it will be an absolute miracle if 25 per cent of the Papua New Guinea population agreed to be vaccinated.

The accepted international standard is that a minimum of 75 per cent vaccine take up is necessary to provide adequate community protection.

There are many reasons why the response so far is tragically low Without going into them comprehensively they centre around cultural opposition to vaccinations generally, an organised social media campaign against vaccinations AND a total lack of community confidence in the Papua New Guinea health system.

What can Australia do in the face of this reality?

It is clear to me that it is beyond our capacity, and beyond Papua New Guinea's capacity, to secure even majority vaccine take up across the diverse communities of Papua New Guinea.

It is apparent the development assistance allocation for the year ahead, though well intended, is frankly misdirected.

I believe the last thing we want on our border and in our populous closest neighbour is Covid-19 being endemic in the population. Even with low testing, and unreliable reporting of cases Papua New Guinea is today experiencing a daily average of 250 new cases with the majority in Port Moresby and Western Province (the Province nearest to Australia) but increasingly in just about all of the 22 provinces in Papua New Guinea.

So while it might not yet be classed as "endemic" it is apparent the virus is spreading rapidly. Since the virus was first detected there have been just 110,00 tests done in a population of more than 8 million (and many of those tests have been taken up by the expatriate community). From those tests 13,500 have been positive. That is by world standards a very high percentage.

One reason why even that number of positive tests has not increased apparent community resistance to vaccinations is that the death rate is comparatively low – 136 deaths up to the middle of last week.

The low though tragic death rate is almost certainly due to the fact that the average age of the PNG population is in the 20's.

Having consulted widely, and read extensively, I believe Australia must urgently revise its approach to development assistance for Papua New Guinea. We have been generous in the provision of protection and testing equipment, and the supply of vaccines.

But the real issue we have to confront as a good neighbour and persuade the Government of Papua New Guinea to confront is the overall condition of the PNG health system – hospitals, health centres and the supply of vital medicines across the country.

While Covid-19 is a crisis for PNG so is the true state of the health system and its devastating impact on the health and living standards of the good people of our neighbour.

Infant mortality rates are alarming, and diseases such as malaria, cholera, HIV Aids and even polio, are either increasing or at best stagnant.

It is hardly a wonder given the run down state of most hospitals, including major hospitals, and the alarming condition of most rural health centres. About half the health centres of the nation are ether closed completely or effectively inoperative because of a lack of trained staff and vital medicines.

The people of Papua New Guinea regard the health system as a failure. One saving grace is that most church-run hospitals and health centres are functioning efficiently even with delays in the provision of much needed funding support from the national government. Another is the work still being done under difficult circumstances caused by border closures by groups such as YWAM, and NGOs in the health sector.

What Australia should be considering with urgency is how we can play a substantial role of rebuilding the health system and in the process restoring public confidence in it.

That is a herculean task I know but here is how we can made a substantial impact as soon as possible. And if we don't want a crisis far worse than Covid-19 incidence on our border it just has to be our focus.

I would start with properly resourcing key national hospitals starting with Angau Hospital in Lae. We should seek the approval of the PNG Government to effectively take over the management of Angau. Australia paid for a much needed rebuilding program but it needs more skilled staff and resources,

Port Moresby General Hospital is also under pressure because of Covid-19 cases (Port Moresby has had over 4,700 cases already). It needs help as well.

But why taking over Angau as first priority makes sense is the capacity to help meet the urgent health needs of the Highlands Region (40 per cent of the national population) and Momase (Madang, Wewak etc) which are more accessible to Lae than Port Moresby.

If Australia managed and resourced Angau it could readily help improve health services in at least half the PNG provinces provinces through the better provision of medicines, and skilled staff.

That is just the first step I believe we must look at. It won't stop the spread of Covid-19. It might slow it though, and it has a real chance of delivering on the first step to getting the people to accept vaccination against the disease. If the health services available to more than half the population are noticeably improved in a short period, then community confidence may increase enough to lift vaccination rates.

It is certainly worth a try – because what exists today is a growing social and health catastrophe we simply cannot afford to have on our northern border, and across every community in our good friend and neighbour.

In my next contribution I will look at how the Australian Government can help worthy groups such as Youth With A Mission (YWAM) which I happily concede I helped take to Papua New Guinea just over a decade ago and a small number of medical and health NGOs doing good work under trying circumstances in Papua New Guinea.

And it means directly funding and resourcing church run hospitals and health centres from Canberra!

But the first response from our government must be to review how we assist Papua New Guinea address the Covid-19 crisis in PNG. That requires DFAT and other agencies to concede mass vaccination is just not going to happen at least in the short to medium term.

We need to help rebuild community confidence in the failed PNG health system – and that is what it is, a failure!

If we can do that there is some chance vaccination acceptance might lift to a level that really helps manage the disease. But that is just not going to happen anytime soon, and most certainly not without radical reform of a health system that is today and has been for some time seriously letting down the good people of Papua New Guinea.

And if anyone in Canberra doubts we have a serious challenge on our border, then surely these alarming stats will persuade them?

There have been 2,300 positive cases in Western Province which adjoins Australia in the Torres Strait. As of mid-last week, just EIGHTY EIGHT people in the Province have been vaccinated.

I rest my case!