The PHAA’s One Health Special Interest Group Convenor, Dr Andrea Britton, recently returned from PNG where she’s been working for the Burnet Institute PNG on a Fleming Fund Country Grant project to tackle antimicrobial resistance. Just out of quarantine, Andrea reflects on her observations, the massive challenges PNG faces in the weeks and months ahead, and she calls for a greater response from Australia to assist our nearest neighbour in its hour of need.
As Australia continues with its policy of snap lockdowns and placing restrictions and COVID testing requirements on travelers associated with new clusters in Brisbane, our nearest neighbour, PNG, is battling surging COVID case numbers and deaths.
While there’s concern about the delayed roll out of vaccinations in Australia, in PNG, where the first vaccination occurred only yesterday, the situation is much more dire. Only a rapid, mass vaccination regime can save the lives of the front liners and most vulnerable of PNG’s 9.5 million population.
The paradox of responding to this SARS-2 pandemic when misinformation, mistrust and misunderstanding is delaying the uptake of public health preventative measures in PNG puts many thousands, if not hundreds of thousands of lives at risk.
With the morgues full and causes of death unknown, increased COVID testing is paramount, with fast and accurate reporting of results vital to make this pandemic more visible to the people of PNG.
Due to the escalating COVID situation in PNG, I returned to Australia earlier this month to get vaccinated, and I plan to return to PNG as soon as possible to continue important laboratory and surveillance system capacity building project work. As a One Health advisor, my public health work is at the human and animal interface, building capacity of countries to mitigate diseases that cross boundaries, like resistant bacteria, and viruses like dog-mediated rabies and SARS-2.
To control COVID we need to strengthen laboratory capacity for accurate diagnosis, and active surveillance systems are needed to measure the incidence and location of cases over time to enable policy development and data-driven decision making.
Placing community at the centre of the response will be vital in PNG, just as it has been in Australia. Building local confidence in COVID vaccines will be essential for the acceptance and uptake of vaccination in PNG. We need to learn from groups (Aboriginal Community Controlled Health Organisations, in particular) supporting Indigenous Australian communities, given the enormous COVID mitigation successes here. Having kept the virus out of Aboriginal and Torres Strait Islander communities, we can now confidently roll out the vaccine.
Factors which may have contributed to the delayed upsurge of COVID-19 in PNG include the young age of population, with a third being aged less than 15 years, and the high percentage of people vaccinated with BCG vaccine (TB prevention vaccine) which appears to reduce the impact of COVID-19 (though this is currently being validated under a multi-country randomised controlled trial).
Sitting in a Brisbane hotel, quarantined for two weeks and listening to news about the surging COVID situation in PNG, I was grateful for the Australian Government’s support of 8,000 doses of the AstraZeneca vaccine, which will soon be rolled out to front line health workers. It’s a start, but we need to do much more, and fast.
The uptake of the COVID vaccine will be a matter of life or death for so many people in PNG whose subsistence living and limited water and power supplies in many communities makes washing hands for 15 seconds and staying away from market places impossible. As Australian politicians and the public argue about the slower than expected vaccine roll out in this country, which has repeatedly shown that strict COVID public health interventions stop the virus transmission, we need to support PNG more and enable much more COVID vaccine to be rolled out.
Understanding of disease and the cause of disease (e.g., viruses or bacteria like TB), varies across communities in PNG, with some believing in sorcery and other non-scientific causes of ill-health and death. Given these traditional beliefs it’s important to have social scientists and trusted community leaders (including church leaders) creating awareness about the COVID-19 virus, and advocating important public health measures to assist in human behaviour change, like wearing face masks.
The stigma associated with being COVID positive is enormous in PNG. It is driving people with clinical signs of COVID, or those who are tested COVID-positive to hide, feel shamed and scared. This stigma needs to be addressed and IEC (information, education and communication) materials are urgently needed to help reduce this stigma. In some communities the wearing of face masks makes people think you have COVID, therefore they don’t want to wear face masks.
PHAA members can join together to support PNG by advocating for one million doses of locally made AstraZeneca vaccine to be deployed to PNG, whilst also assisting provincial health authorities in rolling out the vaccine.
Reducing the community transmission of SARS-2 virus in PNG will significantly reduce the likelihood of new variants arising. Personally, I would delay my vaccination to ensure more vulnerable people in PNG have the opportunity to be vaccinated. I’m hoping many Australians would make a similar sacrifice.
Photograph: Kalolaine Fainu/The Guardian