The last places free of COVID-19
There are only a handful of places that have not reported cases of COVID-19. Many of them are in the Pacific. The Pacific island countries and areas of American Samoa, Cook Islands, Kiribati, Marshall Islands, Federated States of Micronesia, Nauru, Niue, Palau, Pitcairn Island, Samoa, Solomon Islands, Tonga, Tokelau, Tuvalu, Vanuatu, and Wallis and Futuna are still virus-free.
As early as January, countries in the Pacific started to step up their efforts to prepare for the arrival of COVID-19. Many Pacific countries have instituted lock-downs, curfews and shut down their borders to prevent the importation of cases. Most of them have declared a State of Emergency.
As cases start to be reported from mid-March in French Polynesia, New Caledonia, Guam, Fiji, Northern Mariana Islands and Papua New Guinea, the Pacific continued to step up measures to prepare and respond to COVID-19.
None of the countries and areas in the Pacific is complacent. Together with partners, WHO worked with countries and mapped out a Pacific Action Plan for COVID-19 Preparedness & Response.
In the past few months, the Plan was implemented across the Pacific, and this photo essay reflects on some of the achievements in the Pacific during this period.
“It is amazing to see how engaged the community is in Tokelau from decision-making to implementation,” says Dr Durgavasini Devanath, who travelled 30 hours on a boat from Samoa to Tokelau in order to provide support to plan and prepare for COVID-19.
“Tokelau is a very communal society, so everyone is stepping up to protect the community. People were very committed in the training we provided and the whole community took efficient action. For example, we received updates and pictures from an atoll we just left a day earlier on how they were refurbishing identified quarantine and isolation facilities.”
The trip was comprised of the Tokelau Director General of Health, the Head of Public Health, the Head of Clinical Services, Head Nurse, laboratory & biological technicians from Ministry of Health of Tokelau, as well as technical advisors from WHO and the Pacific Community (SPC).
The WHO Health Systems team leader in the Pacific, Dr Akeem Ali, was re-assigned to support the government’s COVID-19 preparedness plan. In early March, in response to the government’s request to train healthcare staff on infection prevention and control and case management for COVID-19, Dr Akeem headed to the Cook Islands.
“Working in health systems means that WHO can tailor our help so that we build a COVID-19 plan that is focused on the local reality, the priority needs, what will make a response successful and also consider some of the issues the country will have to deal with in the medium term.”
Emma Kettle is an experienced trainer who has been working with WHO in the Pacific, reaching people from clinics to ports.
Her favourite part of training, like other WHO experts, is working with the trainees as a group, as they sort, solve and review problems.
“It feels like a great compliment when I can see self-instigated change in the weeks and months after I have left…a standard operating procedure adjusted, a policy re-written, hand sanitiser distributed where it wasn’t before, a communications product re-drafted,” says Ms. Kettle, “ this demonstrates to me that I have understood the community’s motivations for change and have provided them with a pathway. Then it’s always up to them to walk the walk.”
“I think I have met most of the 1600 people living in Niue and trained half of them on the correct way of hand-washing,” says Min Tanuvasa Lene, a registered nurse and health advisor working with WHO in the Pacific to help countries prepare for COVID-19.
“There was an incredible sense of unity, support, urgency and commitment from the Ministry of Health and the community to engage with WHO to help them prepare and navigate the threat of COVID-19. I developed a close and personal working relationship with the healthcare workers, they trust WHO as the credible source of information and support, and having us there on the ground made the connection real and personal. It also made it easier to continue to support them remotely now that we are limited with our travel options.”
Ms. Lene trained over 1,000 people in both Niue and Samoa over a ten-day period, focusing on the training of trainers among healthcare workers, so that they could take over and deliver training on infection prevention and control.
With Samoa on the cusp of declaring the end of its measles outbreak, the twin-island country took the preparation of COVID-19 seriously. The government immediately started to inform the public on how to effectively stop the spread of COVID-19. A basic package of personal protective equipment (PPE) consisting of disposable gloves, N95 respirators, surgical masks, goggles and no-touch thermometers was sent out to Samoa and many other countries by the Joint Incident Management Team (JIMT), aimed at ensuring that the Pacific had an initial supply of key PPE for frontline staff to safely manage up to 100 COVID-19 cases.
Containing COVID-19 in the Pacific
For Fiji, COVID-19 preparedness also started early. By mid-March, Fiji’s molecular laboratory at the Fiji Centre for Disease Control had validated testing for SARS-CoV-2, the virus that causes COVID-19. It meant that Fiji could start testing suspected cases of COVID-19 in-country rather than sending their specimens overseas for testing. In early May, the newly developed testing equipment for SARS-CoV-2 started to arrive in the Pacific, increasing the number of tests performed in Fiji. The new testing cartridges also enable other Pacific countries to test for COVID-19 locally for the first time.
WHO supported the Fiji government in much of this work to prepare and be ready to respond to the first cases in Fiji. One WHO epidemiologist is embedded within the Ministry of Health and Medical Services to support the expansion of the national Health Emergency Operations Centre and Incident Management System with a whole-of-government approach.
In the meantime, WHO delivered biomedical equipment to the Ministry of Health and Medical Services which included autoclaves to support equipment sterilisation in various facilities, and oxygen regulators, flowmeters and humidifiers to assist with supporting oxygen delivery to patients.
WHO also provided support to the government of French Polynesia to prepare and subsequently respond to COVID-19. As a part of early preparation, WHO sent technical staff to the area to set up of the national Health Emergency Operations Centre, an Incident Management Team was officatiated in late March by the President of French Polynesia. The inter-ministerial team operated to make sure of a whole-of-government approach in COVID-19 preparedness and response. WHO also provided capacity training for some of the essential workers, for example, pilots and aircrew were trained on the safe medical evacuation of COVID-19 patients to be ready if the need arose.
Working in partnership — the Pacific JIMT
“From very early on, we recognized that we could be facing an unprecedented crisis and we could only succeed by coming together as partners in an unprecedented way,” says Dr Corinne Capuano, WHO Director of Pacific Support. “We are very grateful to have made that decision and started to work alongside our partners, sat down at the table together to build up better relations and structures back then. Now that many of us are working remotely, we are well prepared and are still able to work effectively.”
The JIMT was established in January 2020 as a common incident management structure for WHO and partners to coordinate and support the health sector preparedness and response objectives of Pacific island countries and areas in the early days of the COVID-19 response. Since then the partnership has evolved and grown to include 20 agencies across the Pacific working together as the Health Cluster of the Pacific Humanitarian Team, supporting Pacific health systems to prepare and respond to the COVID-19 public health emergency through timely, well-coordinated health action.
Led by WHO, the JIMT currently includes representatives from various UN agencies and Pacific regional development partners — International Organization for Migration (IOM), Office of the UN Resident Coordinator (RCO), United Nations Children’s Fund (UNICEF), United Nations Development Programme (UNDP), United Nations Entity for Gender Equality and the Empowerment of Women (UN-Women), United Nations Office for the Coordination of Humanitarian Affairs (OCHA), United Nations Population Fund (UNFPA), World Food Programme (WFP), Asian Development Bank (ADB), Australian Department of Foreign Affairs and Trade (DFAT), International Federation of the Red Cross and Red Crescent Societies (IFRC), New Zealand Ministry of Foreign Affairs and Trade (MFAT), Pacific Community (SPC), Pacific Islands Forum Secretariat (PIFS), Pacific Islands Health Officers’ Association (PIHOA), United States Agency for International Development (USAID), US Centers for Disease Control and Prevention (CDC), US Embassy in Suva and the World Bank.
For COVID-19, six functions are established:
2. Partner coordination
3. Information and planning
4. Health operations and technical expertise
5. Operations support and logistics
6. Finance and administration
The Pacific is still on high alert, as people here are vulnerable to infectious diseases, food and water insecurity and hazards like extreme weather, yet have limited health infrastructure and challenges related to small, widely dispersed populations. Countries and areas with no cases are preparing for their first case, those that have had cases are preparing for a second wave, especially as countries repatriate citizens stranded in other countries, and all are working to ensure that their curative and public health systems are ready to provide safe and effective care to patients with COVID-19, test, and trace contacts of cases for rapid containment and outbreak mitigation.
The JIMT has supported countries and areas across the Pacific to procure critical laboratory and medical supplies needed to test and treat people with COVID-19, and personal protective equipment needed to protect health workers and other first responders.
Despite the anticipated global shortages and challenges to supply chains, by May WHO had over 350 requests from different countries, deployed over 40 technical experts in the region and had been able to support the procurement and distribution of more than 330,000 items across 17 Pacific island countries and areas including Papua New Guinea. These include bio bottles, body bags, chlorine solution, gloves, goggles, disposable gowns, hand sanitizer, N95 respirators, surgical masks, swabs, thermometers and other medical equipment.
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Read our progress report on health sector preparedness and response plan.