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Many Pacific islands are untouched by COVID-19. Its arrival could be disastrous

The Pacific region has seen the fewest cases of COVID-19 — at least 14 Pacific countries and territories report no single case of the coronavirus, despite 3.5 million cases confirmed globally. But these islands have already started to feel the economic effects of the pandemic, and could face a devastating human toll if the virus were to hit.

Excluding Australia, New Zealand and Hawaii, there have been fewer than 270 confirmed cases across the entire region. American Samoa is currently the only U.S. state or territory without a single positive case.

The governments of Pacific islands have warded off the virus so far by imposing early and strict quarantines, and making the most of their geographical remoteness. Their isolation from the rest of the world, often seen as a disadvantage, so far serves in their favor in the case of this pandemic.

The Marshall Islands, in the central Pacific, was the first country in the world to impose a travel ban on Jan. 24. Two days before the U.S. entry ban on foreigners who had visited China came into effect, the Federated States of Micronesia imposed what has been described as “the most drastic anti-coronavirus travel ban in the world,” forbidding anyone who had set foot in China or any other country with a confirmed coronavirus case from entering the country.

That approach extended to ports. Many islands in the Pacific have either turned away or banned cruise ships outright, and the Cook Islands even refused entry to a cargo supply ship.

These hard-line measures are seen as necessary because of the region’s unique vulnerabilities to an outbreak. “The best approach for governments and communities around the Pacific is to prevent and isolate,” said Dr. George Carter, a research fellow at the Australian National University’s College of Asia and the Pacific. Once a highly infectious disease like the coronavirus is introduced to a community, the benefit of being a rural island is likely to disappear.

Coastline around a village in Samoa in 2017. Photo by Phil Walter/Getty Images

What makes the Pacific region vulnerable?

Health care systems in outer islands and rural villages in the Pacific can only provide basic services, and access to intensive care and fully equipped hospitals is only available in some urban areas. In rural regions of Papua New Guinea, where over 80 percent of the country’s 8.6 million population resides, the only health care infrastructure may be an aid post with a village health worker and some basic drugs. Clinics routinely run out of supplies, and 4,000 nurses recently went on strike due to lack of personal protective equipment.

“If something like COVID-19 were to get into those rural areas, there is no way that the medical facilities could gear up to deal with it,” said Tess Newton Cain, an adjunct associate professor at the Griffith Asia Institute and co-writer of the Guardian’s weekly “Coronavirus in the Pacific” briefing.

Only a few Pacific nations can test for COVID-19 effectively, and routing samples through Australia, New Zealand or the United States may delay testing results. While the lag in testing raises uncertainty about current estimates of cases in the region, WHO has not reported any large undetected outbreaks in the region.

Significant levels of both infectious diseases — like malaria, tuberculosis and dengue fever — and non-communicable diseases are another worrisome factor. The Pacific has the world’s highest levels of Type 2 diabetes and is home to eight out of the 10 most obese countries. The prevalence of these ailments stem from challenges in delivering and accessing health care and sanitation resources. Some researchers also theorize the introduction of an “energy-dense” Western diet — foods that are fried, sweet or starchy — combined with genetic and microbiotic factors, might increase susceptibility of Pacific islanders to certain diseases.

People with these underlying chronic conditions tend to be most at risk for poor outcomes if they contract the virus, said Dr. Colin Tukuitonga of Auckland University’s Faculty of Medical Health and Science and the former director-general of the Secretariat of the Pacific Community, a regional intergovernmental organization. Due to these comorbidities, there’s a greater chance that if they contract COVID-19, “many of them would die from the virus,” he said.

Imposing social isolation at the community-level — on top of the strict national rules meant to keep infection out — to protect vulnerable individuals would pose unique challenges to daily life. Pacfic culture revolves around large extended families, which means that the risk of community transmission is very high. “It’s a wonderful thing and a fantastic part of us as a people,” Tukuitonga said. “We love to get together.” Encouraging people to not interact and to practice isolation — measures that have been used all over the globe, including in large, industrial nations like China and the U.S. — would be “very difficult” in the Pacific, and among the Pacific diaspora, he added.

Some people also may not have access to running water or hand sanitizer while living in close quarters with a large extended family, so social distancing and frequent hand-washing rules may not translate without a “very tailored approach” in the Pacific, Newton Cain said.

A category 5 tropical cyclone swept across parts of the Pacific in early April, complicating further coronavirus prevention efforts in the Solomon Islands, Vanuatu, Fiji and Tonga. Despite reports that 80 to 90 percent of people have lost their homes in certain areas of Vanuatu, the government initially refused entry to foreign humanitarian workers, citing fears that they could introduce COVID-19. Thousands of people are living in evacuation shelters with shortages of soap and hygiene products, posing a major risk if the virus arrives.

Given the Pacific’s array of vulnerabilities, “even a small number of cases could quickly cause significant strain on health systems, both in terms of responding and implementing the public health measures necessary to contain spread,” Dr. Corinne Capuano, the World Health Organization’s director of Pacific Technical Support, told Devex in February.

Misinformation and public trust

The U.N. recently warned that misinformation about the virus could be another deadly risk for people in the Pacific. Like elsewhere in the world, false claims linking COVID-19 with 5G wireless technologies or advocating alcohol consumption as a preventative measure have circulated on social media in the region.

WATCH: The dangerous global flood of misinformation surrounding COVID-19

As so much is still unknown about COVID-19, people across the globe are searching for ways to fill gaps in their understanding of the virus, said Leysia Palen, a professor from the University of Colorado Boulder’s department of information science. In the Pacific context, misinformation that might lead the public to pressure their governments to reopen, in countries that are currently coronavirus-free, would be “an utter disaster,” Palen said. “I don’t know that there could be any return from that.”

In 2019, low measles vaccination rates in Samoa—stemming from low levels of public trust in the health system following a high-profile malpractice scandal in 2018, anti-vaccination misinformation stoked by campaigners overseas, and a bungled government response to the outbreak—contributed to the deaths of more than 80 children.

Health workers in Samoa administer MMR vaccines during a deadly measles outbreak in 2019. Photo by Chikara Yoshida/Getty Images

“The memories and scenes of children lost from a great illness is still fresh,” said Carter, who returned to be with his family in Samoa before travel restrictions were put in place. “This time around, communities, workplaces, churches and schools have taken on the lockdown restrictions with calm and understanding,” he said.

While Samoa’s health system and resources remain strained in the aftermath of the measles outbreak, a silver lining of the epidemic may be its influence on the rest of the region to react swiftly to the threat of COVID-19, according to Tukuitonga. “A lot of the islands saw what happened in Samoa” after sending medical assistance, “and so they were indirectly impacted by this tragic event,” he said.

The economic fallout

As gatekeepers to key waterways between the Americas and Asia, the Pacific islands have long been a strategic priority for the U.S. and allies like Australia, Japan and New Zealand. Those countries, as well as China the E.U. and some developing nations have provided medical advice on COVID-19, and resources and funding for Pacific countries to purchase equipment or finance preventative measures. Taiwan has also provided aid to its four diplomatic allies in the Pacific: Nauru, Tuvalu, Palau and Marshall Islands.

However, said Pacific expert Newton Cain, because of the global nature of the pandemic, “the countries and organizations we might normally look to support Pacific islands countries are already stretched domestically,” which could mean less aid. A sign of this, she said, was at a G20 leaders video conference in March, when Australian Prime Minister Scott Morrison pledged support for the Pacific and urged other nations to also contribute.

The economic impacts of the crisis, even in Pacific island countries that do not have infections, are already “extremely significant and very worrying,” Newton Cain added. And COVID-19 will continue to disrupt the Pacific’s significant economic ties to the outside world, “be it through tourism, commodities, trade, migration or aid,” Jonathan Pryke said in an article for the Australia-based Lowy Institute. Countries in the Pacific that rely on exporting commodities to now-shuttered buyers overseas will face their own challenges, as demand crashes. Papua New Guinea, facing the current headwinds on the back of five years of economic stagnation and hard-hit government revenues, in particular is getting “battered,” Rohan Fox, an economist at the Development Policy Center, told the PBS NewsHour.

According to predictions by banking group ANZ, the GDP of the Cook Islands could shrink by up to 60 percent, and other tourism-dependent economies could contract by double digits. Widespread tax shortfalls could then undercut publicly funded health care systems in the region, even if the islands avoid the brunt of the pandemic.

In response to the economic blow, the Pacific’s bilateral partners and multilateral organizations like the World Bank are developing economic support packages, according to Pryke’s analysis. However, loans for stimulus financing have the potential to worsen the region’s debt troubles; the Pacific is already home to many of the world’s most aid-dependent countries, according to analysis by Terrence Wood, a research fellow at the ANU’s Development Policy Center.

Regardless of any aid packages, small businesses in the Pacific are already feeling losses. “No visitors means we’re marketing to ourselves, and no one has money to spare on nonessentials,” Samoa-based business owner Nikki Mariner-Peseta told PBS NewsHour.

Mariner-Peseta, who co-owns an art business in Apia, Samoa’s capital, relies on tourism and international orders through social media to sell paintings and carvings. As a result of shipping delays from Samoa’s strict lockdown on international travel, her business has had to offer large discounts to international buyers. With a temporary rent waiver from her storefront’s landlord, Mariner-Peseta believes that, with difficulties, she can sustain the business for about a year.

In lieu of formal safety nets, many Pacific islanders rely on their extended family networks and traditional subsistence lifestyles, which has worked in their favor, according to experts. Although pessimistic about Papua New Guinea’s national economy, Fox referred to the country’s “subsistence affluence” economy — many people can return to their villages where there is “a common wantok system, whereby clan members share resources, which can limit severe poverty,” he said. But if the virus comes, the benefits of this communal living would be completely at odds with social distancing protocols to control its uninhabited spread.

While Mariner-Peseta said she is frightened of getting sick with Samoa’s limited health services, she is not scared of becoming homeless or going hungry, as “the culture and lifestyle wouldn’t let people go without food or shelter.”

The Pacific’s COVID-19-enforced isolation may also be shaping life in some positive ways. Mariner-Peseta said families are working their farms and spending time on their land. “Eating more fish and local produce feels good,” she said.

Tukuitonga also sees a window for people to go “back to their traditional ways of living, to growing, planting, and eating fresh.” Potential increases in the price and scarcity of imported, processed food is an ideal opportunity for islanders to “reset” their diets, he told the PBS NewsHour. And he hopes the rates of diseases, like diabetes, that affect Pacific health and put people at more risk for this virus may eventually decrease.