A Patchwork Vaccine Rollout in the Pacific Islands

Confronting both the public health and economic crises wrought by the COVID-19 pandemic, Pacific Island nations are racing to roll out vaccine distribution. But patchwork efforts to procure vaccines, immense logistical challenges, and an increasingly fragmented regional architecture all bode ill for a quick and easy rollout. These challenges point to the need for increased coherence and coordination in vaccine strategy among Pacific Island nations as they chart a path to reopening both at the regional and global level.

Efforts to secure vaccines on an individual country basis reflect a lack of collective action on the regional level, and the vaccine rollout has taken place amid a period of unprecedented fragmentation in Pacific regional architecture. A dispute over the selection of the Pacific Islands Forum’s (PIF) leadership has resulted in the departure of the five Micronesian member states from the organization, the heart of regionalism in the Pacific. Though countries still maintain robust cooperation through other organizations like the Pacific Community, the fragmentation of the PIF threatens to hamper the region’s response to the pandemic, including the Pacific Humanitarian Pathway on COVID-19.

Amid this context, vaccine rollout in the Pacific has been anything but uniform. While some countries have seen considerable success in their vaccination campaigns thus far, others are not expected to vaccinate a critical mass of their citizens until at least 2025. That includes the most populous Pacific Island countries of Papua New Guinea, Fiji, and the Solomon Islands. In procuring vaccines, many Pacific nations and territories have turned to COVAX, the COVID-19 Vaccines Global Access Facility led by GAVI and the World Health Organization.

While the first batch of vaccines procured through COVAX have already arrived in Fiji, it remains to be seen whether additional doses will follow in quick order. The fair allocation mechanism for COVID-19 vaccines through COVAX says that distribution may need to be prioritized according to “criteria that includes the threat that COVID-19 poses to [countries] and the vulnerability of their health systems.” The fact that many Pacific Island nations have prevented outbreaks through preemptive border closures and geographic isolation could mean that they will receive COVAX deliveries at a slower pace than countries with more widespread transmission of COVID-19. Moreover, COVAX is only committed to providing 20 percent of a given country’s needs and consequently represents a necessary but not sufficient means for Pacific Island countries to secure vaccines, forcing them to turn to their international partners to fill in the gaps.

Between the United States, Australia, New Zealand, and France, Pacific Island nations have received significant outside support for vaccine procurement and deployment. The region could also see support through the Quad’s recently-announced initiative to supercharge distribution of the U.S.-developed Johnson & Johnson vaccine across the Indo-Pacific. While it remains unclear when or where these doses will be distributed, the single-shot vaccine could be a game-changer for many Pacific countries. 

As signatories of Compact of Free Association agreements with the United States, Palau, the Marshall Islands, and the Federated States of Micronesia have seen significant success in their Centers for Disease Control-administered vaccination campaigns. Palau made headlines in late January for outpacing the United States itself in administering vaccines, with more than 17 percent of the population having received their first jab of the Moderna vaccine. The Marshall Islands has also seen resounding success, canceling its order of vaccines through COVAX after the government found that it had sufficient doses from the United States. While the Federated States of Micronesia initially lagged behind, it has since ramped up vaccination efforts; by early March, 10 percent of its eligible population had already received a second dose of the Moderna vaccine. The pace of vaccine deployment in these three countries will likely quicken as the U.S. government begins to make the Johnson & Johnson single-dose vaccine available for use.

Meanwhile, Australia has pledged to procure and deliver COVID-19 vaccines to its partners in the Pacific and Southeast Asia. It has committed approximately $158 million to support vaccine procurement in Fiji, Kiribati, Nauru, Papua New Guinea, Samoa, the Solomon Islands, Tonga, Tuvalu, and Vanuatu. In March, the Australian government announced plans to distribute up to 1 million COVID-19 vaccine doses in the Pacific beginning in May, in pursuit of achieving 20 percent coverage in the region by the end of June. Ongoing outbreaks in Papua New Guinea have prompted Australia to ship 8,000 AstraZeneca doses as well as personal protective equipment to its neighbor. The government has also earmarked an additional $63 million to support the COVAX facility. However, the European Union’s recent decision to block the export of AstraZeneca vaccines to Australia has led some in Canberra to warn that Papua New Guinea and others in the region could see delays in receiving doses.

States and territories in Polynesia have received robust assistance from Wellington. New Zealand Foreign Minister Nanaia Mahuta announced in December 2020 that the country had earmarked $53 million to provide vaccines for Samoa, Tonga, and Tuvalu, as well as the territories of Tokelau and Niue, and the freely-associated Cook Islands. These vaccines will likely consist of a mix of those pre-ordered for use in New Zealand, which include Pfizer, Johnson & Johnson, AstraZeneca, and Novavax.

In French Polynesia and New Caledonia, France has spearheaded procurement and provided support to local governments. Vaccination began in early January and, by February 3, had already reached more than 3,000 individuals. Vaccine deployment is also set to begin in Wallis and Futuna, where the French government has signaled that it would offer doses immediately to the entire population.

Despite Beijing’s growing political and economic clout in the region, China’s role in vaccine procurement in the Pacific has been marked by mixed signals and false starts. Chinese Foreign Ministry officials on January 4 issued a statement saying that Beijing would “readily consider providing COVID-19 vaccines to [Pacific] countries in light of their needs through various ways.” Countries, including the Solomon Islands, have entered preliminary talks with Beijing on vaccine procurement. However, such discussions remain fraught and have not led to the finalization of any significant agreements. Across the Pacific, only residents of Rapa Nui have begun receiving Sinovac jabs as part of the Chilean government’s order of the Chinese-made vaccine.

In an illustrative case, Chinese State Councilor and Foreign Minister Wang Yi on February 4 announced that China had decided to “assist [Papua New Guinea] with a batch of vaccines,” claiming in a statement that Acting Foreign Minister Rainbo Paita had thanked Beijing for its assistance. This claim was almost immediately disputed by Paita, who downplayed Wang’s announcement and stated that the “possibility of introducing vaccines” was still subject to internal processes and formal discussions. However, the severity of Papua New Guinea’s current outbreak has since led some analysts to argue that the country should accept and roll out Chinese-made vaccines.

Beyond issues related to vaccine procurement, Pacific Islands nations will also face significant impediments in vulnerabilities in health infrastructure and logistical challenges. Cold chain storage facilities are rare, meaning that vaccines that require sub-zero temperatures like Pfizer will be of limited viability in the region. A 2012 study found that only 41 percent of Papua New Guinea clinics had even standard refrigeration. Another study found that 70 percent of refrigerators examined in rural Papua New Guinea were not functional. Moreover, 80 percent of the population lives in rural areas spread across a largely mountainous landscape, and only 23 percent of health clinics are equipped with functional transport. Archipelagic nations like Vanuatu, with a population spread across 60 islands and only 85 registered nurses currently on the public payroll, will face similar challenges in vaccine distribution.

While vaccine procurement and logistics remain at the heart of a successful inoculation campaign, demand-side dynamics will also be critical, and Pacific Islands nations must take action to ensure widespread acceptance of vaccination. At both the national and community levels, Pacific leaders will need to heed the lessons learned from previous health crises and apply them to their coronavirus response.

The 2019 Samoa measles outbreak demonstrates how mistrust of vaccines and gaps in routine healthcare can lead to disastrous consequences. A high-profile medical malpractice case involving the measles vaccine led to an uptick in anti-vaccination sentiment among the public and warnings from traditional doctors against inoculation. The backlash eventually forced the government to suspend its measles immunization program temporarily. The sudden drop in inoculation rates left the population vulnerable to an outbreak of the preventable respiratory illness. Thus, public health education must be at the forefront of the Pacific Islands’ vaccine rollout plan to assuage misconceptions of vaccine safety and efficacy.

Devastated by a growing economic recession that has disproportionately impacted the critically important tourism industry, Pacific Island countries have placed their hopes on vaccination as a silver bullet to resolve the crisis. More immediately, countries like Papua New Guinea face imminent outbreaks and urgently require access to vaccines to stem case numbers. But vaccine procurement and deployment will be easier said than done and will require steady national and community leadership, the steadfast support of the international community, and close coordination between Pacific nations.