There was a time when it seemed Papua New Guinea had managed to dodge a bullet. Instances of SARS-CoV-2 were minimal, along with its disease, COVID-19. Through 2020, the country of eight million people recorded a mere 900 cases. The World Health Organization praised the PNG government in a September 2020 news release in “taking the threat of the pandemic seriously with an all-of-government approach in strengthening the country’s health system and engaging communities to keep them safe from the virus.”

Officials acknowledged that a spike in cases could impair the medical system, despite the fact that three-quarters of the population are under the age of 35. While the elderly population is small, the large number of youthful members poses the problem of asymptomatic transmission. “We know that about 15% of COVID-19 cases will need some form of hospital care,” statedDr Gary Nou, an important figure in the COVID-19 response in the National Capital District. “If 10,000 people get sick – that’s about 1,500 people needing care. This can easily overwhelm our health system.”

Last month, Nou found himself working to a state of exhaustion in the Rita Flynn Sporting Complex in Port Moresby. The complex had become a centre of treatment and testing, taking in moderate and mild coronavirus cases. He concluded that a nightmare was unfolding. “The workload is normally a lot, we have one doctor per 14,000 people, that’s our doctor to patient ratio.” The health system, he gloomily observed, was now in a “perpetual state of disaster”.

Currently, the number of coronavirus cases has almost reached 9,800 with 89 deaths recorded. But these figures may well be skewed. Moses Laman of the Papua New Guinea Institute of Medical Research told Devex at the start of this month that the figure of 100,000 was “closer to reality” given that 1 in 5 tests returned a positive result. “That tells us there is widespread community transmission.” Australian Doctors International’s Mimi Zilliacus does little to dissuade on that score, noting that minimal testing has taken place in the provinces. “Lots of provincial governments have been reluctant to act, even when the response from the central government has ramped up.”

At the start of this month, the PNG Epidemic Response Group, an alliance comprising medical research institutes, NGOs, professional services and Australian churches, warned of an impending calamity, urging the Australian government to “immediately allocate one million of its domestically produced vaccines to PNG now, along with accompanying technical assistance and support for the PNG government and communities to address vaccine hesitancy and distribution.”

Concerning is the number of health workers being infected, a result largely due to a crawling vaccination program. PNG’s Health Minister Jelta Wong promises that “558,000 doses of the AstraZeneca vaccine will be made available to Papua New Guineans” by June, though she could not muster much certainty on the timing.

Structural problems are also bound to blight any vaccination distribution, not least because most of the country exists in a state of electricity deprivation. In parts of the world “where electricity access is poor,” note three authors in The Conversation, “refrigeration of vaccines during transport and storage may prove very difficult.”

The rash of cases in PNG has done enough to worry the World Health Organization (WHO). Its Director-General, Tedros Adhanom Ghebreyesus, was gloomy at a virtual press conference on April 16. The numbers might have been “smaller than other countries” but the increase was worryingly sharp. PNG was, he argued, “a perfect example of why vaccine equity is so important.” The country had held COVID-19 “at bay for so long” but faced a rise in infections, fatigue towards social restrictions, low levels of immunity in the population and a fragile health system.

This has also worried Australia, a country so often inclined to treat PNG with a mixture of splitting headache, condescension and hopeless charity. Ian Kemish, former Australian High Commissioner to the country, calls it Australia’s “blind spot” despite PNG being home to some 20,000 Australians. The former diplomat is unabashed in stressing the virtue of self-interest, which he calls “an important motivator of public attention.” What is good for PNG, he unequivocally asserts, is also good for Australia.

Kemish even goes so far as to praise representatives of Australian mining, with their “world-class testing and treatment protocols” (they can, the implication goes, teach the natives a thing or two). In such praise, he chooses to avoid the obvious question: that PNG’s heavy reliance on mining provided another avenue for coronavirus to enter the country and thrive. A stream of revenue may well have also constituted a viral route.

The Australian Council for International Development is blunter. As Marc Purcell, its chief executive, stated with a note of alarm, any virus mutations in PNG threatened “to undermine the Australian vaccines program.” (At this stage, there is not much to undermine: Australia’s vaccination program remains incipient, tardy and barely worth a mention.)

Canberra’s lack of a coherent vaccination strategy and lamentable planning has meant that parts of northern Australia are vulnerable to possible infection. Proximity to PNG is a factor. Of particular concern are the residents of the Torres Strait, their health potentially fragile to the ravages of the virus. In the words of Bill Bowtell, famed for his role behind Australia’s successful HIV-AIDS response, “The Torres Strait is paying the same price as the rest of Australia for a lack of coherent planning about supply and then obviously distribution.”

Queensland deputy premier Steven Miles has expressed a growing worry from the view of the state government. “There are islands in the Torres Strait where you can see PNG from the beaches and where it is very common for people to travel for traditional trade purposes between PNG and the Torres Strait islands.” It was essential to “get as many of those folk that we know are vulnerable vaccinated as quickly as we can.”

In late March, Australia donated a paltry 8,000 doses while 132 thousand doses from the COVAX facility arrived last week. Concerns remain with the use of the AstraZeneca vaccine, given the bad press that has enveloped it regarding instances of rare blood clotting. The road ahead for PNG looks bumpy and more than a touch vicious.