Papua New Guinea is divided over its Covid-19 response. The virus has spread throughout the country since March and is now pushing hospitals to capacity in the nation’s worst Covid-19 surge so far, but a lack of community education on the pandemic means many are more frightened of the vaccine than they are of the virus.

Endemic vaccine hesitancy has led to death threats against frontline workers. The Delta strain is filling hospitals in Western Province—the region closest to Australia—but people are ignoring restrictions and crossing the province’s porous land border with Delta-stricken Indonesia.

Covid-19 has triggered cascading impacts in PNG’s health, economic, social, civil and administrative sectors while undermining the government’s capacity to address them. Australia should help with PNG’s uphill struggle to respond and recover, and provide more support for the vaccine rollout, governance and community messaging.

Community transmission since March has devastated urban centres and rural villages. Packed hospitals were forced to suspend other critical health services. By May, one in three tests proving positive at Port Moresby General Hospital indicated drastic rates of community infection.

Since then, the highly contagious Delta variant has spread to all areas including the remote Western Province, where the two main hospitals are now full of Covid patients. In Port Moresby, the general hospital’s Covid quarantine facility is at capacity.

PNG’s health system was unprepared. It was already stretched thin and struggling with serious issues with staffing, supplies, infrastructure and community health education. PNG’s maternal, child and infant mortality rates are among the highest in the region, and diseases like malaria, tuberculosis and HIV remain prevalent.

When Covid hit, PNG had only seven doctors per 10,000 people and Australia sent 20 AUSMAT staff with equipment to help in April. Australia had Covid under control at that time, which raised questions about why it didn’t do more then to help PNG. A senior PNG doctor suggested Australia should have sent a team of 100.

Immunisation was already a problem. PNG’s baby boom in hard-to-reach rural areas has led to frantic campaigns for basic childhood inoculations. In 2018, it took five nationwide vaccine campaigns to suppress a polio outbreak. But an immunisation drive requires strong community engagement and education; otherwise, injections can appear sinister and mothers in rural areas worry that jabs will harm their children, especially when ‘they are not sick’.

That the Covid jab is for adults, and not for infants, raises more questions in the community. It’s unrealistic and unreasonable to expect people with little information and many unanswered questions to volunteer to take the vaccine.

In May, a World Health Organization–supervised Covid vaccine launch in the Southern Highlands was disrupted by crowds demanding information. The Post Courier quoted a frustrated local: ‘First we talked about HIV-AIDS, and then came TB and polio and now COVID-19—this is confusing for us simple villagers. So we need more information on the disease, the side effects, how long it will protect us when we get the jabs.’

Vaccine misinformation and conspiracies have spread rapidly via Facebook and WhatsApp, and many people in rural areas lack access to credible information. Solutions could be as simple as financing nationwide radio programs to provide medical updates and combat misinformation.

Vaccine hesitancy is far worse in PNG than in Australia, including among healthcare workers. Some PNG surveys have found that nearly 80% of people mistrust the vaccines for Covid-19. So far, only 194,962 doses have been administered, or enough for 1.1% of the population.

In April, Australia’s contradictory and inconsistent health advice about the AstraZeneca vaccine fuelled widespread fears. By June, PNG administrators were ‘scrambling’ to distribute hundreds of thousands of AstraZeneca vaccines donated by New Zealand under the COVAX program, but it was a hard sell and logistically challenging. PNG had to transfer 30,000 doses to Vietnam to prevent wastage when the vaccines neared expiry.

Chinese state media chimed in, accusing Australia of ‘working in the shadows’ to sabotage China’s vaccine donations and ‘dumping its stockpiled, unsafe vaccines’ in PNG.

Beyond health security, Covid has exacerbated institutional instability in PNG’s governance and service sectors, issues which will take a long time to address.

Just 13% of PNG’s people live in urban areas, but they are the backbone of the economy and the services and governance sectors. They’re especially vulnerable to Covid due to soaring rates of comorbidities like diabetes and drug-resistant tuberculosis. High infection and mortality rates among civil servants and administrators have hindered coordinated action on the unfolding crisis. Covid-19 has already taken many of the bright minds who might have made crucial contributions to the nation’s recovery.

Institutional and governance weaknesses have increased Covid’s impact and allowed it to cast a darker shadow over national resilience and economic recovery. PNG was let down by these issues and the lack of decisive leadership and messaging. By comparison, Fiji has fully vaccinated more than 80% of its population.

For PNG, economic resilience won’t be just a matter of fixing the damage wrought by Covid. Major challenges that existed before the pandemic, including poor fiscal management, corruption and rising national debt, still need to be addressed. Economic dependence on foreign-led resource extraction also undermines resilience, particularly as the large mining sector—the biggest contributor to PNG’s exports—relies on foreign fly-in, fly-out employees, many of whom are Australian. The significant reduction in FIFO workers due to the pandemic has slowed work in the sector.

In May, the Queensland and federal governments reopened some limited FIFO operations, which was a welcome start. The Australia Papua New Guinea Business Council highlighted the importance of restoring FIFO operations to avoid leaving PNG’s economy dead in the water.

Critically, economic recovery is contingent on resolving the nation’s widespread skills shortages. PNG’s burgeoning youth population could be a boon to the economy if these young people were trained for the workforce, but they are not. Around 87% of the population lives in rural areas with patchy access to education and limited work prospects. Cultural norms restrict women’s participation in the workforce. Around 35% of the population is under 15 and the median age is 22. In the long term, PNG’s skills deficit and rising youth unemployment could threaten economic resilience, stability and governance.

And while Australia’s development partnership with PNG, valued at $600 million a year, has sponsored education programs through the World Bank, it doesn’t encompass ongoing support for a cohesive education program for the nation’s young people. It should.

Australia’s national security is linked to our neighbour’s recovery. In my next article, I’ll look at what Australia can do to support PNG’s long road to recovery from Covid-19.